Children atopic dermatitis: Diagnosis, mimics, overlaps, and therapeutic implication

Abstract

Atopic dermatitis (AD) is a chronic inflammatory, itching skin with a significant psychosocial impact on patients and relatives. In adults and adolescents besides flexural eczema, head and neck eczema, and hand eczema, which are the most frequent clinical phenotypes (84.9% and 84.2%, respectively), there are also other possible presentation such as, portrait-like dermatitis (20.1%), diffuse eczema (6.5%), eczema nummulare-like (5.8%), prurigo nodularis-like (2.1%) and erythrodermia (0.7%). Diagnosis can be easy due to the typically distributed eczematous lesions, albeit with agerelated differences, However, it is also extremely heterogeneous in severity, course, and sometimes particular clinical features. Currently, there are no better diagnostic criteria than an experienced dermatologist for the diagnosis of AD. Misdiagnosis and delayed treatment will have an impact not only on the child's physical health, but also and especially on the child's psychological health. The aim of our review was to group the main differential diagnoses in pediatric age where the diagnosis can often hide many pitfalls.

Atopic Dermatitis

“…There is often an imbalance in the types of helper T cells and interleukins. These mediators lead to an increase in the inflammatory response and epidermal hyperplasia (Lockhart & Siegfried, 2022; Napolitano et al, 2022).…”

“…For those 2 years or younger (infantile stage), red papules and vesicles with serous exudate and crusting are the most common (see Figure 1). These lesions are commonly found on the face, trunk, diaper area, and extensor areas of the extremities (Kraft & Prince, 2019; Napolitano et al, 2022). The nose is often spared and may be referred to as the “lightbulb or Yamamoto sign” (Lockhart & Siegfried, 2022).…”

“…In children older than 2 years (childhood stage), the affected areas are more contained to the extremities, including the antecubital and popliteal fossae and volar surfaces of the wrists and ankles (see Figure 2; Lockhart & Siegfried, 2022). Dry skin with lichenified papules and plaques are often noted on the flexor surfaces including the hands and feet (Kraft & Prince, 2019; Napolitano et al, 2022). For adolescents and adults (adult stage), the distribution becomes larger.…”

“…These lesions are often associated with lichenification and excoriation (see Figure 3). Adults may have atypical lesions, and classic lesions are often more persistent, with the face, nipples, and eyelids being common (Kraft & Prince, 2019; Napolitano et al, 2022). Lichenification and pigmentation changes may be more prominent and persistent in people of color (see Figure 4; Lockhart & Siegfried, 2022).…”

Impact of the Family and Household Environment on Pediatric Atopic Dermatitis in Japan

“…The pathophysiology of AD involves a complex interaction between genetic epithelial skin barrier defects, dysregulated immune response, an altered microbiome, and environmental risk factors [3]. In particular, patients with atopic diathesis are genetically predisposed to develop one or more atopic diseases, including AD, hay fever, allergic rhinitis, and asthma [4].…”