Phenotypic analysis of atopic dermatitis in children aged 1–12 months: elaboration of novel diagnostic criteria for infants in China and estimation of prevalence

Abstract

Background Atopic dermatitis (AD) is the most common skin disorder in infancy. However, the diagnosis and definite significance of infantile AD remains a debated issue. Objective To analyse the phenotypes of AD in infancy, to establish diagnostic criteria and to estimate the prevalence of this condition in China. Methods This is a multicentric study, in which 12 locations were chosen from different metropolitan areas of China. Following careful and complete history‐taking and skin examination, the definite diagnosis of AD was made and the severity based on the SCORAD index was determined by local experienced dermatologists. Based on the detailed phenotyping, the major and representative clinical features of infantile AD were selected to establish the diagnostic criteria and evaluate their diagnostic efficacy. Results A total of 5967 infants were included in this study. The overall point prevalence of AD was 30.48%. The infantile AD developed as early as at the second month of life, and its incidence peaked in the third month of life at 40.81%. The proportion of mild, moderate and severe AD was 67.40%, 30.57% and 2.03%, respectively. The most commonly seen manifestations in the infantile AD were facial dermatitis (72.07%), xerosis (42.72%) and scalp dermatitis (27.93%). We established the novel diagnostic criteria of infants, which included: (i) onset after 2 weeks of birth; (ii) pruritus and/or irritability and sleeplessness comparable with lesions; and (iii) all two items above with one of the following items can reach a diagnosis of AD: (i) eczematous lesions distributed on cheeks and/or scalp and/or extensor limbs, and (ii) eczematous lesions on any other parts of body accompanied by xerosis. Conclusions In China, the prevalence of AD in infancy is 30.48% according to clinical diagnosis of dermatologists. The novel Chinese diagnostic criteria for AD in infants show a higher sensitivity and comparable specificity.

Global Burden, Incidence and Disability-Adjusted Life-Years for Dermatitis: A Systematic Analysis Combined With Socioeconomic Development Status, 1990–2019

“…In 2017, the estimated number of new patients with AD was 27 million, ranking second among the three types of dermatitis ( James et al., 2018 ). The prevalence of AD may vary by race: in the USA, the prevalence among whites (11%) is lower than that among African Americans (17%) ( Kim et al., 2019 ; Wan et al., 2019 ); the prevalence of AD in infancy in China is as high as 30.48% ( Guo et al., 2019 ); and the incidence and persistence of AD are higher in certain non-white racial/ethnic subgroups than in non-Hispanic whites ( Kim et al., 2019 ). Although the mortality rate for AD is very low, some studies report that the long-term risk of atrial fibrillation in AD patients increases by 20% ( Schmidt et al., 2020 ).…”

Distinct clinical features and serum cytokine pattern of elderly atopic dermatitis in China

“…The prevalence of AD in China has been increasing rapidly during the past two decades, 13 which is approaching Western countries and developed Asia countries such as Japan 14 and Korea 15 . Previously, most of the interests have been placed in infantile and childhood AD in China, 16,17 and adult AD has also been investigated for diagnosis criteria and clinical features 18 ; however, elderly AD is far less recognized and explored. The present study demonstrated for the first time the unique clinical features and distinct endotype of elderly AD patients in Chinese population.…”

Prevention of Atopic Dermatitis in Mice by Lactobacillus Reuteri Fn041 Through Induction of Regulatory T Cells and Modulation of the Gut Microbiota

“…In recent decades, the prevalence of AD has been increasing globally, with prevalence rates ranging from 10% to 20% in children in developed countries. [1] The overall prevalence of AD in children in China is also on a continuous rise, with prevalence rates of 3.07%, [3] 8.3%, [4] and 12.94% [5] investigated in 2002, 2010, and 2014, respectively, The 2019 survey showed a prevalence of 40.81% [6] in 3-month-old infants. It is generally believed that the prevalence of AD decreases with age and the incidence is lower in rural areas.…”