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Can Kids Grow Out of Atopic Dermatitis?


There are several types of eczema, the most common being atopic dermatitis. Atopic dermatitis is the most common childhood skin condition characterized by itchiness and a rash. Childhood atopic dermatitis is not curable but it is manageable with good hygiene and medications. The good news is that many children will outgrow atopic dermatitis.

What is atopic dermatitis?

Atopic dermatitis is a chronic, relapsing skin condition that can present in childhood. While it is not contagious, it can cause significant health problems. If not treated properly and promptly, it can lead to interference in the child's normal growth, infections, and scarring.

What are the risk factors for developing childhood atopic dermatitis?

There are both genetic and environmental causes of childhood atopic dermatitis.

If one parent has atopic dermatitis, the risk of your child having it is 60%. If both parents have it, the risk jumps to 80%. Most patients who have parents with atopic dermatitis will develop it by age three.

Children with mutations in the filaggrin gene, which encodes a protein involved in the structure of the epidermal barrier, are more likely to develop atopic dermatitis.

Children with mothers who had gestational diabetes have an eight-fold risk of developing atopic dermatitis by age six.

Prolonged obesity in children is also a risk factor for atopic dermatitis. Exposure to aeroallergens, contact irritants, skin colonization by bacteria (Staphylococcus aureus), and food allergens can trigger childhood atopic dermatitis.

Stress can also trigger childhood atopic dermatitis. Thirty to fifty percent of children with asthma or allergic rhinitis will develop atopic dermatitis.

What are the symptoms of atopic dermatitis in children?

Children with atopic dermatitis get stuck in a vicious itch-scratch cycle. It begins as dry skin and itchiness. This leads to scratching and the appearance of rashes. The rashes cause more itchiness, and so the cycle repeats.

Here are the symptoms of childhood atopic dermatitis:

  • Itchiness.
  • Pink, scaly rashes primarily affecting the extensor surfaces of the extremities (outside of the arms and legs) and the face in children and the hands, feet, and flexural areas of the arms and legs in adults.
  • Dry skin (xerosis).
  • Hyperlinear palms (lots of lines on the palms of the hands).
  • Keratosis pilaris (rough spots on the outside of the arms and legs).
  • Skin infections (redness, tenderness, warmth, swelling, and pus).
  • Pityriasis alba (white spots on the face).
  • Skin darkening and skin folds around the eyes.
  • Food intolerance.
  • Eye conditions: conjunctivitis, cataracts, and keratoconus.
  • Intolerance of certain fabrics, like wool.

When do children develop atopic dermatitis?

About 10 to 20% of children get atopic dermatitis, with 90% of childhood atopic dermatitis patients developing it by age five, and 60% by one- year of age. Most cases of atopic dermatitis appear during childhood.

Do children outgrow atopic dermatitis?

Most children outgrow atopic dermatitis. We know that 80% of childhood atopic dermatitis did not persist by the time the child was eight years old, and less than 5% was present by the age of 20.

While children may outgrow atopic dermatitis, signs and symptoms of dry skin into adulthood may still affect them. Often, if atopic dermatitis persists into adulthood, it may be milder.

Why will children not outgrow atopic dermatitis?

There are risk factors that may predict atopic dermatitis persisting into adulthood.

  • The later the onset of atopic dermatitis, the longer it persists. If a child is diagnosed with atopic dermatitis at less than one year of age, it may last only three years. If diagnosed between ages two to five, it may last ten years. If diagnosed at ages six to 11, it can last 14 years on average.
  • Female patients with childhood atopic dermatitis are at higher risk of persistent atopic dermatitis than male patients.
  • Patients with moderate to severe childhood atopic dermatitis are more likely to have it last into adulthood.
  • The longer childhood atopic dermatitis persists, the more likely it is to affect the patient as an adult.
  • If childhood atopic dermatitis patients possess a gene defect in the filaggrin gene, their atopic dermatitis will persist into adulthood.

Can you get atopic dermatitis as an adult?

About 25% of adult atopic dermatitis patients did not present until adulthood. The peak time for the development of atopic dermatitis is around 50 years of age.

What treatments are available for atopic dermatitis?

Effective treatment involves prompt use of medications, and proper hygiene and environment.

Hygiene and environment

  • Cleanse daily with dye and fragrance-free liquid cleansers, not soap. Wash with short, lukewarm showers, not hot water or baths. Pat your skin dry, and never scrub.
  • Use a thick, creamy moisturizer or ointment at least twice a day. Make sure it is dye and fragrance-free as well. Use a non-comedogenic one for the face.
  • Make sure all products you use (sunscreen, laundry detergent, makeup, etc.) are all dye and fragrance-free. Avoid bleach and fabric softener.
  • Wear loose-fitting cotton clothing. Avoid wool.
  • Use a humidifier if you live in a dry climate.
  • Lower your stress and avoid getting sick.

Medications

  • Topical and systemic steroids can help reduce inflammation to ease itching and rash.
  • Topical immunomodulators also help reduce inflammation.
  • Antihistamines can help ease the itch.
  • Phototherapy also helps reduce the itch.
  • Systemic medications are helpful in severe cases to reduce inflammation and heal the rash.

Key takeaways

Most children outgrow atopic dermatitis.

Dry skin or mild rashes may still occur as an adult.

Proper, immediate care of a child with atopic dermatitis by a dermatologist is critical for the health and well-being of the child.

References

Abuabara, K., Margolis, D.J. (2013). Do children really outgrow their eczema, or is there more than one eczema? Journal of Allergy and Clinical Immunology.

American Academy of Dermatology. Atopic dermatitis.

Bolognia, J., Jorizzo, J.L., Schaffer, J.V. (2012). Dermatology. Philadelphia: Elsevier Saunders.

Kim, J.P., Chao, L.X., Simpson, E.L., Silverberg, J.I. (2016). Persistence of atopic dermatitis (AD): A systematic review and meta-analysis. Journal of the American Academy of Dermatology.

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