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Is your little one experiencing symptoms of atopic dermatitis? If so, let&#8217;s take an in-depth look at “Atopic Dermatitis in Children” with the expert pediatric allergist Dr. Suwanee Charoenlap, Pediatric Allergist and Immunologist at the Allergy Center, Phyathai 3 Hospital…
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<h2 style="color: #008080;">How does atopic dermatitis occur? 
</h2>
Atopic dermatitis is a chronic inflammatory skin condition caused by allergic reactions. It is commonly found in children. The disease can be divided into two types:
<ol>
<li>Intrinsic type (intrinsic or non-IgE associated) 
This is a genetic defect affecting the production of moisturizing substances in the skin, which is a factor from the skin’s own abnormality.</li>
<li>Extrinsic type (extrinsic or IgE associated) 
Patients in this group have high levels of IgE in the blood or positive results on skin prick tests. Some patients may have a personal or family history of allergic diseases such as asthma or allergic rhinitis.</li>
</ol>
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<h2 style="color: #008080;">What are the symptoms of atopic dermatitis? 
</h2>
The skin rash in atopic dermatitis shows various stages of inflammation, from acute to chronic. The typical features include red, itchy bumps, red patches, scaling, and flaking. The distribution of the rash varies by age as follows:
<ul>
<li>Infants usually start at 2-3 months old, with rashes on the cheeks, outer arms, and legs where the skin contacts irritants or experiences friction.</li>
<li>Older children have thicker rashes with scratch marks, typically on the neck and folds of the arms and legs.</li>
</ul>
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<h2 style="color: #008080;">How do doctors diagnose atopic dermatitis? 
</h2>
Doctors diagnose atopic dermatitis based on symptoms and rash characteristics, including itching, rash location by age, history of recurrent rash, and family history of allergies, which support the diagnosis.
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If proper treatment does not improve symptoms or if symptoms worsen, additional laboratory tests may be needed to identify triggers that cause flare-ups, such as food and airborne allergens like dust mites, pets, or pollen. Additional tests include:
<ul>
<li>Skin tests such as skin prick test or patch test</li>
<li>Blood tests for specific IgE to various allergens</li>
<li>Oral food challenge tests</li>
</ul>
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<h4></h4>
<h2 style="color: #008080;">How is atopic dermatitis treated?</h2>
<ol>
<li>Avoid triggers that may cause flare-ups, especially if there is a clear history, such as certain foods, sweat, or irritating chemicals.</li>
<li>Moisturize the skin by avoiding excessive bathing or very hot water, which can dry the skin. Apply creams or lotions immediately after bathing while the skin is still damp to retain moisture.</li>
<li>Use anti-inflammatory topical medications as prescribed when rashes occur. Treatment depends on the rash type and stage. For acute inflammation with oozing, saline compresses may be used. For chronic rashes, topical corticosteroids are prescribed, with the type and strength chosen based on rash characteristics and location. Do not buy corticosteroids over the counter, as children with atopic dermatitis may experience side effects such as thinning skin, cracking, infections, other types of rashes, and systemic absorption causing adrenal gland dysfunction. Currently, calcineurin inhibitors are available as alternatives to corticosteroids to avoid side effects in children requiring long-term treatment, but they are expensive and used selectively, especially in patients with corticosteroid side effects.</li>
</ol>
<ol>
<li>Monitor and watch for secondary skin infections. If detected, treat accordingly, such as using antibiotics for bacterial infections.</li>
<li>Take anti-itch medications to relieve itching, which is common in atopic dermatitis patients.</li>
<li>Other treatments include:</li>
</ol>
<ul>
<li style="list-style-type: none;">
<ul>
<li>UV light therapy or immunosuppressive drugs in severe cases unresponsive to basic treatment. Referral to a pediatric dermatologist is recommended.</li>
<li>Allergen-specific immunotherapy or allergy shots may benefit patients with clear allergic reactions confirmed by specific IgE blood tests or skin prick tests, especially those allergic to dust mites. Studies in adults and children show that allergen immunotherapy reduces disease severity and steroid use. Always consult a specialist before starting this treatment.</li>
</ul>
</li>
</ul>
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<h2 style="color: #008080;">Can atopic dermatitis be cured?</h2>
Atopic dermatitis is a chronic condition with varying severity among patients. Patients experience recurrent rashes with periods of remission and flare-ups, depending on skin care and exposure to triggers, which differ individually. The disease is usually more severe in childhood; about 60% of patients have symptoms before age 1. Most improve with age, mainly because patients learn better skin care techniques.
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<h2 style="color: #008080;">Can atopic dermatitis be prevented? 
</h2>
Since atopic dermatitis arises from multiple factors, including genetic predisposition in the patient or family members with allergies, there is currently no definitive way to prevent the disease. However, avoiding triggers such as certain foods, weather conditions, irritants like chemicals, perfumes, soaps, powders, detergents, dust mites, sweat, irritating fabrics, bacterial or fungal infections, scratching, and stress can help prevent rashes and reduce severity.
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Recent studies support that using appropriate moisturizing creams for infants and sensitive skin from birth to 6 months can reduce the incidence of atopic dermatitis.

Atopic dermatitis in children is characterized by rashes, red bumps, red patches, severe itching, peeling, and scaling. In infants, it usually occurs on the cheeks, arms, and outer legs. In older children, the rash becomes thicker and often has scratch marks on the neck and the folds of the arms and legs.

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