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Childhood impetiginized atopic dermatitis — Clinical Guidelines

Overview

Impetiginized atopic dermatitis (AD) is a common inflammatory skin disease in children characterized by intense pruritus and disruption of the skin barrier, often complicated by secondary bacterial infection 3 5. It is the most common allergic disease, potentially preceding the development of other allergic conditions in the "atopic march" 3 10.

Diagnosis

No specific diagnostic criteria for impetiginized AD were detailed in the provided abstracts. However, general AD diagnosis and severity assessment are mentioned:

Eczema Area and Severity Index (EASI) is used to assess eczema severity 1 2 6.

Investigator's Global Assessment (IGA) and validated Investigator Global Assessment-Atopic Dermatitis (vIGA-AD) are used for clinical assessment 1 8.

Numeric Rating Scale for Itch (NRS) is used to assess pruritus 1.

SCORAD scores are used to evaluate AD clinical expression 4.

Management

First-line treatment includes basic skin care, hydration, emollients, and topical anti-inflammatory medications such as topical corticosteroids (TCS) and calcineurin inhibitors (TCIs) 3 5 11.

Antimicrobial treatment is a component of initial management 3.

Systemic therapies are considered for moderate-to-severe refractory AD 3 5.

Dupilumab, a biologic targeting the IL-4 receptor alpha subunit, is an option for pediatric AD 1 2 6 7.

Janus kinase inhibitors (JAKi), such as upadacitinib and baricitinib, are available systemic targeted therapies for pediatric AD 1 2 8.

Nutritional and dietary interventions, including probiotics, prebiotics, and vitamin D, have been explored 4.

Special Populations

Pediatrics: Management strategies are determined by disease severity in children <18 years old 5. Dupilumab has shown efficacy in infants and toddlers (6 months to 2 years) and older children 6. Baricitinib is approved for patients aged 2 to <18 years 8. Topical medications are also used in this age group 11.

Key Recommendations

Topical steroids and calcineurin inhibitors are effective and safe in mild to moderate pediatric AD 3. (Evidence: Strong)

Systemic targeted therapies (biologics and small molecules) significantly improve eczema severity in children with AD 2. (Evidence: Strong)

Dupilumab demonstrates efficacy in improving IGA, NRS for itch, and EASI outcomes in pediatric AD compared to placebo 1. (Evidence: Strong)

Dupilumab reduced the risk of new or worsening allergic events in children with AD, suggesting a potential role in attenuating the atopic march 10. (Evidence: Strong)

Baricitinib demonstrated sustained long-term efficacy and no new safety signals in pediatric patients aged 2 to <18 years 8. (Evidence: Strong)

References

1 Liao Q, Pan H, Guo Y, Lan Y, Huang Z, Wu P. Comparative efficacy and safety of dupilumab versus newly approved biologics and JAKi in pediatric atopic dermatitis: A systematic review and network meta-analysis. PloS one 2025. link 2 Kawamoto N, Murai H, Nogami K, Yamamoto T, Kikkawa T, Yasutomi-Sakai M et al.. Efficacy and safety of systemic targeted therapies for atopic dermatitis in children: A systematic review and meta-analysis. Allergology international : official journal of the Japanese Society of Allergology 2025. link 3 Mahajan R, Sarkar R, Panda M, Katakam BK, Padhiyar J, Haritha T et al.. Evidence-Based Recommendations for Managing Atopic Dermatitis in Pediatric Patients: A Systematic Review and Meta-Analysis From the Pediatric Dermatology Special Interest Group of IADVL. International journal of dermatology 2025. link 4 Vassilopoulou E, Comotti A, Douladiris N, Konstantinou GΝ, Zuberbier T, Alberti I et al.. A systematic review and meta-analysis of nutritional and dietary interventions in randomized controlled trials for skin symptoms in children with atopic dermatitis and without food allergy: An EAACI task force report. Allergy 2024. link 5 Eichenfield LF, Boguniewicz M, Lauren CT, Leung DYM, Levy ML, Schneider LC et al.. Systemic Therapy for Atopic Dermatitis in Children and Adolescents: A US Expert Consensus. Dermatology (Basel, Switzerland) 2024. link 6 Zheng Y, Ding RL, Bu J. Effectiveness and safety of systemic therapy for moderate-to-severe atopic dermatitis in children and adolescent patients: a systematic review. Frontiers in immunology 2024. link 7 Starrenburg ME, Bel Imam M, Lopez JF, Buergi L, Nguyen NT, Nouwen AEM et al.. Dupilumab treatment decreases MBC2s, correlating with reduced IgE levels in pediatric atopic dermatitis. The Journal of allergy and clinical immunology 2024. link 8 Wollenberg A, Ikeda M, Chu CY, Eichenfield LF, Seyger MMB, Prakash A et al.. Longer-term safety and efficacy of baricitinib for atopic dermatitis in pediatric patients 2 to <18 years old: a randomized clinical trial of extended treatment to 3.6 years. The Journal of dermatological treatment 2024. link 9 Wang Q, Liu L, Gao S, Su S. Guidelines for the Management of Atopic Dermatitis in Children: A Systematic Review. International archives of allergy and immunology 2023. link 10 Geba GP, Li D, Xu M, Mohammadi K, Attre R, Ardeleanu M et al.. Attenuating the atopic march: Meta-analysis of the dupilumab atopic dermatitis database for incident allergic events. The Journal of allergy and clinical immunology 2023. link 11 Zhao S, Hwang A, Miller C, Lio P. Safety of topical medications in the management of paediatric atopic dermatitis: An updated systematic review. British journal of clinical pharmacology 2023. link

Childhood impetiginized atopic dermatitis