ATOPIC DERMATITIS AT PEDIATRIC TERTIARY CARE CENTERS IN THAILAND: A MULTICENTER STUDY

Atopic dermatitis (AD) is the most common chronic inflammatory skin disease in children. The aim of this prospective study was to investigate the clinical characteristics and management of AD in patients aged <= 15 years who received care at the tertiary pediatric dermatology clinics in Thailand during January 2008 to March 2009. Of 560 included patients, the median age was 4.5 (range 0-15.2) years, and 298 (53.2%) were females. Age of onset was younger than two years in 410 (73.2%) patients. Concomitant asthma and allergic rhinitis (AR) were found in 59 (10.5%) and 206 (36.8%) of patients. Family history of AR was found in 276 (49.3%), AD in 175 (31.3%), and asthma in 134 (23.9%) patients. The common features were chronicity (97.6%), typical morphology with age-specific distribution (97.2%), pruritus (95.8%), xerosis (91.9%), and itch when sweating (78.8%). Using Rajka and Langeland severity grading, 30.9% of cases were mild, 51.8% were moderate, and 17.3% were severe. Factors significantly associated with severe AD were younger age at onset (p=0.03), history of cow's milk allergy (p=0.02), and food allergy (p=0.01). Exclusive breastfeeding for months and early cow's milk exposure were not found to significantly correlate with disease severity or age of onset. Dry skin was the most common (79.8%) aggravating factor. Topical corticosteroids, calcineurin inhibitors, and antibiotics were prescribed in 90.0%, 12.9%, and 7.0% of patients, respectively. Early-onset AD should be closely monitored and aggressively controlled the aggravating factors.