DOI: 10.26820/reciamuc/7.(1).enero.2023.

843-854
URL:
https://reciamuc.com/index.php/RECIAMUC/articIe/view/1071EDITOR
IAL: Knowledge of Knowledge
MAGAZINE: RECIAMUC
ISSN: 2588-0748 TECHGACETI CIA. LTDA.
RESEARCH TYPE: Review articleUNESCO °4 *

CODE: 32 Medical Sciences PAGES: 843-854

Topical treatments of Atopic Dermatijis in patients

pediatrics: an update
Topical treatments of atopic dermatitis inpediatricpatients: an update Topical
treatments of atopic dermatitis in pediatric patients: an update
Jssel n Estefanía Méndez Espín: Ilaviá Alexe Itisfrís Luceni2: Raúl/tIejanáro llrava ¥ega': Jeselin
Yamara Cevallss Cevallas'
RECEIVED: 01/28/2023 ACCEPTED: 02/28/2023 PUBLICATED: 03/27/2023
1. Surgeon;DoctorOccupational; Independent Researcher; Quito, Ecuador; joselynmendezespin
gmail.com;@https://orcid.org/0009-0008-808S-6226
2. Doctor Surgeon; DoctorResident; Investigator Independent; quit, Ecuador; avid.riofrio
hotmail.com;@https://orcid.org/0009-0007-4383-0118
3 General Practitioner;DoctorGeneralCenterHealthGuyB.Calpi; Riobamba, Ecuador; a.bravo951
gmail.com;andhttps://orcid.org/0000-0002-6511-2519
4. General Practitioner;DoctorResidentof theHospitaltheArmed Forces No. 1;Quito, Ecuador; joselinyo-
sea hotmail.com; @https://orcid.org/0009-0001-2903-9617

CORRESPONDENCE

›seirn utefanra MéndeZ ÉS§Ín

joselynmendezespin@gmail.c om

Quito, Ecuador

@ RECiauuc, Editorial Knowledge of Knowledge, 2023

 rssumsn
inflammatory pathologyofthefurknownasatopic dermatitis (AD)isaskin diseasechronicleandof etiolo-
giamultifactorialanduncertain that exposes afurwithcheckedxerosisofwidespread form andaalteration inthebarrier function
thatisneed to reset. Their repercussions are directly in hecost oftreatment, theabsence school andheemotional
state;affectingofthis waythequalityoflifeof thepatient.Primary care for this pathologyusuallybe one of its mostly unknown
aspectsbythedoctorsandbythepatients,especially fortheagepediatrichas tothere is a knowledge ofastackle it
oncediagnosedinhetreatmentmust participatea multidisciplinary
team.HEsearchofthepublicationsmedicalreferentstotheAtopic dermatitischildishpublishedbetweentheyears 2018and2023
fortakethediscussionsandupdated scientific findingsHEconsider findings thatexposethecriteriabasicthatderiveinthe
protocolsoftreatments applied forover thererescuetheupdatesinsubjectoftopical treatments bybethesea relevant variable
intheBibliographic research. Numerous epidemiological studies have established a strongassociationbetween
DA,asthmaandrhinitisallergic. The mechanismspathophysiologicalfurtherimportantimplicatedinhe developmentof
thediseasearetheanomaliesinthe structure and function oftheepidermisandthesecondary skin inflammationtoan alteration
oftheresponse ofsystemimmuneto certainantigenscombinedtoothersfactorsastheallergic, infectious, neurovegetative and
psychological.As soon asto thetreatment updateHEconcludes
thatNoexistfindingsspecificforthetreatmentsmerelytopicsinhetreatmentoftheatopic
dermatitisinthepatientspediatricfurtherthere
oftheacquaintances,withoutembargo,inthebibliographiesconsultedthediscussionHEdirectsintheexecutionofatherapydefini
temultifactorialandmultidisciplinary agreeto thediagnosisofeachpatientinwheretheskin manifestations come to represent
asymptomsecondaryofthedisease.
Keywords:Atopic Dermatitis, EczemaChildish,Treatmentstopics,PruritusChildish,DermatitisPediatric.
ABSTRACT
Theinflammatory pathologyoftheskinknown asatopicdermatitis(AD)estochronic skin diseaseofmultifactorial and
uncertain etiology thatexposesskinwith marked xerosisina generalized wayandan alterationinthebarrierfunction
thatneedstobabyrestored.itsrepercussions are directlyinthecostoftreatment,theschoolsabsence andtheemotional
state;thusaffectingthe qualityoflifeofthepatient.Theprimary careofthis pathologyesusually oneofitsaspects thatesmostlyunknown
by doctorsandbypatients, especiallyforthepediatric age there
mustbabyknowledgeofhowtoapproachsince,elevendiagnosed,tomultidisciplinary team must participateinthetreatment.
TOsearchesmadeforthemedical publicationsreferraltochildhood Atopic Dermatitis published between
2018and2023totakethediscussionsandupdated scientificfindings,they are consideredfindingsthatexpose
theBASICcriteria that derive from thetreatmentprotocolsappliedtorescue the updates from there.intermsoftopicaltreatments
asestosaretorelevant variableinbibliographic research. Numerous epidemiological studies have establishedtostrongassociation
between AD, asthma,andallergic rhinitis.Themost important pathophysiological mechanisms involvedinthedevelopmentofthe
disease are abnormalitiesinthe structureandfunctionoftheepidermis andskinsecondary
inflammationtostillalterationintheresponseoftheimmune systemtocertain antigens combined with other factors
suchaceallergies,infections,neurovegetativeandpsychological.
Regardingtheupdatingoftreatments,ItemesconcludedthatthereareNospecificfindingsfor merely topical treatmentsinthe
treatmentofatopicdermatitisinpediatricpatientsbeyondthose known, however,inthebibliographies consulted,thediscussion
isdirectedat the executionoftodefined multifactorial and multidisciplinary therapyaccordingto thediagnosisofeach patient
wheretheskindemonstrations cometorepresenttosecondary symptomsofthedisease.
Keywords:AtopicDermatitis,childhoodEczema,TopicalTreatments,infantilePruritus, Pediatric Dermatitis.
rssumo
TOinflammatory pathologygivespeelknownasatopic dermatitis (AD)anduma doençachroniclegivesfight with
umaetiologymultifactorial and uncertain that exposestopeelcoma marked generalized
xeroseandumaalterationgivesfunctionofbarrier thataccurateofberestored.Aceits repercussions are directly
relatedcomeithercustodotreatment,toabsenceschoolandeitherstateemotional,affectinglikewisethe quality of
lifepatient.Youprimary care of this pathologysaousually umtwoits aspectsmoreunknownby doctors and patients,
especiallyfor tofaixapediatric age,must have knowledge ofasapproach it, once diagnosed, a multidisciplinary team
mustparticipateNotreatment.foicarried outumaresearch of medical publicationsaboutatopic
dermatitispediatricpublishedbetween2018and2023,tofilmoftakeacediscussionsand updated scientific discoveries,
whichsaoconsider-roadsteadsdiscoveries what an expoemyoucriteriabasicwhat derivestwoprotocols oftreatment applied
to wateraceupdates ontopical treatments,once you arethere is onerelevant variablenabibliographic research. Numerous
studiesepidemiologicalestablish oneforteassociationbetweentoAD,toasthmaandtorhinitisallergic.YouI-Physiopathological
canismsmoreimportant wrappedNodevelopmentgivesdoenca saoabnormalities nastructureandfunction of the
epidermisandsecondary skin inflammationtoan answeraltereddosystemimmunitytodeterminedantigens, together
comothersThai factorsas factors allergic, infectious,neurovegetativeandpsychological. no that says
respecttoupdatetwotreatments, I concluded thatnothingthere are specific discoveriesforpurely treatmentsyou
actNodermatitis treatmentatopicumpediatric doctors for germantwoknown. Nowhile,nasconsulted bibliographies,
todiscussionis addressed totoexecution of a defined multifactorial and multidisciplinary therapy
ofagreementcomeitherdiagnosis ofeachteacherum whatacemanifestationscutaneouspassamtorepresent
umsymptomsecondarygivesdoença.
Keywords:Atopic dermatitis, Eczemachildish,Treatmentstopics,itchingchildish,Pediatric dermatitis.
TOPIC TREATMENTS OF ATOPIC DERMATITIS IN PEDIATRIC PATIENTS: AN UPDATE
Introduction
the skin actsasa barrier betweenheI-external
gaveandheinternal. protects us
fromtheexogenous aggressor agents,
exerting abalance in the elimination of
substances and in the loss of
transepidermal water. It also intervenes
regulating body temperature. In Atopic
Dermatitis (AD) we have skinwithmarked
generalized xerosisandan alteration in the
barrier function thatisnecessary to
reestablish (Ricardo Alonso, Rodríguez,
Hernández, & Alonso, 2019).
Illustration 1:infantile
eczemaFountain:Mayo Foundation for
Medical Educationcation and Research
(2022)
The inflammatory pathology of the skin
known as atopic dermatitis (AD) is a
chronic skin disease with multifactorial
etiology.anduncertain; which arises from
genetic, metabolic, immune,
neuroendocrine interactionanddistribution
environmentworldwide, whose prevalence
has doubled inthelast two decades,
especially in industrialized countries where
it affects up tohe30oá of the child
populationand10 oftheAdults. It constitutes a
problem that prevailssignificantly
reads,having great variability between
different geographical areas. According to
the WHO, it represents one of the most
frequent dermatoses in the school
population of underdeveloped countries
andHEfound withintheten sick-
most frequent conditions in pediatrics,
affecting betweenhe10%and20oá of the
child population. its
repercussionsaredirectlyteain the cost of
treatment, school absenceandthe
stateemotional; thus affecting the quality of
life of the patient (Viada Peláez, LeschinsKy,
& Gomila, 2019;Folgar, Ramos, &
Pastrana, 2019)
HEIt is a clinically well-defined disease,
whichHEassociates, upina80%ofthecases
to bronchial asthma and
rhinoconjunctivitis,andin which
constitutional factors intervene, such as a
greater immune sensitivity, genetic
alterationsticsandexposure to multiple
factors that help maintainandto
exacerbatethesymptoms produced by it.
(Leyva Montero, Rodríguez Moldón,
Rodriguez Duque,Mejia Alcivar, & Luyo
Joza, 2020)
Primary care for this pathology usuallywill
beoneoftheiraspects mostly unknown by
doctorsandbythepatients. an important
aspectisthe fact that because it is a visible
manifestation inthe skin and more in pediatric
age should existhave a minimum
knowledge of how to approach it because,
once diagnosed in the treatment, a
multidisciplinary team consisting of a
dermatologist, allergist, paediatrician,
immunologist and psychologist must
participate, in addition to the active
participation of the family caregiver
environment.
Depending on updating the approach to
follow fromthispathology,HEaims tofocus
the search for information
regardingthetopical treatments available to
date.
Methodology
Consideringheresearch
objectiveHEperforms a search through the
web tools of the Google platform
tofindmedical publications referring to
childhood Atopic Dermatitis whose year of
publication is betweenthe
years2018and2023 to take the discussions
and find-updated scientific gos.
I\1ÉNDEZ ESPÍN, JE, RIOFRÍO LUCERO, DA, BRAVO VEGA, PA, & CEVALLOS CEVALLOS, JY
From the resultsobtainedHEconsider then
those who exposethecriteriabasics that
lead tothetreatment protocols applied to
retrieve the updates from thereinmatter of
treatmentcoughtopics for being
thesearelay
variablebeforeintheBibliographic research.
through the summaryandanalysis of the
information
collectedHEorganizeanddisplays the
information presented.
Results
Atopic dermatitis (AD) was first described
in 1808 as a prurigo-like entity, which
generally begins in childhood.eitherin
adolescence characterized by lesions of
specific morphology and distribution
according to age, relatedwithdifferent causal
factors. Regardingthe co-occurrence of
eczema symptomsandother
manifestationsallergic,HEhas stated that
thisconditioncutaneous, is
thefermentationmost common early onset
atopic disease, it is frequently associated
withothersallergic disorders,andisa sea-
development car of rhinitisIasthma. (Leyva
Montero, Rodríguez Moldón, Rodríguez Duque,
Mejía Alcivar, & Luyo Joza, 2020)
Numerous epidemiological studieshave
established a strong association between
AD, asthmaandallergic rhinitis. between
the 20thand60% ofthecasesof AD is
associated with respiratory manifestations
(asthma-rhinitis)and40-67% of patients have
a personal historyIrelatives of atopy The
World Allergy Organization (WAO)
established the name of an extrinsic form of
AD mediated by IgE, whichHEreport-
tainhe80%ofthecases, which presents with
high levels of IgEandhistory of allergic
diseases,andother intrinsiceithernot
mediated by IgE, which occurs with low
levels of IgE andNoHEassociated with
allergic diseases, reporting these, from 16
toa25%of the AD (Ricardo Alonso,
Rodriguez, Hernández, & Alonso, 2019).
Man/festaC/ones C//útC5IS
The essential clinical features arethe
presence of skin
itchingandoftheeczematous lesions with
typical distribution that settle on a base of
dry skin (cutaneous xerosis), which course
chronicallyeitherbuds, next tothehistory of
atopic disease. There is no single skin lesion
that is characteristic ofthedisease. The lesions
may vary in their morphology depending on the
stage of the eczema (acute).yes,
subacuteandchronic), and
inhisdistribution, depending onthepatient
age(phasesinfant, child and adult).
Recognize the factors triggerseitherthat
exacerbatetheoutbreaks is also an
important step in doing custom avoidance.
These factors canbevery
varied,example:heclimate, pollution,clothing,
the presence of dust mites in houses,
cosmetics, certain foods, diet changes,
psychological stressors (sweat,
infections),heemotional stressandsudden
changes in temperature, etc. Omega-3 and 6
fatty acid supplements may be beneficial in
preventing of the DA. Vitamin D also increases
the expression ofthefilaggrin, andinAD
patientandvitamin D deficiency improves the
evolution of the process ifHEthey give
supplements. Itching is the dermatological
symptom predominant in AD, affects
psychologically, emotionallyandphysical to the
childandto their relatives. Causes
aelectnegative abouthisquality of life, causes
sleep disorders and interferes with daily
activities. Scratching causessionsinskin that
favor the entry of allergens, irritants and
germs. Therefore, the control of pruritus is
another ofthepillars in the treatment of AD
(Ricardo Alonso, Rodriguez, Hernández, &
Alonso, 2019).
However,HESome elementary injuries can
be pointed out according to Ricardo et al
(2019):
— Eczema: made up of erythema,
edema, vesiculation,
exudationandscabs.
TOPIC TREATMENTS OF ATOPIC DERMATITIS IN PEDIATRIC PATIENTS: AN UPDATE

— Prurigo: small papules with a — Phasechildish:(fromthe2 tothe12

vesicleinhiscusp, which disappears years).The lesionsHEbecome more
rapidlywithhescratched being replaced papular and less exudative with a
by a small scab. tendencytolichenification, activated
byhescratching and tend to be located
— lichenilication:ill-defined inthefolds, mainly
plaquesandthickened, with grooves antecubitalandpopliteal. It can affect the
delimiting shiny rhomboid areas. Lesions facial, palpebral, and perioral regions
can occur inthreestadiums: (cheilitis, with involvement of the upper
— Acute:intensely pruritic lesions with lip being specific to this
papules on erythematous skin, disease),theauricular folds, thewrists,
vesiculation, exudateserous,scratch hands, anklesand thefeet.
abrasionsand,occasional-mind, bleeding — Phaseadolescent-adult:(older than 12
from injuries. years) papulation
— Subacute: erythematous predominatesandlichenification on a
papulescamativesandexcoriations. base of intense xerosis. Alterations are
frequentnesof skin pigmentation inareas
— Chronic: lichenilication with thickening of the AD, sometimes
of the skin, accentuation ofthefolds, hypopigmentationandat other times,
papules with increaseof pigmentation. The
hyperkeratosisandchangesinthe localizationissimilar to that of the
pigmentation of the skin. All this on the infantile stage with preferential
basis ofxerosiseitherDry Skin. Different involvement of the flexion
factors can coexistsesin the same patient, foldsandfacial region.(Ricardo Alonso,
in a deter-mined moment of Rodríguez, Hernández, & Alonso,
evolutioneithersucceedintime. 2019)
(RichardAlonso, Rodríguez,
Hernández, & Alonso, 2019)
CfíiÍCÁS FORMS
The distributionof lesions varies according
to the age of the patient:
— Infant phase: (fromthe2monthsup to 2
years) pruritic eczematous lesions that
inthecharacteristic casesHEstart between
the monthand thethreemonthsoflife, in the
form of an erythematous rashwith
papulovesicular elementswithlarge
exudative component that forms crusts,
located on the cheeks, from where it can
spread to the forehead, ear folds, scalp,
but respecting the nasolabial triangle. It
can extend over time to the neck, anterior
region of the trunk, extensor surface of
limbs.and,inthecasesmore serious,
generalize with intense itching, affect-tionof
the general stateandfrequentlysigns of
impetiginization.
I\1ÉNDEZ ESPÍN, JE, RIOFRÍO LUCERO, DA, BRAVO VEGA, PA, & CEVALLOS CEVALLOS, JY

Table 1.Evolutionary Clinical Phases of atopic dermatitis

I will go

Fountain:Escarrer Jaume & Guerra Pérez (2019)

Etiopafogeny and Fis/opafo/og/á epidermal cell adhesion. Inthepatients with

AD there are alterations inhestratum
The final causes of the development of AD corneum, as a
are not completely known. At the deficiencyteahydrationandaincreased
momentHEconsiders that the alteration in transepidermal water loss, changes in lipid
the barrier functionishemajor pathogenic composition, elevation of pH, aberrant
factorandattached to the serine protease activityandreduction of the
interactionwithgenetic, immunological diversity oftheskin microbiotatoin favor of
factorsandenvironmental, gives rise to the an increase in the presence of
beginninganddisease progress. Other Staphylococcus aureus. The alteration of
factors are brought upastheallergic, the barrier function will beheresult of the
infectious, neurovege- combination of differentandnumerous
tativesandpsychological. hereditary factorsandexogenous. In all
The most important pathophysiological these demonstrations,isessential lilagrine
mechanisms involved in the development (FLG), whichisa structural protein of the
of the disease are abnormalitiesinthe stratum corneum essential for
structureture and function of the developmentandmaintenancetoof the skin
epidermisandskin inflammation secondary barrier. (Ricardo Alonso, Rodríguez
to an alteration in the response of the Sánchez, Hernández Fernández, & Alonso
immune system to certain antigens. The González, 2018)
two most important structures in this barrier
function of the skin arehestratum corneum
and proteins
TOPIC TREATMENTS OF ATOPIC DERMATITIS IN PEDIATRIC PATIENTS: AN UPDATE

In the pathophysiology of AD there is Moldón, Rodriguez Duque, Mejía Alcivar,

abalance between the profile of Th2 &Luyo Joza, 2020)
cytokines (IL-4, IL-5), which favors the
production of IgEandincreased expression Langerhans cellsHEincreased in damaged
of antigen-presenting cells forhisinteract-tion skinthesepatients, determining an
with lymphocytesyoucells, which once inflammatory reaction, in addition to
activated induce the production of more IL- monocytes, eosinolyles,
4andIL-5andamplifies the inflammatory macrophagesandmast cells. There is also an
response. Other immunological findings in increase inthehistamine bytheBasoliles,
AD are decreasedinthe Th1 chronic activation of macrophages with
responseandits cytokines, natural killer increase in GM-CSF, increase in
cellsanddysfunctional TCD8 lymphocytes; prostaglandin E2, IFN-gamma, marked
these alterationsintogether, they also favor decrease in phagocytosis
viral infectionsandbacteria on the skin. capacityandchemotactic for
Depression of cellular immunity increases neutrolilesandmonocytes, among others.
cellsyoucooperativeanddecreases (Leyva Montero, Rodríguez Moldón, Rodríguez
cellsyousuppressive. Th1 cells mediate Duque, Mejía Alcivar, & Luyo Joza, 2020)
delayed hypersensitivity reactions, recruit diagnostic criteria
monocytesandmacrophages and
induceproduction of killer T cells; Th2 cells ThefurtherUsed foratopic dermatitis,
produce large amounts of cytokinesandare according to Aguirre et al. (2018) were
IgE inducersandoftheeosinolyles. (Leyva developed by Hanilin and Rajka in 1980
Montero, Rodriguez and laterbereviewed by the American
AcademyDermatology cana later.

wise 2.American Academy of Dermatology recommended diagnostic criteriafor atopic

dermatitis

caBCt0nSt¢aS49¢rld8les(d0b9tl CBi8Clerí9tces?rp0rIzfIBs(0bset- CBf8CIefíS(USaS0Ó8dBS(9st0S Ü0fldi¢i0ne9ofexcCl

esbrptentes) va‹bsenlaeyoriaofbabycases, clinical
associationshelptodans‹gorIeddagnoslño)
sqe*rhedbgrostic,hairare
tooinspecJóapaiaestixliasofi
westigaonandepóemiolóqct
s)
ebempraadeqx#dón AnswersB scrbraipoi(pdóez scabies

ecce‹za(water,subacute
eitherooiko)
1. morblogiatypicalandpassions
2. History ofcxriicity
0I4¢lJfí9I1ÓB
Atgiia
CatOi0soculaB60pe*0óita10S DeM dlitsbywithla¢t0
1.personal/family history
ot4afindingsregiords(cam• ichthosis
ái0Sg¢ri0lzles0@nBxJnCul8res)
actionpetiblioiBr,iguenfi- ünbnacutzieoofcellsyou
xemes cacbri,pfüúg0p0rii1sed0S

R
E
Fountain:Aguirre, Mendoza, & López (2018) C
I
M
A
I\1ÉNDEZ ESPÍN, JE, RIOFRÍO LUCERO, DA, BRAVO VEGA, PA, & CEVALLOS CEVALLOS, JY

Byotherpart, the severity of the AD can On the other hand, the severity of AD canbe assessed
using multiple scales,beassessed using multiple scales, mostlyHEusesthe SCORAD
scale, the SCORAD scale is mostly used, despite the fact that since
2014,HErecommends despite the fact that since 2014,HErecommends applying the EASI
scale forhisability to apply the EASI scale for their ability toobjective of evaluation, which
allows homo- objective of evaluation,itwhich allows to standardize criteria, especially in
trials, to standardize criteria, especially in clinical trials (Aguirre, Mendoza, & López,
2018). clinicians (Aguirre, Mendoza, & López, 2018).

Mild:&25
IndexSCORED Moderate:25-50
Serious:>fifty
Extension:l¥eglaofthe9

Scalemore than

to the aaheither+i.e.

(Them4areasofset¥teditydnerythemabeefHE Oritablñzan.Round outto theworthmts

Illustration 2:SCORAD
indexFountain:Escarrer Jaume & Guerra Pérez (2019)

SCORAD valuesthreeparameters: • C:thesubjective symptoms inthelast three

last days: itching and loss of sleep,
• A: the extension of the area affected by
giving each0and10 points for
the dermatitis, whichHEexpressasbody
ascalevirtual analog.It represents 20%
surface area percentage affected by
of the total.
inflammation.HEemploystheRule ofthe

9asmeasure instrument(theI know that- SCORAD index = A/5+7xB/2+c.

give withoutotherinjury does not
count).Cansupposeup to 20% of the settle downthreedegrees:
total.

• B:theintensity of the various injuries. ^ Mild: score of0to 25.

HEvaluesix types: erythema, edema/
exudate/scab, excoriation, II-
quenilicationanddryness, punctuating
each of0to3.supposes uphe60%
of the total.
• Moderate: score25tofifty.papule,
• Severe: score greater than 50. (Scale-
Jaume & Guerra Pérez, 2019)
LADER TOPICAL TREATMENTS 1ATOPIC ATITIS IN PEDIATRIC PATIENTS: AN UPDATE

Table 3.Some diagnostic aids and severity scales used bythe specialists

Ask (57%)

poblacidriattended<18year 40 92
populationattended>18year 59 65 8
criteñosdiagnostics
clinicians 74 31 28
Hanifin Rajka 26 59 57
williams 0 3 fifteen
Other6 0 0
Supportdiagnosis
Lab‹xatorios. biometryhematiœ,lgEtolaleitherecpecffiœ,
twenty-one
chemistryblood
Evidencecutaneoustoaeroallergens” 24 0
bopcia 5 fifteen
0 2 0
None 3 0 0
Scaleofgravityused
easy 5 48 42
POEM 0 Four. tJ.2
Five
SCORED 71 5 14.2
Surfaceœrporal 9 2 14.2
Noused fifteen 0 14.2
EASY=ECZOI theAreaa‹xISeaeflt/ifxlex,POEM=PdtBfit-OrŁ« t4dECze«IadoUfe,SCORAO=S¢œngAØțăC0Øz BótİS.

Fountain:(Herrera, Hernández, & Vivas, 2019)

Atopic dermatitis occurs in the first year of Atopic dermatitis follows a chronic
life in 60% ofthecases, and at the age of recurrent course formonthsor years.most
fiveyears inalmost the85%ofthecases. no ofthepatientsare free of disease in
laboratory adulthood, but in about30%the
testbyYeahonlyreinforceseitherexcludeshe illnesspersists. The patientswith atopic
diagnosiscoof atopic dermatitis. Although dermatitis are predisposed to the
immunoglobulin EHEis elevated by up development of bacterial infectionsandskin
to80oáof affected viruses. Duetothat Staphylococcus aureus
patients,thisfindingishighly nonspecific, co-lonizaalmost 100% ofthepatients, the
sinceThis skin disorder can coexist with impetiginization of atopic dermatitis
allergic diseases that by themselves lesionsisfrequentandHEassociateswithexa
elevate IgE. Skin tests, although they may cerbation of the disease. However,
be positivein it65% ofthecases, are infection by resistant Staphylococcus
unreliable sincethesepatients present aureustocommunity-acquired
hyperreactivityintrinsic skin vitality, with methicillinNoiscommon among children
decreasedto theitch threshold and external with atopic dermatitis. (Aguirre, Mendoza,
stimuli, both physical and chemical. (Aguirre, & López, 2018)
Men-doza, & López, 2018)
I\1ÉNDEZ ESPÍN, JE, RIOFRÍO LUCERO, DA, BRAVO VEGA, PA, & CEVALLOS CEVALLOS, JY

differential diagnosisshould perform- 3weeksandafter onceto theday until the

HEwith scabies, ringworm of the skin, disappearance ofthesymptoms. Death in
seborrheic dermatitis, nummular eczema, 2016 ensures thatheClobetasol should not
psoriasis, nutritional deficiencies, contact be used in childhood. Pimecrolimus 1%
dermatitis that sometimes tend to be cream can be used in the prodromal
added to the primary disease, phases.andto prevent the progression of
andfurtherremotelywithmastocytosisandCut the flare in mild-moderate AD. Tacroli-
aneous lymphomas, mainly Sézary musointment (0.03%, 0.1%, 0.3%) canbe
syndrome. (Aguirre, Mendoza, & López, used in cases of moderate intensity,
2018) severeeithersevere, refractory to
treatmentconventionaleitherinthethatthetop
TreatmentPharmacological ical corticosteroids are contraindicated
Several studies suggest that the use of mild (they have no therapeutic
emollients fromhebirth could protect against indicationinchildren under two years of age)
the start oftheinflammation ofthe (López, Núñez, & Chaverri, 2020;Ricardo
skininnewborns at risk of atopy. Several Alonso, Rodriguez, Hernandez,& Alonso,
studies support thattheemollients correct 2019; Mendez,andothers, 2019)
subclinical dysfunction of the skin Other treatments thatHEcan add
barrierandearly inflammation, lessening arethetopical anti-inflammatory
severityeitherAD development. (Escarrer medicationsspikes, which include
Jaume & Guerra Pérez, 2019) corticosteroidsandcalcineurin inhibitors.
Topical corticosteroids arehefirst line The illnessfurthersevere and recalcitrant
treatment.Hischoice will depend may warrant the addition of
onthelocation of lesions, type of phototherapyIsystemic
eczemaanddegree of affectation.HEapply medicationsmonkeysvariable efficacyand
in a small amount, only in the area with withsecurity limitations. The development
injury, not to exceed 7-10 days in general of agents that block key steps in type 2
toavoidsecondary elect. Use inflammation has represented a
antibioticscostopicsYeahthere is not very breakthrough,andA hopefor patients, both
extensive infectionsa(mupirocin, fusidic adultscoughlike 6 year oldsto11
acid), for a short period of time (7 days). yearsandadolescent-you,who suffering
from moderate to severe AD have seen the
Second-line treatment, approved for the possibility of controlling it.
treatment of moderate to severe AD in
adults and children over two years of age Dupilumab, a monoclonal antibody, dual
arethetopical calcineurin inhibitors, such signaling pathway inhibitor of IL-4 and IL-13,
ashetacrolimus,hetacroli- key mediatorsandcentral of thetype 2
musandpimecrolimus. They are drugs inflammation, enterheconcep-toof
ofFamily ofthemacrolides with immunomodulation of the disease that has
immunomodulatory and anti-inflammatory the possibility of long-term control of the
properties. They inhibit the synthesis of disease.Aeffective treatmentandinsurance
proinflammatory forthepatients with moderate ADandsevere,
cytokines.Theiradvantages are that they do also in children 6 years of ageandmore,
not causeskin atrophy (notproduce whose disease cannot be adequately
alteration of collagen synthesis), nor controlledwithprescription topical
purpura.HEcan-give applywithincreased therapieseitherwhen said therapies are not
security in areasaseyelids, faceandfolds. advisable. Also, it can be used
They do not present tachylylaxiaandThey witheitherwithout topical corticosteroids.
have minimal systemic absorption. The Betweentheirelectedadverse stand
treatment regimen would be the application outthereactionslocal injection of the
twice a day during drugandconjunctivitis. Although he has
supposed
TOPIC TREATMENTS OF ATOPIC DERMATITIS IN PEDIATRIC PATIENTS: AN UPDATE
a therapeutic revolutionhehighcostof the
drugandthe lack of studies in younger
children limits its use. (Sarmiento, 2022;
López, Núñez, & Chaverri, 2020)
Tralokinumab and lebrikizumab: are
monoclonal antibodies directed against IL-13
that have shown significant
improvementinheSCORAD,heDermatology
Life Quality Index andhepruritus (López, Núñez,
& Chaverri, 2020)
Baricitinib antagonizestoJAK 1andJAK 2 and is
targetedtopatients with moderate
ADandserious,withoutHowever,
asymptomatic elevationofthecreatine kinase
is one oftheelectedreported adverse events.
Upadacitinibandabrocitinibareselective JAK
inhibitors1.HEhave developed new small
molecules that allow us to
considerhisusetopic. (López, Núñez, &
Chaverri, 2020)
Topical crisaborole: works by inhibiting
phosphodiesterase 4 (PDE4) and its useHEhas
approvedonlyin patients older than 12 years
with mild ADandmoderate. its
effectivenessHEhas comparedwith
themoderately potent corticosteroidswithlower
frequency of adverse effects, noHEhas
evidenced skin atrophy,
telangiectasiasandhypopigmentation,withoute
mbargo,HEhas documented sensation of
paineitherburning at the application site. At
the momentHEfindininvestigationthetopical
inhibitors ofthevia JAK/STAT. Topical tofacitinib
and ruxolitinib seem to show efficacy intheEASI
reductionandof itching. (López, Núñez, &
Chaverri, 2020)
conclusions
Atopic Dermatitis (AD) is an inflammatory skin
disease characterized by pruritus,
xerosisandeczematous lesions that vary in
topographyandmorphology according to the
age of the patientandthe stage of the disease.
The diagnosis of asthmaHEbased primarily
on the clinical characteristics of the
patientandthepersonal historyandrelatives.
The mainstay of treatmentthepatientswithDA
are general interventionsandtherestoration of
the skin barrierwithemolien-
you,thathelp reduce the need for topical
corticosteroidsthepatients. Investigation of
an allergic etiology is necessary in cases of
moderate ADandserious, especiallyintheearly
years of life, whenthefoodcan be triggering
factorseitheradjuvants inthebuds.
Regarding the update of treatmentI
coughconcludes that there are no specific
findings for the treatments
merelyteatopical in the treatment of atopic
dermatitis inthepediatric patients,however,
in the bibliographies consulted, the
discussion is directed towards the
execution of a defined multilactorial and
multidisciplinary therapy according to the
diagnosis of each patient where the skin
manifestations come to represent a
secondary symptom of the disease.
blbllography
aguirre,YO.,Mendoza, D., & Lopez, G.c.(2018). Right-
matitisatopicandcomorbiditiesinhepediatric
patient. allergies,asthmaandYoPediatric
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fromhttps://www.medi-
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Escarrer Jaume, M., & Guerra Pérez, M.T.(2019). Right—
matitisatopic. Diagnostic
ProtocolTherapeuticPediatricofthe
AsociationSpanishadePediatrician,161-175.
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default/fiIes/documents/11dermatitisatopic.pdf
hang out,m.J.,bouquets,M., & Pastrana,K.(2019).
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dermatitisinchildrenandadolescents from
rural/urban areasofHonduras.
MagazinescientificScienceMedical, 22(2), 22-
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López, S., Núñez, e.,&Chaverri,g.(2020). Updateinatopic RichardAlonso, O., Rodriguez.M.,Hernandez, M.,&

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MayFoundationfordoctorEducationandresearch.(2
8ofOctoberof2022).
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w.mayoclinic.org/es-es/diseases-
conditions/atopic-dermatitis-eczema/symptoms-
causes/syc-20353273
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infantsof2yearswithdermatitisatopic.Magazinesci
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Hernández Fernández, M., & Alonso
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QUOTE THIS ARTICLE:

Mendez Espin, JE, Riofrio Lucero, D.TO.,Bravo Vega, P.A.&cevallosEC-
fences,J.AND.(2023). topical treatments oftheAtopic Dermatitisinpatient-you
havepediatric:aupdate. RECIAMUC, 7(1), 843-854.https://doi.
org/10.26820/reciamuc/7.(1).january.2023.843-854

854 RECIMAUCV0L.75^ 112023)