Presentation of Atopic Dermatitis in Adults and Pediatrics



Andrew Alexis, MD, MPH, FAAD: When it comes to atopic dermatitis [AD] in pediatric populations versus adult populations, there are a number of important clinical differences. Candrice, given your background as a pediatric dermatologist as well as one who sees adults, could you comment on some of the key differences between pediatric AD and adult AD?

Candrice Heath, MD: Absolutely. I love to take care of patients with atopic dermatitis. You never know exactly what the patient is going to look like when you open the door. However, if you take a look at the patient’s age, you may begin to get a great idea of what they may look like. Infants who have atopic dermatitis may present just with involvement of the cheeks, they have a very prominent facial involvement of their atopic dermatitis. Then as they get a little older, they will lose the predominance on the face. They will also start to see atopic dermatitis creeping down to the dorsal surfaces of the arms and legs.

Then as we move into school-age children, then you’re going to see more of that classic location in the antecubital fossa, the posterior fossa, and also on the back of the neck. Of course these are generalizations, and every child is different. But in general, you can count on seeing these areas involved in pediatric patients who have atopic dermatitis.

Andrew Alexis, MD, MPH, FAAD: When you think about the patients we see with atopic dermatitis and think of the AD population as a whole, you begin to appreciate the impact that it has on patients beyond their skin, and also the impact that it has beyond the patient themselves, but also those in the patient’s household and the patient’s caregivers, if they’re of an age where they are still living under the supervision of a caregiver. Heather, can you speak to how atopic dermatitis can impact patients and families beyond just their skin?

Heather Woolery-Lloyd, MD: I’m glad you brought this up, because it’s something that is important for us to address. I do not only see patients with atopic dermatitis in my regular practice but also in clinical trials. A lot of times, the parents have a lot of guilt around atopic dermatitis because they feel like they did something wrong. They almost come in saying, “I do this, and I do this, and I do this.”

The very first thing I say to those patients is, “You didn’t do anything wrong. You’re not doing anything wrong. Your child has this, and we’re going to take the steps to get him or her better.” I try to dispel that guilt that parents have when their children have atopic dermatitis. Because there is this stigma that maybe they’re not moisturizing enough, or they bought the soap, or changed detergent and didn’t know. I like to dispel that right off the top and assure parents because most parents are doing things right. There are some things we can improve on, but it’s not the parent’s fault. That’s important to communicate.

The other issue is sleep. Sleep is a big issue because parents lose sleep, children lose sleep, and it impacts your everyday life, especially if your kid is up itching. My son has atopic dermatitis. I remember, watching him scratching at night would drive me crazy because you feel so bad for your child. Atopic dermatitis has a tremendous impact on the caregivers. I’d like to emphasize that they didn’t do anything wrong. Their child has this condition, and we’ll take all the steps we can to get them better.

Andrew Alexis, MD, MPH, FAAD: Yes, indeed. If the patient isn’t sleeping, most of their household isn’t sleeping either. The impact goes far beyond.

Transcript Edited for Clarity

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