The Net Guide: Atopic Dermatitis

MDNG Pediatrics, October 2010, Volume 8, Issue 3

Educated PatientAll About Eczema

There’s a reason why pages from TeensHealth, a Nemours Foundation website, have been cited many times before in this publication. The site provides helpful information in a tone that is easy for adolescents to understand. In addition to listing basic facts about skin, defining eczema, and listing the signs and symptoms of the disease, this resource provides detailed information about what young patients with eczema can ex¬pect during a doctor visit, what they can do to prevent eczema, and how to deal with it on a daily basis. An audio version of the article is also available.

Link Code: k8321

Medical Websites

Allergy Cases: Atopic Dermatitis

Part of a case-based curriculum of allergy and immunology created by V. Dimov, MD, allergist/immunolo¬gist and assistant professor at the University of Chicago, this resource provides all of the essential information about atopic dermatitis (AD), a disease that is “marked by exacerba¬tions and remissions.” At this site, readers can learn about the major and minor features of AD, and different treatment options, including bathing and moisturizers, topical corticosteroids, and topical calcineurin inhibitors, with recommenda¬tions specific to pediatric patients included. Also featured here is the flowchart that illustrates “A suggested approach to topical treatment of moderately severe atopic dermatitis” and tips on how to use bleach baths to treat AD.

Link Code: k8311

Atopic Eczema

Although this medical reference from the University of Maryland Medical Center offers useful information on the causes, incidence, risk factors, symptoms, and treatment of atopic eczema, visitors will glean perhaps the most value from the photos depicting conditions such as kerato¬sis pilaris, atopy, dermatitis (on the arms, face, and legs), hyperlinearity in atopic dermatitis, and eczema. For those who want to be able to access this information on the go, the new UMMS iPhone Medical Encyclopedia is now available for download.

Link Code: k8312

Management of Atopic Dermatitis in the Pediatric Population

Originally published in Pediatrics journal in 2008, this article contains information that is still relevant to the management of atopic dermatitis (AD), “a chronic illness that requires a multifaceted treatment strategy in the setting of limited therapeutic options.” Lead author Andrew C. Krakowski, MD, of the University of California, San Diego, and col¬leagues discuss the epidemiology and etiology of the disease; diagnosis of AD; the significance of early and effective management; approaches to treatment, including education as intervention, avoidance of triggers, breastfeeding, timing of solid food introduction, probiotics, skin care, and bathing; pharmacologic treatment of acute AD; and topical corticosteroid and TCI use in disease management, including adjunctive therapy, antimicrobial agents, wet wraps, and systemic therapies. The article also covers instances in which specialty referrals are warranted.

Link Code: k8313

Online CMEPediatric Dermatology: Atopic DermatitisCredits: 1.00

Fee: $20.00 (AAP members)/$24.00 (non-members)

Expires: March 30, 2013

Multimedia: None

One of five courses offered as part of the PediaLink Pediatric Dermatology series, this module will explore the mechanisms of atopic dermatitis (AD) and its perceived causes, clinical features in different age and ethnic groups, complications and impact on quality of life, and the recommended treatment for the disease. The program will also discuss the clinical manifestations of AD, based on four major criteria, and the appropriate management of AD, including avoid¬ance of exacerbating factors, the use of corticosteroids, patient education, and follow-up.

Link code: k8331

An Update on the Genetics of Atopic Dermatitis: Scratching the Surface in 2009Credits: 1.00

Fee: None

Expires: December 31, 2011

Multimedia: None

Based on an article that was published in the Journal of Allergy and Clinical Immunology in January of 2010, this educational offering will help participants become familiar with traditional and newer methods used to identify candidate genes for AD; recognize the role of the innate and adaptive immune response in the development of the disease; and understand the contribution of skin barrier gene dysfunctions in the susceptibility of AD. Note: free registration with the journal’s website is required to view this activity.

Link Code: k8332

eAbstractsThe Self-Administered Eczema Area and Severity Index in Children with Moderate to Severe Atopic Dermatitis: Better Estimation of AD Body Surface Area than SeverityJournal: Pediatric Dermatology (September/October)

Authors: Van Velsen SG, Knol MJ, Haeck IM, et al.

Purpose: The aim of this study was to evaluate the correlation of the Self-Administered Eczema Area and Severity Index (SA-EASI) with two physician-based disease activity scores (objective SCORAD and SASSAD score) and with Thymus and Activation-Regulated Cytokine (TARC), a serum marker for AD, in children with the disease.

Results: The association between the SA-EASI and the objective SCORAD was found to be high, “mainly based on high correlation between the body surface area (BSA) measurements of both scores.” It was concluded that educating parents in the severity scoring of AD “may improve agree¬ment of the SA-EASI and the objective SCORAD, TARC, and SASSAD score,” and that additional use of the SA-EASI in routine clinical practice may “facilitate more frequent but still accurate assessment of AD.”

Link Code: k8351

Eczema Prevalence in the United States: Data from the 2003 National Survey of Children's Health

Journal: Journal of Investigative Dermatology (September 2010)

Authors: Shaw TE, Currie GP, Koudelka CW, Simpson EL

Purpose: To determine, using data from the 2003 National Survey of Children’s Health, the national prevalence of eczema in the US pediatric population, and to further examine geographic and demographic associations previously reported in other countries.

Results: Researchers found that overall, 10.7% of children were diagnosed with eczema in the past year, with the prevalence ranging from 8.7% to 18.1% between states and districts. Metropolitan living, African American ethnicity, and educational level were found to be significant factors in predicting higher disease prevalence. “The wide range of prevalence suggests that social or environmental factors may influence disease expression,” they wrote.

Link Code: k8352

Clinical TrialsGenetic Screening for Filaggrin Mutation in Atopic Dermatitis and Ichthyosis Vulgaris in the African American PopulationStudy Type: Interventional

Age/Gender Requirements: 6 months (male/female)

Sponsor: Northwestern University

Purpose: To identify common and rare mutations in the filaggrin gene in African American patients with a diagnosis of atopic dermatitis and ichthyosis vulgaris. DNA will be extracted from buccal swabs during a single visit.

Link Code: k8361

Eczema Prevention StudyStudy Type: Interventional

Age/Gender Requirements: Up to 1 month (male/female)

Sponsor: Oregon Health and Science University

Purpose: To determine whether early use of a bland emollient in newborns prior to the clinical signs of skin disease will delay the onset or prevent the development of atopic dermatitis (AD). Neonates with a family history of asthma, hay fever, or AD will be treated with Cetaphil cream starting within one week of birth, and will be followed for two years.

Link Code: k8362

Podcasts

Atopic Dermatitis—A Disease Caused by a Barrier Defect?

Listen as Lisa Beck, MD, and Susan Rabizadeh, MD, discuss the possible causes of the skin barrier defect observed in subjects with atopic dermatitis (AD); describe why such a barrier defect might lead to development of the disease; and explain how some enzymatically active allergens may break the skin barrier.

Link Code: k83331

Pharma Focus

Protopic (tacrolimus)

Clinical TrialsMeasuring Adherence to Topical Therapy in Children with Atopic Dermatitis and the Impact of a Return VisitStudy Type: Interventional

Age/Gender Requirements: 2-15 years (male/female)

Sponsor: Wake Forest University

Purpose: To evaluate adherence to topical therapy using adherence data collected by the MEMS cap (Medication Electronic Monitoring System) in pediatric patients with AD and the impact of a return visit.

Link Code: k8363

eAbstractsThe Safety and Efficacy of Tacrolimus Ointment in Pediatric Patients with Atopic DermatitisJournal: Pediatric Dermatology (July 2010)

Authors: McCollum AD, Paik A, Eichenfield LF

Purpose: To determine the effectiveness of long-term use of tacrolimus ointment, a treatment approved for patients aged two years and older that has been proven effective for short-term relief of symptoms in pediatric patients with AD.

Results: Tacrolimus was found to have “a low potential for systemic accumulation, and analysis of long-term studies indicates that it has a good safety profile. Treatment with tacrolimus, alone or in combination with topical corticosteroids for acute flares, may be a useful option for long-term management of AD in pediatric patients.”

Link Code: k8353