Skip to main content

Advertisement

SpringerLink
Log in

Atopic Dermatitis in Infants and Toddlers: a Diagnostic Challenge in Daily Practice

  • Atopic Dermatitis (T.Bieber, Section Editor)
  • Published:
Current Dermatology Reports Aims and scope Submit manuscript

Abstract

The presentation of newborns (0 to 28 days), infants, and toddlers (28 days to 2 years) with eczematous skin lesions is always a diagnostic and therapeutic challenge. Although these lesions represent most commonly an early atopic dermatitis (AD), various other eczematous skin diseases must be ruled out. These differential diagnoses of early AD include immunodeficiency disorders. Ascertaining a diagnosis of early AD is difficult, because the clinical phenotype is extremely heterogeneous and pruritus, the hallmark of AD, is difficult to recognize at this early age. Most sets of diagnostic criteria for atopic dermatitis are not applicable in this very early age of life. Thus, the definitive diagnosis of early AD is challenging and may better be delayed with a preliminary diagnosis of indetermined “eczema infantum.” Once the clinical characteristics become evident in the further course of the disease and the chronically recurring course can be assessed, a diagnosis of early AD may be made.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9

Similar content being viewed by others

References

  1. Fölster-Holst R. Itch management in childhood. Curr Probl Dermatol. 2016;50:173–91.

    Article  PubMed  Google Scholar 

  2. Eichenfield LF, Tom WL, Chamlin SL, Feldman SR, Hanifin JM, Simpson EL, et al. Guidelines of care for the management of atopic dermatitis: section 1. Diagnosis and assessment of atopic dermatitis. J Am Acad Dermatol. 2014;70(2):338–51.

    Article  PubMed  Google Scholar 

  3. Perkin MR, Strachan DP, Williams HC, Kennedy CT, Golding J; ALSPAC Study Team. Natural history of atopic dermatitis and its relationship to serum total immunoglobulin E in a population-based birth cohort study. Pediatr Allergy Immunol 2004;15(3):221–229.

  4. Belgrave DC, Granell R, Simpson A, Guiver J, Bishop C, Buchan I, et al. Developmental profiles of eczema, wheeze, and rhinitis: two population-based birth cohort studies. PLoS Med. 2014;11(10)

  5. Bieber T. Atopic dermatitis. N Engl J Med. 2008;358:1483–94.

    Article  CAS  PubMed  Google Scholar 

  6. Fölster-Holst R, Dähnhardt-Pfeiffer S, Dähnhardt D, Proksch E. The role of skin barrier function in atopic dermatitis: an update. Expert Rev Dermatol. 2012;7/3:247–57.

    Article  Google Scholar 

  7. Weidinger S, Novak N. Atopic dermatitis. Lancet. 2016;387(10023):1109–22.

    Article  PubMed  Google Scholar 

  8. FDA. Pediatric Exclusivity Study Age Group, Page Last Updated: 12/10/2014.

  9. Fölster-Holst R. Management of atopic dermatitis: are there differences between children and adults? J Eur Acad Dermatol Venereol. 2014;28(Suppl 3):5–8.

    Article  PubMed  Google Scholar 

  10. Wüthrich B Neurodermitis atopica (atopische dermatitis). In: Fuchs E, Schulz KH (eds). Manuale allergologicum. Dustri, Deisenhofen. 1996.

  11. Ott H, Hütten M, Baron JM, Merk HF, Fölster-Holst R. Erythrodermien im Neugeborenen- und frühen Säuglingsalter JDDG 2008;6:1070–87.

  12. Sarkar R, Garg VK. Erythroderma in children. Indian J Dermatol Venereol Leprol. 2010;76(4):341–7.

    Article  PubMed  Google Scholar 

  13. Hagl B, Heinz V, Schlesinger A, Spielberger BD, Sawalle-Belohradsky J, Senn-Rauh M, et al. Key findings to expedite the diagnosis of hyper-IgE syndromes in infants and young children. Pediatr Allergy Immunol. 2016;27(2):177–84.

    Article  PubMed  Google Scholar 

  14. Sillevis Smitt JH, Kuijpers TW. Cutaneous manifestations of primary immunodeficiency. Curr Opin Pediatr. 2013;25(4):492–7.

    Article  PubMed  Google Scholar 

  15. Leiner K. Über Erythrodermia desquamativa, eine eigenartige universelle Dermatose der Brustkinder. Arch Dermatol Syphilol. 89:65–75. 163-186

  16. Wollenberg A, Oranje A, Deleuran M, Simon D, Szalai Z, Kunz B, et al. European task force on atopic dermatitis/EADV eczema task force. ETFAD/EADV eczema task force 2015 position paper on diagnosis and treatment of atopic dermatitis in adult and paediatric patients. J Eur Acad Dermatol Venereol. 2016;30(5):729–47.

    Article  CAS  PubMed  Google Scholar 

  17. Williams HC, Burney PG, Hay RJ, Archer CB, Shipley MJ, Hunter JJ, et al. The U.K. Working Party's diagnostic criteria for atopic dermatitis. I. Derivation of a minimum set of discriminators for atopic dermatitis. Br J Dermatol. 1994;131(3):383–96.

    Article  CAS  PubMed  Google Scholar 

  18. Hanifin JM, Rajka G. Diagnostic features of atopic dermatitis. Acta Derm Venereol. 1980;92(Suppl):44–7.

    Google Scholar 

  19. Brenninkmeijer EE, Schram ME, Leeflang MM, Bos JD, Spuls PI. Diagnostic criteria for atopic dermatitis: a systematic review. Br J Dermatol. 2008;158(4):754–65.

    Article  CAS  PubMed  Google Scholar 

  20. Tada J. Diagnostic standard for atopic dermatitis. JMAJ. 2002;45(11):460–5.

    Google Scholar 

  21. Saeki H. Management of atopic dermatitis in Japan. J Nippon Med Sch. 2017;84(1):2–11.

    Article  PubMed  Google Scholar 

  22. Sampson HA. Pathogenesis of eczema. Clin Exp Allergy. 1990;20(5):459–67.

    Article  CAS  PubMed  Google Scholar 

  23. Boralevi F, Taieb A. Special aspects in pediatrics. In: Bieber T, Leung DYM, editors. Atopic dermatitis. Second ed. New York: CRC Press; 2009. p. 379–94.

    Google Scholar 

  24. Taieb A, Boralevi F. Atopic eczema in infants. In: Ring J, Przybilla B, Ruzicka T, editors. Handbook of atopic eczem. Second ed. Berlin: Springer; 2006. p. 45–53.

    Chapter  Google Scholar 

  25. Jøhnke H, Vach W, Norberg LA, Bindslev-Jensen C, Høst A, Andersen KE. A comparison between criteria for diagnosing atopic eczema in infants. Br J Dermatol. 2005;153(2):352–8.

    Article  PubMed  Google Scholar 

  26. Jenneck C, Foelster-Holst R, Hagemann T, Novak N. Associated diseases and differential diagnostic considerations in childhood atopic eczema. Hautarzt. 2007;58(2):163–74.

    Article  CAS  PubMed  Google Scholar 

  27. Alexopoulos A, Kakourou T, Orfanou I, Xaidara A, Chrousos G. Retrospective analysis of the relationship between infantile seborrheic dermatitis and atopic dermatitis. Pediatr Dermatol. 2014;31(2):125–30.

    Article  PubMed  Google Scholar 

  28. Moises-Alfaro CB, Caceres-Rios HW, Rueda M, Velazquez-Acosta A, Ruiz-Maldonado R. Are infantile seborrheic and atopic dermatitis clinical variants of the same disease? Int J Dermatol. 2002;41(6):349–51.

    Article  PubMed  Google Scholar 

  29. Fölster-Holst R, Weichenthal M, Steinsland K, Polzhofer G, Christophers E. Eczema infantum and its prognosis. Acta Derm Venereol. 2004;84(5):410–2.

    PubMed  Google Scholar 

  30. Belloni Fortina A, Romano I, Peserico A, Eichenfield LF. Contact sensitization in very young children. J Am Acad Dermatol. 2011;65(4):772–9.

    Article  PubMed  Google Scholar 

  31. Yu J, Treat J, Chaney K, Brod B. Potential allergens in disposable diaper wipes, topical diaper preparations, and disposable diapers: under-recognized etiology of pediatric perineal dermatitis. Dermatitis. 2016;27(3):110–8.

    Article  CAS  PubMed  Google Scholar 

  32. Sunderkötter C, Feldmeier H, Fölster-Holst R, Geisel B, Klinke-Rehbein S, Nast A, et al. S1 guidelines on the diagnosis and treatment of scabies—short version. J Dtsch Dermatol Ges. 2016;14(11):1155–67.

    Article  PubMed  Google Scholar 

  33. Fölster-Holst R, Sunderkötter C. Scabies in childhood and adolescence. Hautarzt. 2016;67(12):1007–20.

    Article  PubMed  Google Scholar 

  34. Panzer R, Fölster-Holst R. Eczematous skin lesions of a suckling. J Dtsch Dermatol Ges. 2009t;7(10):913–4.

    Article  PubMed  Google Scholar 

  35. Dorsey MJ, Dvorak CC, Cowan MJ, Puck JM. Treatment of infants identified as having severe combined immunodeficiency by means of newborn screening. J Allergy Clin Immunol. 2017;139(3):733–42.

    Article  PubMed  Google Scholar 

  36. Paller AS, Mancini AJ. Hereditary disorders of cornification. In: Hurwitz Clinical pediatric dermatology, fifth edition, Elsevier; 2016, 95–118.

  37. Singh S, Khan I, Khim S, Seymour B, Sommer K, Wielgosz M, et al. Safe and effective gene therapy for murine Wiskott-Aldrich syndrome using an insulated lentiviral vector. Mol Ther Methods Clin Dev. 2016;4:1–16.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Aleman K, Noordzij JG, de Groot R, van Dongen JJ, Hartwig NG. Reviewing Omenn syndrome. Eur J Pediatr. 2001;160(12):718–25.

    Article  CAS  PubMed  Google Scholar 

  39. Villa A, Sobacchi C, Notarangelo LD, Bozzi F, Abinun M, Abrahamsen TG, et al. V(D)J recombination defects in lymphocytes due to RAG mutations: severe immunodeficiency with a spectrum of clinical presentations. Blood. 2001;97(1):81-8.

  40. Boos AC, Hagl B, Schlesinger A, Halm BE, Ballenberger N, Pinarci M, et al. Atopic dermatitis, STAT3- and DOCK8-hyper-IgE syndromes differ in IgE-based sensitization pattern. Allergy. 2014;69(7):943–53.

    Article  CAS  PubMed  Google Scholar 

  41. Fraitag S, Bodemer C. Neonatal erythroderma. Curr Opin Pediatr. 2010;22(4):438–44.

    Article  PubMed  Google Scholar 

  42. Bittencourt Mde J, Moure ER, Pies OT, Mendes AD, Deprá MM, Mello AL. Trichoscopy as a diagnostic tool in trichorrhexis invaginata and Netherton syndrome. An Bras Dermatol. 2015;90(1):114–6.

    Article  PubMed  Google Scholar 

  43. Stoll C, Alembik Y, Tchomakov D, Messer J, Heid E, Boehm N, et al. Severe hypernatremic dehydration in an infant with Netherton syndrome. Genet Couns. 2001;12(3):237–43.

    CAS  PubMed  Google Scholar 

  44. Fölster-Holst R, Swensson O, Stockfleth E, Mönig H, Mrowietz U, Christophers E. Comèl-Netherton syndrome complicated by papillomatous skin lesions containing human papillomaviruses 51 and 52 and plane warts containing human papillomavirus 16. Br J Dermatol. 1999;140(6):1139–43.

    Article  PubMed  Google Scholar 

  45. Mosterd K, van Marion A, van Steensel MA. Neonatal Langerhans’ cell histiocytosis: a rare and potentially life-threatening disease. Int J Dermatol. 2008;47:10–2.

    Article  PubMed  Google Scholar 

  46. Martin A, Macmillan S, Murphy D, Carachi R. Langerhans cell histiocytosis: 23 years’ paediatric experience highlights severe long-term sequelae. Scott Med J. 2014;59(3):149–57.

    Article  PubMed  Google Scholar 

  47. Gadner H, Grois N, Arico M, et al. A randomised trial of treatment for multisystem Langerhans’ cell histiocytosis. J Pediatr. 2001;138:728–34.

  48. Panzer R, Küry S, Schmitt S, Fölster-Holst R. Identification of a novel mutation in the SLC39A4 Gene in a case of Acrodermatitis enteropathica. Acta Derm Venereol. 2016;96(3):424–5.

  49. Barzaghi F, Passerini L, Bacchetta R. Immune dysregulation, polyendocrinopathy, enteropathy, x-linked syndrome: a paradigm of immunodeficiency with autoimmunity. Front Immunol. 2012;3:211.

  50. TsudaM, Torgerson TR, Selmi C, Gambineri E, Carneiro-Sampaio M, Mannurita SC, et al. The spectrum of autoantibodies in IPEX 665 syndrome is broad and includes anti-mitochondrial autoantibodies. J Autoimmun. 2010;35:265–26810.

  51. Newland K, Warren L, Gold M. Food allergy testing in infantile eczema: a clinical approach and algorithm. Aust J Dermatol. 2013;54(2):79–84.

  52. Ott H, Folster-Holst R, Merk HF, Baron JM. Allergen microarrays: a novel tool for high-resolution IgE profiling in adults with atopic dermatitis. Eur J Dermatol. 2010;20:54–61.

  53. Wichmann K, Heratizadeh A, Werfel T. Food allergy in atopic dermatitis. Hautarzt. 2012;63(4):315–24.

  54. Hill DJ, Heine RG, Hosking CS, Brown J, Thiele L, Allen KJ, et al. IgE food sensitization in infants with eczema attending a dermatology department. J Pediatr. 2007;151(4):359–63.

  55. Worth A, Sheikh A. Food allergy and atopic eczema. Curr Opin Allergy Clin Immunol. 2010;10(3):226–30.

  56. Hill DJ, Heine RG, Hosking CS. The diagnostic value of skin prick testing in children with food allergy. Pediatr Allergy Immunol. 2004;15(5):435–41.

  57. Chauveau A, Dalphin ML, Kaulek V, Roduit C, Pugin A, von Mutius E, et al. Disagreement between skin prick tests and specific IgE in early childhood. Int Arch Allergy Immunol. 2016;170(2):69–74.

  58. Cudowska B, Kaczmarski M, Wasilewska J. Cross allergic reactions in infants and toddlers with atopic dermatitis. Adv Med Sci. 2013;58(2):401–7.

  59. Kerschenlohr K, Decard S, Darsow U, Ollert M, Wollenberg A.Clinical and immunologic reactivity to aeroallergens in “intrinsic” atopic dermatitis patients. J Allergy Clin Immunol. 2003;111:195–7.

  60. Wollenberg A, Vogel S. Patch testing for noncontact dermatitis: the atopy patch test for food and inhalants. Curr Allergy Asthma Rep. 2013;13(5):539–44.

  61. Darsow U, Laifaoui J, Kerschenlohr K,Wollenberg A, Przybilla B, Wüthrich B, et al. The prevalence of positive reactions in the atopy patch test with aeroallergens and food allergens in subjects with atopic eczema: a European multicenter study. Allergy. 2004;59(12):1318–25.

  62. Roehr CC, Reibel S, Ziegert M, Sommerfeld C, Wahn U, Niggemann B. Atopy patch tests, together with determination of specific IgE levels, reduce the need for oral food challenges in children with atopic dermatitis. J Allergy Clin Immunol. 2001;107:548–53. 707

  63. Niggemann B, Reibel S, Wahn U. The atopy patch test (APT)—a useful tool for the diagnosis of food allergy in children with atopic dermatitis. Allergy. 2000;55:281–5.

Download references

Author information

Authors and Affiliations

  1. Campus Kiel, Dermatology, Venereology and Allergy, University clinics of Schleswig-Holstein, Kiel, Germany

    Regina Fölster-Holst

  2. Department of Dermatology and Allergy, Ludwig-Maximilian-University, Munich, Germany

    Andreas Wollenberg

Authors
  1. Regina Fölster-Holst
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Andreas Wollenberg
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Regina Fölster-Holst.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Atopic Dermatitis

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Fölster-Holst, R., Wollenberg, A. Atopic Dermatitis in Infants and Toddlers: a Diagnostic Challenge in Daily Practice. Curr Derm Rep 6, 230–240 (2017). https://doi.org/10.1007/s13671-017-0195-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13671-017-0195-4

Keywords

Search

Navigation