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Atopic Dermatitis Phenotypes in Children

Publish date:

Different atopic dermatitis (AD) phenotypes exist among preschool and school-age children, suggesting the importance of a stratified approach to AD management, according to a recent study. Researchers performed a cross-sectional multicenter study with a structured questionnaire administered to 371 children with AD. Patients were divided into 2 groups: preschool children (aged <5 years) and school-age children (aged 6-14 years). A latent class analysis (LCA) was used to detect AD phenotypes and to investigate their association with risk factors and other atopic diseases. Among the findings:

  • LCA identified 5 AD phenotypes in the preschool group and 4 AD phenotypes in school-age children.
  • Parental history of asthma and eczema, early daycare attendance, and mold exposure were significantly associated to the “moderate-to-severe AD, high comorbidity” phenotype in preschool children.
  • The “moderate-to-severe AD” phenotypes were also shown to have a higher burden in terms of medication use and daily activities limitation.

Citation:

Galli E, Maiello N, Cipriani F, et al. Atopic dermatitis phenotypes in preschool and school-age children: A latent class analysis. [Published online ahead of print May 27, 2019]. J Invesitig Allergol Clin Immunol. doi: 10.18176/jiaci.0409.

Commentary:

Our European colleagues tend to separate atopic dermatitis patients on the basis of clinical morphology and allergy test results more than we do in the US. This report looks at different levels of AD severity and patterns of comorbidities. They found that preschoolers had less comorbidities, except for food allergy, than older children and that respiratory disease was increased to almost half of the older children. This is one more confirmation of the concept of the "atopic march" which starts with skin disease and progresses to the addition of respiratory disease. Of note is the low incidence (5%) of food allergy in the younger group and its absence in older children. This reinforces a finding by a joint committee of allergists and dermatologists several years ago, that food allergy is much less important in AD than many had previously thought. — Joseph Fowler, Jr., MD, Clinical Professor of Dermatology, University of Louisville, KY

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