Atopic dermatitis is the most common chronic inflammatory skin disease in children, affecting 15-20% of the pediatric population. The disease is characterized by inflammatory skin changes, dryness, and itching, with typical flare-ups occurring after periods of remission. The disease often begins at an early age, with 60% of children showing symptoms before their first birthday, and 85% affected by the age of five. It is important to note that there is a hereditary predisposition for the disease, and if one parent has any form of atopic disease, the child has a 60% risk of being atopic. If both parents are atopic, the risk increases to more than 80%. Atopic dermatitis is often the first disease in the so-called “atopic march,” which can lead to the development of other atopic diseases. Children with severe atopic dermatitis have a 40-50% risk of developing bronchial asthma over time, and a 70% risk of developing allergic rhinitis.
The cause of atopic dermatitis is very complex, with only partial understanding of the disease’s underlying mechanisms. It is associated with genetic predisposition and an inherited immune imbalance, along with a compromised epidermal barrier resulting from a mutation in the filaggrin protein, which is essential for the skin’s protective barrier. As a result, children with atopic dermatitis have a dysfunctional protective skin barrier, making their skin dry, prone to water loss, and allowing allergens and microorganisms to penetrate deeper skin layers, leading to allergic reactions. Environmental factors, such as irritants, excessive skin drying, secondary skin infections, and allergens to which the child has become sensitized, can significantly worsen the disease.
Avoiding exposure to allergens that trigger symptoms is an important method of managing allergic diseases, especially when the causative allergens are identified and elimination is possible. Early sensitization to airborne allergens, primarily house dust mites and tobacco smoke, are key risk factors for asthma and allergic rhinitis, as well as for worsening atopic dermatitis in early childhood. Therefore, measures to reduce mite concentrations in the child’s environment and avoid exposure to tobacco smoke are recommended. In children with proven food allergies, complete elimination diets are advised, which often lead to symptom regression and improved disease control.
How Common is Food Allergy in Atopic Dermatitis?
Food allergies occur in 30-50% of children with atopic dermatitis, with the risk being higher if the disease appears earlier and if the clinical picture is more severe. The most common food allergens are cow’s milk, eggs, soy, wheat flour, peanuts, and fish. Food allergies often resolve completely, with children developing tolerance by the age of 3-5 years, depending on the severity of the allergic reaction and adherence to an allergen-free diet. However, this is not true for all food allergens, as sensitivities to peanuts, shellfish, and crustaceans usually remain lifelong.
How is Atopic Dermatitis Treated?
The treatment of atopic dermatitis is highly dependent on daily skin care with neutral fatty creams, and the use of therapeutic oil baths to repair the skin barrier, achieve adequate rehydration, and restore skin lipids. It is important to note that daily application of neutral fatty creams can reduce the occurrence of inflammatory changes, reduce the need for corticosteroids, alleviate itching, and decrease skin permeability to environmental allergens. However, corticosteroids remain the standard treatment for atopic dermatitis, necessary during flare-ups. The quantity and strength of corticosteroid preparations should be carefully controlled to avoid complications, which parents fear even with minimal use of these treatments, despite there being no real basis for this fear. For severe forms of the disease, phototherapy with narrow-spectrum UVB rays is used for children over 4 years old. In extremely severe cases, immunosuppressive drugs and, more recently, biologic therapies may be used.
How Does the Disease Affect the Child’s and Family’s Quality of Life?
The early onset and chronic nature of atopic dermatitis places a significant burden on the entire family and reduces overall quality of life. It is well known that atopic dermatitis in children can severely affect the quality of life for both the child and the family. Children often feel different from their peers due to the appearance of their skin lesions, resulting in reduced social interactions. Lack of sleep, due to waking up during the night from itchy skin, leads to fatigue, mood changes, irritability, and psychosocial dysfunction. Family relationships can be strained due to the demands of care, therapy costs, and parental fatigue from disrupted sleep. It is crucial to assess the quality of life for affected children and their parents, as well as the psychological aspects of the disease.
The Importance of Organizing “Atopy School” – Educating Parents to Control the Disease in Children with Atopic Dermatitis
Failure to treat atopic dermatitis can be directly related to inadequate adherence to therapy instructions, which often results from a lack of understanding of the disease and its treatment principles. Interdisciplinary educational programs, such as Atopy School, involving pediatric dermatologists, psychologists, nutritionists, and specialized nurses, have become an essential standard for achieving disease control and improving the quality of life for both patients and their families. These programs aim to provide clear information about the disease and train patients and their parents to take control of the treatment. The main reason for treatment failure is poor adherence to the prescribed therapy, and the use of alternative treatment methods due to misunderstandings, lack of information, exhaustion, helplessness, and a loss of trust in medical treatments. One significant factor in non-adherence is the irrational fear of using corticosteroids, also known as “corticophobia.” Parents of young children should be educated on the safety and effectiveness of topical corticosteroids and how to use them correctly.
Our Experience in Educating Parents in Atopy School
The education program for parents of children with atopic dermatitis in Croatia began in 2011 at the Clinic for Skin and Venereal Diseases at the KBC “Sestre milosrdnice,” organized by prim. dr. sc. Lena Kotrulja, a specialist in dermatology and venereology with a focus on pediatric dermatology. The goal of this program is to help parents understand the causes and pathogenesis of the disease, factors that contribute to inflammation, proper therapy, and the importance of maintaining a functional epidermal barrier. It is essential for patients to understand that atopic dermatitis is a chronic, recurring disease that can be well-controlled but not completely cured. Additionally, it is important to assess the association of the disease with food allergies, as an elimination diet may cause concern among parents about potential nutrient deficiencies.
Recent Research on Atopic Dermatitis: New Insights into Treatment
Recent research on atopic dermatitis has confirmed that environmental factors, in addition to genetic factors, play a key role in the development of the disease. Studies indicate that a genetically conditioned immune imbalance, as well as defects in epidermal barrier function, play crucial roles in the onset and maintenance of skin inflammation in atopic dermatitis. Mutations in the gene responsible for the filaggrin protein lead to poor functionality and increased permeability of the epidermal barrier. Recent studies also show that the composition and diversity of the skin microbiome are critically important in propagating inflammation in atopic dermatitis, and therapy should focus on maintaining microbial diversity or altering the properties of skin bacteria.
