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PEDIATRIC ERMATOLOGY D A supplement to Pediatric News & Dermatology News JUNE 2020 Early onset of atopic dermatitis linked Patch testing in atopic dermatitis: When to poorer control, could signify more and how persistent disease Topical calcineurin inhibitors are an Patients with atopic dermatitis should be effective treatment option for perioricial routinely asked about conjunctivitis dermatitis Hope on the horizon: New cantharidin Psychology consults for children’s skin formulation alleviates molluscum issues can boost adherence, wellness contagiosum in pivotal trials Commentaries by Robert Sidbury, MD, MPH, & Lawrence F. Eicheneld, MD PedDermASupp_Cover.indd 1 5/6/2020 7:38:35 AM 2 June 2020 • Pediatric Dermatology Dermatologic treatments can be complementary BY ROBERT SIDBURY, MD, AND Topical calcineurin inhibitors such as high-risk infants will help better target LAWRENCE F. EICHENFIELD, MD tacrolimus and pimecrolimus have been prevention eorts as they continue to FDA-approved AD therapies for 2 de- evolve. he articles described herein con- cades, but Ollech et al. point to a poten- In a separate article, Wan et al. tain a variety of diagnostic and tial role treating perioricial dermatitis. demonstrate that earlier onset of AD Ttherapeutic updates, correlates with persistence, sometimes with complemen- increasing the importance of tary themes. The discussion early identication and inter- of patch testing is a good ex- vention for high-risk infants. ample. Jonathan I. Silverberg, Armed with risk stratication MD, PhD, reminds us that data, pediatricians can inter- patients with atopic derma- vene earlier in infancy as rash titis (AD) are at greater risk and itch that might otherwise for allergic contact dermatitis be attributed to irritants may (ACD), and the culprit often sooner be labeled AD. is a product being used to New treatments for acne treat the disease itself. Tra- and molluscum as well as tips ditional IgE-based allergy for reducing procedural stress tests assessing immediate in pediatric patients compose Type 1 hypersensitivity such other ground covered in this as a prick test or radioaller- Dr. Robert Sidbury Dr. Lawrence F. Eicheneld wide-ranging sample of the lit- gosorbent test (RAST) will erature from the past year. not help; patch testing for Type IV de- We continue to learn more about layed-type hypersensitivity is indicated. the genetic basis, natural history, and Dr. Sidbury is chief of dermatology at Seattle Because ACD can be challenging to best care practices for AD. While a Children’s Hospital and professor, depart- uncouple from concomitant AD, most genetic basis for AD has long been ment of pediatrics, University of Washington, experts advise patch testing prior to known, studies such as that by Ayelet Seattle. He is a site principal investigator for consideration of systemic therapy, in- Ravn, MD, put a ner point on related dupilumab trials, for which the hospital has cluding newer biologic medications. questions. Does a maternal history of a contract with Regeneron. One such agent, omalizumab, typi- AD and atopy confer greater risk upon cally is indicated for chronic urticaria the child than a paternal history as Dr. Eicheneld is chief of pediatric and ad- or asthma, but Chan et al. demon- long suspected? This does not appear olescent dermatology at Rady Children’s strate benet in AD. Dupilumab, the to be the case. Does a parental history Hospital-San Diego. He is vice chair of the only Food and Drug Administration– of AD as opposed to asthma or aller- department of dermatology and professor of approved nonsteroidal systemic med- gic rhinitis confer greater risk of AD dermatology and pediatrics at the University ication for AD, has revolutionized the to the child? Yes, it does. These are of California, San Diego. He disclosed that care of moderate to severe disease, important questions not only because he has served as an investigator and/or but providers should be alert to po- they are of great interest to parents, consultant to Abbvie, Lilly, Pzer, Regeneron, tential ocular adverse eects. but because improved identication of Sano-Genzyme, and Verrica. Editors Pediatric Dermatology is a supplement to Medical Communications Inc. will not Catherine Cooper Nellist Pediatric News and Dermatology News, assume responsibility for damages, loss, and Elizabeth Mechcatie independent newspapers that provide or claims of any kind arising from or Manager, Art Directors the practicing specialist with timely and related to the information contained in Elizabeth B. Lobdell relevant news and commentary about this publication, including any claims Creative Director Louise A. Koenig clinical developments in their respective related to the products, drugs, or services Director, Production/Manufacturing elds and about the impact of health mentioned herein. Rebecca Slebodnik care policy on the specialties and the ©Copyright 2020, by Frontline Medical Group Publisher physician’s practice. Communications Inc. All rights reserved. Sally Cioci Fischer The ideas and opinions expressed in [email protected] Pediatric Dermatology do not necessarily Cover: SolStock/E+/Getty Images reect those of the Publisher. Frontline PedDermASupp_02_3_4.indd 2 5/6/2020 8:31:48 AM A Supplement to Pediatric News & Dermatology News 3 Which children are at greatest risk for AD? BY BRUCE JANCIN It’s also information that clinicians a parental history of atopic dermatitis will nd helpful in appropriately tar- are a particularly high-risk group.” REPORTING FROM THE EADV CONGRESS geting primary prevention interven- Of note, the risk of pediatric atopic MADRID – A parental history of asthma tions if and when methods of proven dermatitis was the same regardless of or allergic rhinitis signicantly increas- ecacy become available. That’s a like- whether the father or mother was the es the risk that a child will develop ly prospect, as this is now an extremely one with a history of atopic disease. If atopic dermatitis, and that risk dou- active eld of research, she noted. one parent had a history of an atopic bles if a parent has a history of atopic disease, the pediatric risk was increased dermatitis rather than another atopic 1.3-fold compared to when the paren- disease, Nina H. Ravn reported at a tal history was negative. If both par- meeting of the European Task Force ents had a history of atopic illness, the on Atopic Dermatitis held in conjunc- risk jumped to 2.08-fold. And if one tion with the annual congress of the parent had a history of more than one European Academy of Dermatology form of atopic disease, the pediatric and Venereology. risk of atopic dermatitis was increased She presented a comprehensive meta- 2.32-fold. analysis of 149 published studies ad- Dr. Ravn Dr. Wollenberg “A n interesting result that was new dressing the risk of developing atopic to me what that fathers’ and mothers’ dermatitis according to parental history The meta-analysis showed that a pa- contribution to risk is equal,” said ses- of atopic disease. rental history of atopic dermatitis was sion cochair Andreas Wollenberg, MD, The studies included more than associated with a 3.3-fold greater risk professor of dermatology at Ludwig 656,000 participants. The picture that of atopic dermatitis in the ospring Maximilian University of Munich. “For emerged from the meta-analysis was than in families without a parental the past 2 decades we were always one of a stepwise increase in the risk of history of atopy. A parental history of taught that the mother would have a pediatric atopic dermatitis according to asthma was associated with a 1.56-fold greater impact on that risk.” the type and number of parental atopic increased risk, while allergic rhinitis in “I was also surprised by our ndings,” diseases present. a parent was linked to a 1.68-fold in- Ms. Ravn replied. “But when we pooled “This is something that hopefully creased risk. all the data there really was no dier- can be useful when you talk with “It does matter what type of atopic ence, nor in any of our subanalyses.” parents or parents-to-be with atopic disease the parents have,” she ob- She reported having no nancial diseases and they want to know how served. “Those with a parental history conicts regarding her study. their disease might aect their child,” of asthma or allergic rhinitis can be [email protected] explained Ms. Ravn of the University considered as being at more of an in- of Copenhagen. termediate-risk level, while those with SOURCE: Ravn NH. THE EADV CONGRESS. Commentary by Dr. Eichenfield including studies of twins, showing strong hereditary factors in AD development, as well as incredibly strong genetic inuences ATOPIC DERMATITIS (AD) continues to be the focus of much re- on the association of AD and asthma. search, including epidemiologic work and the development of new Others have postulated that different pathways could mediate therapies. some of the parental effects, including epigenetic modications, as The large meta-analysis by Nina H. Ravn from the University well as common “clustering” of environmental hazards. of Copenhagen presented several months ago included over Is this kind of research important? Absolutely! The individual 650,000 individuals in 149 published studies looking at the and global burden of AD is signicant, with its high prevalence inuence of parental eczema and other atopic conditions. It and association with the development of other atopic conditions. showed, as have other studies, that having parents with a history Can we prevent its development in high-risk children? Research of AD markedly increases a child’s risk of developing AD (3.3-fold to prevent its development includes emollient application studies increase), and that other atopic diseases (asthma, allergic rhini- in early life, pre- and probiotic supplementation, environmental tis) increased the odds of a child developing AD, but by less of modication studies, and others. While the answers are elusive an amount.

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