How To Improve Pediatric Eczema Screening, Prevention

Lawrence Eichenfield, MD, discusses recent achievements in identifying and possibly preventing atopic dermatitis development in infants.

Pediatric patients of practically any chronic disease or age group within dermatology may have been benefitted from a recent boom in evidenced agents reaching the US market.

But just as these systemic, biologic and novel therapies raise the bar for treating disease like atopic dermatitis and psoriasis, they also raise the challenge to now better screening and diagnostics for pediatric patients.

In the second segment of an interview with HCPLive during the Fall Clinical Dermatology 2022 Meeting this week, Lawrence Eichenfield, MD, chief of pediatric and adolescent dermatology at the University of California, San Diego, discussed the capability of modern pediatric dermatologic disease detection strategies relative to new treatment capabilities in which therapy may be initiated even earlier—and with greater outcomes possible.

“I’d say, both yes and no,” Eichenfield said.

“A lot of our pediatric colleagues haven’t even heard about severity measures in atopic dermatitis and they’re not necessarily recognizing those patients early who may benefit from early intervention,” he added. “We have some decent outcome measures for how eczema impacts on individuals and their quality of lives.”

Transferring that knowledge to clinical practice becomes trickier. That said, Eichenfield repeated his “mantra” of improve and minimize pediatric rash, itch and sleep disturbances.

Regarding pediatric dermatitis biomarkers, Eichenfield reviewed recent data showing tape stripping on infant —could help predict risk of atopic dermatitis based on thymus and activation-regulated chemokine (TARC) levels.

“It’s known that TARC is a pretty good biomarker for atopic dermatitis—in fact, it’s a member of the T helper cytokine family, so it tends to correlate with atopic dermatitis,” he explained. Countries including Japan have made blood tests for such biomarkers available and in regular use for more than 2 decades now. However, such tests are highly accurate at 2 months of life in high-risk patients—even in those without prior signs or history of disease.

He paired those observations with another paper showing that use of twice-daily over-the-counter moisturizers from birth through 2 months could result in “markedly decreased development of eczema” in the adherent treatment arms. Though the findings were limited by lacking diversity of pediatric patient populations and moisturizer products, it showed a good path toward putting reliable biomarkers to absolute best use in pediatric atopic dermatitis.

“It raises the question, if you did moisturizer for 2 months, could you abrogate that and maybe get beyond the development risk?” Eichenfield said. “We don’t have the full answer yet, but it’s a positive for someone wanting to try an intervention if you have a high-risk family and they’re asking what they might do for their kids.”

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