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3999S1_01_Nikhar-1 - ATOPIC DERMATITIS Clinical Course and...

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Pediatric Subcommittee of the AIDAC Pediatric Subcommittee of the AIDAC October 29-30, 2003 ATOPIC DERMATITIS ATOPIC DERMATITIS Clinical Course and Therapeutic Options Bindi M. Nikhar, M.D., FAAP Division of Dermatologic and Dental Drug Products, ODE V
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2 Pediatric Subcommittee of the AIDAC Pediatric Subcommittee of the AIDAC October 29-30, 2003 Introduction Introduction Atopic dermatitis is a chronic inflammatory disease of the skin primarily seen in the pediatric age group Characterized by dry skin, pruritus, erythema, edema, scaling, excoriations, oozing, lichenification Increasing prevalence, rising costs Together with asthma and allergic rhinitis forms part of the ‘atopic triad’
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3 Pediatric Subcommittee of the AIDAC Pediatric Subcommittee of the AIDAC October 29-30, 2003 Epidemiology Epidemiology 10-20% of children in industrialized countries develop atopic dermatitis Rising incidence, commoner in higher socioeconomic groups Overall clearance 50-60%. 80% of children with severe disease continue to have lifelong exacerbations.
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4 Pediatric Subcommittee of the AIDAC Pediatric Subcommittee of the AIDAC October 29-30, 2003 Morbidity Morbidity Impact on quality of life occurs at all ages. Psychological problems from visible skin lesions due to stigmatization Itch-scratch cycle Sleeplessness, lack of concentration at school or work Repeated treatments, time involved, financial costs
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5 Pediatric Subcommittee of the AIDAC Pediatric Subcommittee of the AIDAC October 29-30, 2003 Cost Cost Drain on financial resources of patients and health services Costs increase with disease severity, highest in first few years While FDA does not consider pharmacoeconomic issues in drug approvals, we recognize that cost is an important factor in drug availability.
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6 Pediatric Subcommittee of the AIDAC Pediatric Subcommittee of the AIDAC October 29-30, 2003 Clinical Manifestations Clinical Manifestations Seen in early infancy, in 50 - 75% of cases, age of onset is 6 months or younger Clearance rate of 60% expected by age 16, relapses occur in adulthood Worse prognosis – severe childhood disease, early onset, concomitant or family history of asthma/allergic rhinitis, biparental history of atopy
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7 Pediatric Subcommittee of the AIDAC Pediatric Subcommittee of the AIDAC October 29-30, 2003 Clinical Features Clinical Features Three main age-related stages. Dry skin and pruritus associated with all stages. Skin barrier function decreased, may lead to increased absorption of topically applied treatments. Usually improves with adequate treatment
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8 Pediatric Subcommittee of the AIDAC Pediatric Subcommittee of the AIDAC October 29-30, 2003 Clinical Phases Clinical Phases Infantile Phase ( 0-2 years ) Onset around 3 months of age. Under 6 months, the face and scalp commonly involved, at an older age, limb folds and hands involved Red, scaly, crusted weeping patches with excoriations seen on both cheeks and extensor surfaces of extremities Course chronically relapsing and remitting
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