International Journal for Doctor of Medicine and  Medical Students (IJDMMS)

Abstract

Atopic dermatitis (AD), commonly known as eczema, is a chronic inflammatory skin disorder that predominantly affects children. It is characterized by pruritus, xerosis, and relapsing eczematous lesions. The disease significantly impacts quality of life and is associated with other allergic conditions such as asthma and allergic rhinitis. This article aims to provide a comprehensive overview of pediatric atopic dermatitis, including epidemiology, pathophysiology, clinical features, diagnosis, and current management strategies. A structured review of literature was conducted using peer-reviewed studies and clinical guidelines. The findings highlight that AD affects approximately 10–20% of children globally and involves a complex interplay between genetic predisposition, immune dysregulation, environmental factors, and skin barrier dysfunction. Current treatment focuses on skin barrier repair, anti-inflammatory therapy, and trigger avoidance. Early intervention and patient education remain critical for improving long-term outcomes.

Introduction

Atopic dermatitis (AD) is one of the most common chronic dermatological disorders in childhood and represents a major global public health concern. It is characterized by recurrent pruritic skin lesions and impaired skin barrier function. The disease often begins in infancy and may persist into adolescence or adulthood. Approximately 60% of cases occur within the first year of life, and most cases develop before five years of age (Krakowski et al., 2008).

Recent epidemiological data show a global increase in prevalence. A large population-based study by Jin et al. (2025) reported that pediatric AD affects nearly 10–30% of children worldwide and is increasing particularly in urban settings. Available at:
https://pubmed.ncbi.nlm.nih.gov/39674276/

Similarly, epidemiological and clinical overviews published in StatPearls highlight the rising global burden of AD and the role of environmental and lifestyle changes. Available at:
https://www.ncbi.nlm.nih.gov/books/n/statpearls/article-20378/

Beyond physical symptoms, AD significantly affects sleep, emotional well-being, and academic performance. It is also linked with the “atopic march,” which includes progression from eczema to asthma and allergic rhinitis. Understanding pediatric AD is essential for reducing disease burden and improving long-term outcomes.

Materials and Methods

A structured literature review was conducted using databases such as PubMed, ScienceDirect, and international dermatology guideline repositories. Keywords included “atopic dermatitis,” “eczema,” “children,” “pediatric dermatology,” and “management.”

Studies published between 2000 and 2025 were included. Clinical trials, observational studies, and systematic reviews focusing on pediatric populations were prioritized. Global and regional guideline documents were also reviewed. Articles not focusing on children or lacking clinical relevance were excluded.

Results

Epidemiology

Atopic dermatitis affects approximately 10–20% of children globally, with higher prevalence in developed countries. A global study estimated over 70 million pediatric cases, with increasing trends in urban and industrial regions (Jin et al., 2025).
https://pubmed.ncbi.nlm.nih.gov/39674276/

WHO regional reports have also highlighted increasing prevalence in developing countries due to urbanization, pollution, and lifestyle changes.
https://www.emro.who.int/emhj-volume-31-2025/volume-31-issue-9/adolopment-of-atopic-dermatitis-management-guidelines-for-pakistan.html

Twin and family studies demonstrate strong genetic predisposition. Concordance rates are higher in monozygotic twins, suggesting heritability (Practical Approach, 2010).
https://www.sciencedirect.com/science/article/abs/pii/S1751722210001861

The peak incidence occurs in early childhood, especially between ages 1 and 5 years. Females may be slightly more affected than males.

Pathogenesis

The pathogenesis of AD involves a complex interaction between genetic, immunological, and environmental factors.

1. Skin Barrier Dysfunction

Mutations in the filaggrin gene lead to impaired skin hydration and increased allergen penetration. This results in xerosis and chronic inflammation.

2. Immune Dysregulation

The disease is characterized by Th2-mediated immune responses with elevated cytokines such as IL-4, IL-5, and IL-13, leading to increased IgE production.

3. Microbial Colonization

Skin colonization with Staphylococcus aureus contributes to disease exacerbation.

4. Environmental Triggers

Pollution, climate, allergens, irritants, and infections contribute to disease onset and flares.

A detailed discussion of pediatric AD pathophysiology is available in:
https://pubmed.ncbi.nlm.nih.gov/29455854/

Clinical Features

Clinical manifestations vary with age.

Infantile Phase (0–2 years)

Erythematous, oozing lesions
Cheeks, scalp, and extensor surfaces
Severe itching

Childhood Phase (2–12 years)

Flexural involvement
Lichenification
Chronic relapsing course

Adolescent Phase

Chronic plaques
Hand and foot dermatitis

Pruritus is the hallmark symptom and leads to sleep disturbances, irritability, and decreased quality of life (Krakowski et al., 2008).
https://pubmed.ncbi.nlm.nih.gov/18829806/

Diagnosis

Diagnosis is clinical and based on characteristic features.

Common diagnostic criteria include:

Chronic relapsing eczema
Intense pruritus
Typical morphology and distribution
Personal or family history of atopy

Laboratory tests are supportive but not diagnostic:

Serum IgE
Skin prick tests
Patch testing

Differential diagnoses include:

Seborrheic dermatitis
Contact dermatitis
Scabies
Psoriasis

Risk Factors and Triggers

Major risk factors include:

Family history
Food allergies
Environmental allergens
Irritants such as soaps
Climate and pollution

Dietary triggers such as milk, eggs, peanuts, and seafood may exacerbate symptoms in some children (Nadeem et al., 2017).
https://www.ijord.com/index.php/ijord/article/view/174

Management

1. Skin Barrier Repair

Regular use of emollients is the cornerstone of treatment. Moisturizers reduce flares and improve quality of life.

2. Topical Corticosteroids

First-line treatment during exacerbations.

3. Topical Calcineurin Inhibitors

Tacrolimus and pimecrolimus are useful in sensitive areas.

4. Antihistamines

Provide symptomatic relief from itching.

5. Systemic Therapy

Used in severe disease:

Cyclosporine
Methotrexate
Biologic therapy

Recent guidelines emphasize individualized treatment approaches and caregiver education.
https://karger.com/iaa/article/184/2/132/841891/Guidelines-for-the-Management-of-Atopic-Dermatitis

Psychosocial Impact

AD significantly affects emotional and psychological well-being. Sleep disturbances, anxiety, and depression are common. Family stress and economic burden are also significant. School performance and social interaction may be impaired.

Discussion

The rising prevalence of pediatric AD is linked with environmental pollution, climate change, urbanization, and lifestyle modifications. Early diagnosis and intervention can reduce disease progression and prevent the atopic march.

Emerging therapies such as biologics and targeted immunomodulators have shown promising outcomes in moderate to severe cases. However, accessibility and affordability remain challenges in low-resource settings.

Preventive strategies include:

Early skin barrier care
Breastfeeding
Allergen avoidance
Caregiver education

Future research should focus on genetic, microbiome, and environmental factors.

Conclusion

Atopic dermatitis is a chronic inflammatory disease affecting millions of children globally. It involves genetic susceptibility, immune dysfunction, and environmental triggers. Early intervention, skin care, and individualized treatment are essential. Advances in targeted therapies offer promising outcomes, but prevention and education remain key.

References

1. Jin L, et al. Global prevalence of atopic dermatitis in children. 2025.
   https://pubmed.ncbi.nlm.nih.gov/39674276/

2. Krakowski AC, et al. Pediatric atopic dermatitis management.
   https://pubmed.ncbi.nlm.nih.gov/18829806/

3. Sayaseng KY, Vernon P. Pathophysiology of pediatric AD.
   https://pubmed.ncbi.nlm.nih.gov/29455854/

4. StatPearls. Atopic dermatitis overview.
   https://www.ncbi.nlm.nih.gov/books/n/statpearls/article-20378/

5. WHO EMRO AD burden report.
   https://www.emro.who.int/emhj-volume-31-2025/volume-31-issue-9/adolopment-of-atopic-dermatitis-management-guidelines-for-pakistan.html

6. Practical approach to pediatric eczema.
   https://www.sciencedirect.com/science/article/abs/pii/S1751722210001861

7. Nadeem A, et al. Dietary triggers in eczema.
   https://www.ijord.com/index.php/ijord/article/view/174

8. Wang Q, Liu L. Guidelines for AD.
   https://karger.com/iaa/article/184/2/132/841891/Guidelines-for-the-Management-of-Atopic-Dermatitis

9. ISAAC eczema prevalence reports.

10. American Academy of Dermatology guidelines.

11. NICE eczema guidelines.

12. Hanifin JM, Rajka G. Diagnostic criteria.

13. Bieber T. Immunopathogenesis of AD.

14. Weidinger S. Genetics of eczema.

15. Cork MJ. Skin barrier dysfunction.

16. Simpson EL. Biologic therapy.

17. Leung DY. Immune mechanisms.

18. Eichenfield LF. Pediatric treatment.

19. Global Atlas of Atopic Dermatitis.

20. European eczema trends study.