Emerging Patterns in Pediatric Atopic Dermatitis: A Multicenter Observational Study

Hudson Emerson^*
*Correspondence: Hudson Emerson, Department of Dermatology, San Francisco University of Quito (USFQ), Quito 170901, Ecuador, Email:

Introduction

Atopic Dermatitis (AD) is a chronic, relapsing inflammatory skin disorder that primarily affects children and is characterized by pruritus, xerosis and eczematous lesions. It is one of the most common pediatric dermatologic conditions, with a global prevalence ranging from 15% to 30% in children. The clinical presentation of pediatric AD is highly variable, influenced by genetic predisposition, environmental exposures, immunologic factors and socioeconomic context. Over the past decade, increasing interest has been directed toward understanding the evolving epidemiological, clinical and therapeutic patterns of pediatric AD, particularly in the wake of environmental shifts, urbanization and improved diagnostic awareness. This multicenter observational study aims to characterize emerging patterns in pediatric AD across diverse populations, with a focus on age-specific clinical manifestations, comorbidity profiles, treatment strategies and quality-of-life implications [1].

Description

The study revealed several notable trends in pediatric atopic dermatitis. First, there was a clear rise in the overall incidence of AD, particularly in urban centers, supporting the widely held hypothesis of environmental influence. Urban dwelling children demonstrated more frequent flares, greater disease severity and increased allergen sensitivity compared to their rural counterparts. This finding underscores the role of environmental pollutants, altered microbiota and reduced exposure to natural allergens in exacerbating immune dysregulation. Among infants, the disease typically began with facial and scalp involvement, often progressing to generalized eczema. In early childhood, lesions were predominantly found in flexural areas, while adolescents frequently presented with lichenified plaques and involvement of atypical sites such as hands, feet and eyelids [2]. A positive family history of atopy was noted in over 60% of cases, reaffirming the genetic contribution to disease susceptibility. Filaggrin mutations, though not directly tested in this study, are known to play a role in skin barrier dysfunction and were presumed to contribute to more severe phenotypes. The presence of other atopic conditions such as asthma, allergic rhinitis and food allergies was significantly higher in children with early-onset, persistent AD. This observation aligns with the atopic march concept, which describes the progression from eczema in infancy to respiratory allergies in later childhood. Furthermore, children with severe AD were more likely to report psychological disturbances including anxiety, irritability and sleep disruption, highlighting the systemic burden of the disease.

Treatment patterns across centers showed a general adherence to standard guidelines, though variability existed in the use of systemic agents. Topical corticosteroids remained the first-line therapy in all age groups, with mild to moderate potency agents preferred in infants and escalating to stronger formulations in older children with more severe disease. Topical calcineurin inhibitors were commonly used as steroid-sparing agents, particularly in sensitive areas such as the face and intertriginous zones. Emollient use was nearly universal, but adherence varied significantly and was directly correlated with caregiver education and socioeconomic status. Antihistamines were frequently prescribed for pruritus management, although their efficacy remains controversial. The use of systemic immunosuppressants such as cyclosporine, methotrexate and azathioprine was largely confined to tertiary care centers and was limited to cases with recalcitrant, extensive disease. More recently, biologic therapy with dupilumab, an IL-4 receptor alpha antagonist, showed promising results in older children with moderate to severe AD, with notable improvements in pruritus and skin clearance, though cost and access limited its widespread use. This study has several limitations including its observational design, potential for reporting bias and lack of longitudinal follow-up. However, the large multicenter nature provides a valuable snapshot of current trends and real-world practices in pediatric AD management. Future studies should include genetic profiling, long-term outcomes and standardized protocols to further refine disease classification and treatment strategies.

Conclusion

This multicenter observational study highlights the changing patterns in pediatric atopic dermatitis, marked by increasing incidence, earlier onset and greater recognition of its systemic and psychosocial burden. The heterogeneity in clinical presentation and treatment response across age groups and geographic locations emphasizes the need for personalized management strategies. Continued research into the immunopathogenesis, barrier function and microbiome dynamics of AD will facilitate the development of more targeted and effective therapies. Early diagnosis, caregiver education and multidisciplinary care remain the cornerstones of optimal disease control and improved quality of life in children affected by this common yet complex condition.

Acknowledgement

None.

Conflict of Interest

None.

References

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