2018, Número 3
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Alerg Asma Inmunol Pediatr 2018; 27 (3)
Dermatitis atópica y comorbilidades en el paciente pediátrico
Aguirre MIL, Mendoza HD, López PGT, Carmona BM
Idioma: Español
Referencias bibliográficas: 75
Paginas: 71-78
Archivo PDF: 163. Kb.
RESUMEN
La dermatitis atópica (DA) es una enfermedad de la piel caracterizada por manifestaciones de inflamación crónica: prurigo intenso, piel seca, eritema y exudado. Esta afecta predominantemente en las superficies de flexión: pliegues de codos o rodillas así como cara y cuello. Desde el punto de vista fisiopatológico se considera multifactorial. La atopia se define como la predisposición a producir IgE frente a alérgenos, por lo que se ha propuesto una nomenclatura que utiliza el término «eczema atópico» cuando se demuestra sensibilización IgE y «eczema no atópico» cuando no se demuestra. El diagnóstico es clínico, se basa en los criterios mayores y menores de Hanifin y Rajka; es esencial la presencia de prurito y al menos dos de los otros criterios mayores y de tres «criterios menores». La sensibilización a alergénicos se puede demostrar a través de pruebas cutáneas, IgE específica en suero y pruebas de parche, mientras que la biopsia de piel es útil para descartar otras enfermedades de la piel o asociaciones. Se debe hacer diagnóstico diferencial con otros tipos de dermatitis, enfermedades infecciosas de la piel, inmunodeficiencias congénitas, trastornos de queratinización, deficiencia nutricional y enfermedad neoplásica. La evaluación de la gravedad se realiza con la Escala de dermatitis atópica (SCORAD). El tratamiento de primera línea es tópico con emolientes y antiinflamatorios (esteroides e inhibidores de calcineurina), la fototerapia y terapias inmunomoduladoras orales deben ser utilizadas para la Dermatitis Atópica crónica refractaria. Actualmente la DA es un trastorno multisistémico que tiene comorbilidades y pueden imitar una variedad de condiciones de la piel, las podemos dividir en alérgicas y no alérgicas, las cuales ameritan una revisión adicional.
REFERENCIAS (EN ESTE ARTÍCULO)
Hill LW, Sulzberger MB. Yearbook of dermatology and syphilology. Chicago: Year Book Medical Publishers; 1933. pp. 1-70.
Williams H, Robertson C, Stewart A, Ait-Khaled N, Anabwani G, Anderson R et al. Worldwide variations in the prevalence of symptoms of atopic eczema in the International Study of Asthma and Allergies in Childhood. J Allergy Clin Immunol. 1999; 103: 125-138.
Mao W, Mao J, Zhang J, Wang L, Cao D, Qu Y. Atopic eczema: a disease modulated by gene and environment. Front Biosci (Landmark Ed). 2014; 19: 707-717.
Van der Hulst AE, Klip H, Brand PL. Risk of developing asthma in young children with atopic eczema: a systematic review. J Allergy Clin Immunol. 2007; 120 (3): 565-569. [PubMed: 17655920]
Hayashida S, Furusho N, Uchi H, Miyazaki S, Eiraku K, Gondo C et al. Are lifetime prevalence of impetigo, molluscum and herpes infection really increased in children having atopic dermatitis? J Dermatol Sci. 2010; 60 (3): 173-178. [PubMed: 20971618]
Zheng T, Yu J, Oh MH, Zhu Z. The atopic march: Progression from atopic dermatitis to allergic rhinitis and asthma. Allergy Asthma Immunol Res. 2011; 3 (2): 67-73. [PubMed: 21461244]
Williams HC. Atopic dermatitis. N Engl J Med. 2005; 352: 2314-2324.
Slattery MJ, Essex MJ, Paletz EM, Vanness ER, Infante M, Rogers GM et al. Depression, anxiety, and dermatologic quality of life in adolescents with atopic dermatitis. J Allergy Clin Immunol. 2011; 128 (3): 668-671. [PubMed: 21684588]
Schmitt J, Romanos M, Schmitt NM, Meurer M, Kirch W. Atopic eczema and attention-deficit/hyperactivity disorder in a population-based sample of children and adolescents. JAMA. 2009; 301 (7): 724-726. [PubMed: 19224748]
Schmitt J, Romanos M, Pfennig A, Leopold K, Meurer M. Psychiatric comorbidity in adult eczema. Br J Dermatol. 2009; 161: 878-883. [PubMed: 19624545]
Chamlin SL, Mattson CL, Frieden IJ, Williams ML, Mancini AJ, Cella D et al. The price of pruritus: sleep disturbance and cosleeping in atopic dermatitis. Arch Pediatr Adolesc Med. 2005; 159: 745-750. [PubMed: 16061782]
Camfferman D, Kennedy JD, Gold M, Martin AJ, Winwood P, Lushington K. Eczema, sleep, and behavior in children. J Clin Sleep Med. 2010; 6 (6): 581-588. [PubMed: 21206547]
Su JC, Kemp AS, Varigos GA, Nolan TM. Atopic eczema: its impact on the family and financial cost. Arch Dis Child. 1997; 76 (2): 159-162. [PubMed: 9068310]
Valeant Pharmaceuticals North America. Data on file, 2012.
Odhiambo JA, Williams HC, Clayton TO, Robertson CF, Asher MI; ISAAC Phase Three Study Group. Global variations in prevalence of eczema symptoms in children from ISAAC Phase Three. J Allergy Clin Immunol. 2009; 124: 1251-8.e23.
Williams H, Stewart A, von Mutius E, Cookson W, Anderson HR; International Study of Asthma and Allergies in Childhood (ISAAC) Phase One and Three Study Groups. Is eczema really on the increase worldwide? J Allergy Clin Immunol. 2008; 121 (4): 947-954.e15. [PubMed: 18155278]
Shaw TE, Currie GP, Koudelka CW, Simpson EL. Eczema prevalence in the United States: data from the 2003 National Survey of Children’s Health. J Invest Dermatol. 2011; 131: 67-73.
Rodríguez-Orozco A, Núñez-Tapia RM. Prevalencia de dermatitis atópica en niños de 6 a 14 años de edad en Morelia, Michoacán. Rev Aler Mex. 2007; 54 (1): 20-23.
Levin J, Friedlander SF, Del Rosso JQ. Atopic dermatitis and the stratum corneum: part 1: the role of filaggrin in the stratum corneum barrier and atopic skin. J Clin Aesthet Dermatol. 2013; 6: 16-22.
Eyerich K, Novak N. Immunology of atopic eczema: overcoming the Th1/Th2 paradigm. Allergy. 2013; 68: 974-982.
Grimalt R, Mengeaud V, Cambazard F. Study Investigators’ Group. The steroid-sparing effect of an emollient therapy in infants with atopic dermatitis: a randomized controlled study. Dermatology. 2007; 214: 61-67.
Cork MJ, Robinson DA, Vasilopoulos Y, Ferguson A, Moustafa M, MacGowan A et al. New perspectives on epidermal barrier dysfunction in atopic dermatitis: gene-environment interactions. J Allergy Clin Immunol. 2006; 118: 3-21.
Verdier-Sévrain S, Bonté F. Skin hydration: a review on its molecular mechanisms. J Cosmet Dermatol. 2007; 6: 75-82.
Cork MJ, Danby SG, Vasilopoulos Y, Hadgraft J, Lane ME, Moustafa M et al. Epidermal barrier dysfunction in atopic dermatitis. J Invest Dermatol. 2009; 129: 1892-1908.
Flohr C, England K, Radulovic S, McLean WH, Campbel LE, Barker J et al. Filaggrin loss-of- function mutations are associated with early-onset eczema, eczema severity and transepidermal water loss at 3 months of age. Br J Dermatol. 2010; 163: 1333-1336.
Rawlings AV, Harding CR. Moisturization and skin barrier function. Dermatol Ther. 2004; 17 (Suppl 1): 43-48.
Hanifin JM, Cooper KD, Ho VC, Kang S, Krafchik BR, Margolis DJ et al. Guidelines of care for atopic dermatitis, developed in accordance with the American Academy of Dermatology (AAD)/American Academy of Dermatology Association “Administrative Regulations for Evidence-Based Clinical Practice Guidelines”. J Am Acad Dermatol. 2004; 50 (3): 391-404.
Rudikoff D, Lebwohl M. Atopic dermatitis. Lancet. 1998; 351: 1715-1721.
Hanifin JM. Atopic dermatitis. In: Middleton E, Reed CE Jr., Ellis EF, Adkinson NF Jr., editors. Allergy: principles and practice. 4ª ed. St. Louis: Ed. St. Louis-Mosby; 1993. pp. 1581-1604.
Williams HC, Strachan DP. The natural history of childhood eczema: observations from the British 1958 birth cohort study. Br J Dermatol. 1998; 139: 834-839.
Burr ML, Dunstan FD, Hand S, Ingram JR, Jones KP. The natural history of eczema from birth to adult life: a cohort study. Br J Dermatol. 2013; 168 (6): 1339-1342.
Garmhausen D, Hagemann T, Bieber T, Dimitriou I, Fimmers R, Diepgen T et al. Characterization of different courses of atopic dermatitis in adolescent and adult patients. Allergy. 2013; 68 (4): 498-506.
Matiz C, Tom WL, Eichenfield LF, Pong A, Friedlander SF. Children with atopic dermatitis appear less likely to be infected with community acquired methicillin-resistant Staphylococcus aureus: the San Diego experience. Pediatr Dermatol. 2011; 28 (1): 6-11.
Balma-Mena A, Lara-Corrales I, Zeller J, Richardson S, McGavin MJ, Weinstein M et al. Colonization with community-acquired methicillin-resistant Staphylococcus aureus in children with atopic dermatitis: a cross-sectional study. Int J Dermatol. 2011; 50 (6): 682-688.
Huang JT, Abrams M, Tlougan B, Rademaker A, Paller AS. Treatment of Staphylococcus aureus colonization in atopic dermatitis decreases disease severity. Pediatrics. 2009; 123 (5): e808-e814.
Spergel JM. Epidemiology of atopic dermatitis and atopic march in children. Immunol Allergy Clin North Am. 2010; 30 (3): 269-280. [PubMed: 20670812]
Spergel JM. From atopic dermatitis to asthma: the atopic march. Ann Allergy Asthma Immunol. 2010; 105 (2): 99-106. [PubMed: 20674819]
Palmer CN, Irvine AD, Terron-Kwiatkowski A, Zhao Y, Liao H, Lee SP et al. Common loss-of-function variants of the epidermal barrier protein filaggrin are a major predisposing factor for atopic dermatitis. Nat Genet. 2006; 38 (4): 441-446. [PubMed: 16550169]
Illi S, von Mutius E, Lau S, Nickel R, Grüber C, Niggemann B et al. The natural course of atopic dermatitis from birth to age 7 years and the association with asthma. J Allergy Clin Immunol. 2004; 113 (5): 925-931. [PubMed: 15131576]
Meijer A. Asthma predictors in infantile atopic dermatitis. J Asthma Res. 1975; 12 (3): 181-188. [PubMed: 1194191]
Gustafsson D, Sjöberg O, Foucard T. Development of allergies and asthma in infants and young children with atopic dermatitis-a prospective follow-up to 7 years of age. Allergy. 2000; 55: 240-245. [PubMed: 10753014]
Ponińska J, Samoliński B, Tomaszewska A, Raciborski F, Samel-Kowalik P, Walkiewicz A et al. Filaggrin gene defects are independent risk factors for atopic asthma in a Polish population: a study in ECAP cohort. PLoS One. 2011; 6 (2): e16933. [PubMed: 21365004]
Palmer CN, Ismail T, Lee SP, Terron-Kwiatkowski A, Zhao Y, Liao H et al. Filaggrin null mutations are associated with increased asthma severity in children and young adults. J Allergy Clin Immunol. 2007 120 (1): 64-68. [PubMed: 17531295]
Bartnikas LM, Gurish MF, Burton OT, Leisten S, Janssen E, Oettgen HC et al. Epicutaneous sensitization results in IgE-dependent intestinal mast cell expansion and food-induced anaphylaxis. J Allergy Clin Immunol. 2013; 131 (2): 451-460.e1-6.
Brough HA, Simpson A, Makinson K, Hankinson J, Brown S, Douiri A et al. Peanut allergy: effect of environmental peanut exposure in children with filaggrin loss-of-function mutations. J Allergy Clin Immunol. 2014; 134 (4): 867-875.e1.
Eigenmann PA, Sicherer SH, Borkowski TA, Cohen BA, Sampson HA. Prevalence of IgE-mediated food allergy among children with atopic dermatitis. Pediatrics. 1998; 101 (3): E8. [PubMed: 9481027]
Burks AW, James JM, Hiegel A, Wilson G, Wheeler JG, Jones SM et al. Atopic dermatitis and food hypersensitivity reactions. J Pediatr. 1998; 132 (1): 132-136.
Brough HA, Liu AH, Sicherer S, Makinson K, Douiri A, Brown SJ et al. Atopic dermatitis increases the effect of exposure to peanut antigen in dust on peanut sensitization and likely peanut allergy. J Allergy Clin Immunol. 2015; 135 (1): 164-170.
Ong PY, Ohtake T, Brandt C, Strickland I, Boguniewicz M, Ganz T et al. Endogenous antimicrobial peptides and skin infections in atopic dermatitis. N Engl J Med. 2002; 347 (15): 1151-1160. [PubMed: 12374875]
Cai SC, Chen H, Koh WP, Common JE, van Bever HP, McLean WH et al. Filaggrin mutations are associated with recurrent skin infection in Singaporean Chinese patients with atopic dermatitis. Br J Dermatol. 2012; 166 (1): 200-203.
Chen JJ, Applebaum DS, Sun GS, Pflugfelder SC. Atopic keratoconjunctivitis: a review. J Am Acad Dermatol. 2014; 70 (3): 569-575.
Pattnaik L, Acharya L. A comprehensive review on vernal keratoconjunctivitis with emphasis on proteomics. Life Sci. 2015; 128: 47-54.
Brunsting LA. Atopic dermatitis (disseminated neurodermatitis) of young adults. Analysis of precipitating factors in one hundred and one cases and report of ten cases with associated juvenile cataract. Arch Derm Syphilol. 1936; 34 (6): 935-957.
Alexander F. Psychosomatic medicine. New York: Norton Company; 1950.
Graham DT, Wolf S. The relationship of eczema to attitudes and to vascular reactions of the human skin. J Lab Clin Med. 1953; 42: 238-254.
Faulstich ME, Williamson DA, Duchmann EG, Conerly SL, Brantley PJ. Psychophysiological analysis of atopic dermatitis. J Psychosom Res. 1985; 29 (4): 415-417. [PubMed: 4057129]
Yaghmaie P, Koudelka CW, Simpson EL. Mental health comorbidity in patients with atopic dermatitis. J Allergy Clin Immunol. 2013; 131 (2): 428-433.
Chen MH, Su TP, Chen YS, Hsu JW, Huang KL, Chang WH et al. Is atopy in early childhood a risk factor for ADHD and ASD? a longitudinal study. J Psychosom Res. 2014; 77 (4): 316-321.
Romanos M, Gerlach M, Warnke A, Schmitt J. Association of attention-deficit/hyperactivity disorder and atopic eczema modified by sleep disturbance in a large population-based sample. J Epidemiol Community Health. 2010; 64 (3): 269-273.
Buske-Kirschbaum A, Schmitt J, Plessow F, Romanos M, Weidinger S, Roessner V. Psychoendocrine and psychoneuroimmunological mechanisms in the comorbidity of atopic eczema and attention deficit/hyperactivity disorder. Psychoneuroendocrinology. 2013; 38 (1): 12-23.
Zhang A, Silverberg JI. Association of atopic dermatitis with being overweight and obese: a systematic review and metaanalysis. J Am Acad Dermatol. 2015; 72 (4): 606-616.e4.
Silverberg JI, Silverberg NB, Lee-Wong M. Association between atopic dermatitis and obesity in adulthood. Br J Dermatol. 2012; 166 (3): 498-504.
Wollenberg A, Schnopp C. Evolution of conventional therapy in atopic dermatitis. Immunol Allergy Clin North Am. 2010; 30: 351-368.
Darsow U, Wollenberg A, Simon D, Taïeb A, Werfel T, Oranje et al. Difficult to control atopic dermatitis. World Allergy Organ J. 2013; 6: 6.
Draelos ZD. An evaluation of prescription device moisturizers. J Cosmet Dermatol. 2009; 8: 40-43.
Nuovo J, Ellsworth AJ, Larson EB. Treatment of atopic dermatitis with antihistamines: lessons from a single-patient, randomized clinical trial. J Am Board Fam Pract. 1992; 5: 137-141.
Klein PA, Clark RA. An evidence-based review of the efficacy of antihistamines in relieving pruritus in atopic dermatitis. Arch Dermatol. 1999; 135: 1522-1525.
Eichenfield LF, Tom WL, Berger TG, Krol A, Paller AS, Schwarzenberger K et al. Guidelines of care for the management of atopic dermatitis: Section 2. Management and treatment of atopic dermatitis with topical therapies. J Am Acad Dermatol. 2014; 71 (1): 116-132.
Hoare C, Li Wan Po A, Williams H. Systematic review of treatments for atopic eczema. Health Technol Assess. 2000; 4: 1-191.
Boguniewicz M, Fiedler VC, Raimer S, Lawrence ID, Leung DY, Hanifin JM. A randomized, vehicle-controlled trial of tacrolimus ointment for treatment of atopic dermatitis in children: pediatric tacrolimus study group. J Allergy Clin Immunol. 1998; 102: 637-644.
Eichenfield LF, Lucky AW, Boguniewicz M, Langley RG, Cherill R, Marshall K et al. Safety and efficacy of pimecrolimus (ASM 981) cream 1% in the treatment of mild and moderate atopic dermatitis in children and adolescents. J Am Acad Dermatol. 2002; 46: 495-504.
Kang S, Lucky AW, Pariser D, Lawrence I, Hanifin JM. Long-term safety and efficacy of tacrolimus ointment for the treatment of atopic dermatitis in children. J Am Acad Dermatol. 2001; 44 (1 Suppl): S58-S64.
Baumer JH. Atopic eczema in children, NICE. Arch Dis Cihild Educ Pract Ed. 2008; 93: 93-97.
Meduri NB, Vandergriff T, Rasmussen H, Jacobe H. Phototherapy in the management of atopic dermatitis: a systematic review. Photodermatol Photoimmunol Photomed. 2007; 23 (4): 106-112.
Sidbury R, Davis DM, Cohen DE, Cordoro KM, Berger TG, Bergman JN et al. Guidelines of care for the management of atopic dermatitis: section 3. Management and treatment with phototherapy and systemic agents. J Am Acad Dermatol. 2014; 71 (2): 327-349.