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Atopic dermatitis in the first six months of life
1Department of Dermatology, University of Bari, Italy.
Insights
Early-onset atopic dermatitis (AD) in infants under six months presents diagnostic challenges due to subtle symptoms like exudative lesions and minimal scratching. Despite difficulties, AD is the most distinct dermatological condition in this age group.
Area of Science:
- Pediatric Dermatology
- Allergy and Immunology
Background:
- Atopic dermatitis (AD) frequently begins in infancy, with a significant proportion of cases starting within the first six months of life.
- Diagnosing AD in early infancy can be challenging due to the absence of typical scratching, brief clinical history, and the later onset of associated atopic conditions like asthma and rhinitis.
Purpose of the Study:
- To highlight the diagnostic considerations for atopic dermatitis in infants under six months.
- To differentiate AD from other common infantile dermatoses.
Main Methods:
- Clinical case review focusing on infants diagnosed with atopic dermatitis in the first six months of life.
- Comparative analysis of clinical presentation of AD versus other infantile skin conditions.
Main Results:
- A substantial number of atopic dermatitis cases (1,476/2,320) initiate within the first six months of life.
- Infants with early-onset AD often present with exudative lesions and may show limited or no scratching.
- Atopic dermatitis is the most clearly defined dermatological disorder in this age group, distinguishing it from less defined conditions like infantile seborrheic dermatitis.
Conclusions:
- Early-onset atopic dermatitis requires careful clinical evaluation in infants, considering its unique presentation.
- Distinguishing AD from infantile seborrheic dermatitis and its variants is crucial for accurate diagnosis and management in neonates and young infants.
Abstract:
1,476/2,320 of our cases of atopic dermatitis (AD) start in the first six months of life. The diagnosis is usually easy, but at this age it is sometimes more difficult, mainly because of lack of or rare evidence of scratching, but also because of the brief clinical history that does not allow observation of the characteristic chronic and relapsing course. Moreover, the major atopic disorders-asthma, rhinitis-usually appears later in the natural history of atopic subjects. From a differential diagnosis point of view, AD is the most definite dermatological disorder at this age. Other not well defined conditions occurring in the first six months of life are usually referred to as infantile seborrheic dermatitis, a name that has been used for at least four different disorders: cradle cap, cradle cap with involvement of inguinal, axillary and retroauricular folds, napkin psoriasis and Leiner's erythroderma. From a clinical point of view, AD in the first months of life is characterized by the prevalence of exudating lesions; moreover, the lack of or the rare evidence of scratching allows us to observe isolated vesicular lesions that are found with difficulty in the further course of the disease.