Pruritus in pediatric patients with atopic dermatitis: a multidisciplinary approach - summary document from an Italian expert group

Abstract

Given the inadequate overall awareness of the main disease features and treatment modalities of pruritus in pediatric patients with atopic dermatitis, a multidisciplinary Italian expert group met with the major aim of increasing knowledge of the condition for improved diagnosis and better management among specialists involved in disease management. Herein, the overall features of the condition are reviewed, along with its etiopathogenesis and symptoms. Likewise, management options are summarized, emphasizing the need for a multidisciplinary approach, minimally composed of a management team that includes a pediatrician, dermatologist, psychologist, play assistant, and dedicated nurse. In addition to more traditional therapies such as emollients as highlighted by European guidelines, therapeutic patient education in a group or individually is highly encouraged as it helps patients and their parents to better understand the disease and provide practical guidance for dressing and bandaging. It can also aid in outlining coping strategies for itching and sleep disturbance. The utility of distraction techniques should also be stressed as such educational interventions involving the child and their parents can substantially improve the overall quality of life. All approaches should be tailored according to patient age and clinical features and requires individualized strategy to ensure good adherence by both children and their parents. Thus, a holistic approach embracing systemic, topical and psychological interventions is advocated in order to provide patients and their caregivers the best possible care.

Correlation between quality of life and disease severity of pediatric patients with atopic dermatitis

“…Itching had the highest score in all age groups and negatively impacted the QoL. The frequent need for scratching and grating of the lesions leads to nocturnal awakening, fatigue, and irritability (14)(15)(16).…”

Differential Diagnosis and Treatment of Itching in Children and Adolescents

“…The assessment of pruritus in an individual child is also a problem due to the subjective nature of the itching sensation. Like adults, the SCORAD index, the Eczema Area and Severity Index (EASI), and the investigator global assessment (IGA) are still the most commonly used to assess the intensity of AD in childhood and adolescence, although there are limitations to assessing them accurately from the anamnesis of very young patients [ 3 , 19 ]. The classic lichenifications in the folds of the extremities, which are associated with permanent scratching, appear in later childhood.…”

“…Pruritus (itch, or more commonly, itching) is prevalent in children with skin disorders such as atopic dermatitis, and is associated with effects on mood, quality of life, sleep, scholastic performance, and social and family functioning [ 1 , 2 ]. Itch is common in children; therefore, it is surprising that there are no data on the childhood prevalence of pruritus in the general population [ 3 ]. Most previous articles are related to specific diseases and usually include case reports.…”

Уровень Цинка И Особенности Течения Атопического Дерматита У Детей

“…Дослідження за останнє десятиліття виявили генетичні, екологічні й імунологічні патогенетичні фактори АД [7][8][9][10][11][12]. У пошуках основоположних патогенних механізмів і покращення варіантів профілактики й лікування все більше уваги приділяється стану імунної системи та забезпеченню мікроелементами організму дитини [13][14][15]. З'являються окремі дослідження, в яких наголошується на ролі дефіциту есенціальних мікроелементів у формуванні та несприятливому перебігу алергічних хвороб [16][17][18][19].…”