Children born to mothers with atopic dermatitis (AD) are more likely to develop AD, with some children developing other allergic illnesses (OAIs) prior to developing AD.
Key Findings:
- Children of mothers with AD were significantly more likely to develop the condition.
- Maternal history of OAI increased the child’s risk of developing AD.
- The majority of children diagnosed with AD developed the condition before OAI like asthma and seasonal allergies.
- Some children may develop asthma or seasonal allergies before AD.
- The sequential development of AD, or atopic march, demonstrates a complex and individualized disease progression.
Introduction: An Association Between Parental Allergic Disease and the Development of Atopic Dermatitis in Offspring Has Not Been Established
AD is a common inflammatory skin condition that begins in childhood. AD is thought to precede the development of OAIs, such as asthma and food allergies, in a temporal manner, a process referred to as atopic march. This indicates common pathophysiology and environmental triggers. It is, however, unclear how allergic conditions in mothers influence the risk of AD and atopic march paradigm in their offspring.
A study published in the Journal of the American Academy of Dermatology assessed the risk of incident AD and the timing and progression of allergic disease onset in children born to mothers diagnosed with AD compared to non-AD mothers.
Methodology: Retrospective Longitudinal Cohort Study
The study collected longitudinal and randomized data from a primary care database in the United Kingdom. A total of 1,224,243 child–mother pairs were included. The median age of the mothers was 28.6 (28.5–28.6) years at the time of the birth of their children. Approximately 15.28% of the mothers were diagnosed with AD.
Compared to mothers without AD, mothers with AD demonstrated a greater prevalence of OAIs, and children of these mothers reported a significantly higher likelihood of AD and OAIs (p < 0.00001). The average age of AD diagnosis was earlier in children of mothers suffering from AD compared to mothers without AD (2.98 (2.95–3.02) years vs. 3.42 (3.40–3.44) years, respectively).
Results:
- Children Born to Mothers With Atopic Dermatitis Were More Likely to Develop Atopic Dermatitis
In the adjusted models, children had a 59% greater likelihood of AD diagnosis if their mothers were also diagnosed with AD. Similarly, children of mothers with OAI including asthma, seasonal allergy, and food allergy also reported a 7%, 30%, and 29% increased risk of AD development compared to children born to mothers without the development of OAI. The risk of AD in children was proportionally related to the number of OAI in the mother.
- The Majority of Children Diagnosed With Atopic Dermatitis Developed the Disease Prior to Other Allergic Illnesses
Among children who were diagnosed with AD, 91.0% exhibited the classic “atopic march” pattern, in which AD precedes OAIs. However, 6.47% of the children had a recorded diagnosis of asthma first and 2.53% of the children were first diagnosed with seasonal allergies prior to AD. Of the children who had a recorded diagnosis of AD first, the age of AD onset was earlier compared to when AD development occurred after asthma and seasonal allergies.
- Some Children Demonstrated the Development of Other Allergic Illnesses Before Atopic Dermatitis
Of the children who were diagnosed with asthma, 66.0% were diagnosed with asthma before they were diagnosed with AD, 27.8% were diagnosed with AD first, and 6.30% were diagnosed with seasonal allergies first. Of the children who were diagnosed with seasonal allergies, 38.8% were diagnosed with seasonal allergies before they were diagnosed with AD, 36.8% were diagnosed with AD first, and 24.35% were diagnosed with asthma first.
Conclusion: Children of Mothers With AD Have an Increased Risk of AD and Other Allergic Illnesses
Children born to mothers diagnosed with AD were more prone to the development of AD and OAI, with a higher risk of disease development at an earlier age compared to children born to mothers without AD. Many children follow the atopic march trajectory, developing AD first before OAIs like asthma or allergies; however, a significant subset develops OAIs prior to AD.
Future studies are needed to investigate the timing of the onset of AD and OAI in relation to one another.
Source:
Fuxench, Z. C. C., Mitra, N., Del Pozo, D., Hoffstad, O., Shin, D. B., & Margolis, D. J. (2023). Risk of atopic dermatitis and the atopic march paradigm in children of mothers with atopic illnesses: A birth cohort study from the United Kingdom. Journal of the American Academy of Dermatology, 90(3), 561–568. https://doi.org/10.1016/j.jaad.2023.11.013
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Topical corticosteroids are a class of medication used to treat various skin conditions and dermatological diseases. They work by reducing inflammation and itching of the skin. When applied appropriately and as directed by a healthcare professional, topical steroids can effectively treat many inflammatory and autoimmune skin conditions.
Chemical Composition and Mechanism of Action
All topical steroids contain synthetic versions of the corticosteroid hormones naturally produced by the adrenal glands. The active ingredients include cortisone, hydrocortisone, prednisone, dexamethasone, betamethasone, and others. They work by binding to glucocorticoid receptors in skin cells and suppressing the production of chemicals that cause inflammation. This reduces redness, swelling, and other inflammatory symptoms associated with many skin diseases. Topical steroids also help to restore the skin barrier and relieve itching.
Types of Topical Corticosteroids
Topical Corticosteroids are classified based on their potency as mild, moderate, moderately potent, and very potent (or super-potent). The choice of product depends on the condition being treated and its severity:
– Mild corticosteroids like hydrocortisone are used for minor rashes and mild flare-ups. They have the least amount of side effects.
– Moderate corticosteroids like triamcinolone acetonide are used for more severe rashes and long-term control of chronic conditions.
– Moderately potent corticosteroids like betamethasone dipropionate or mometasone furoate are prescribed as middle-of-the-road options.
– Very potent corticosteroids like clobetasol propionate or halobetasol propionate are used as short-term treatments for severe, unresponsive conditions under medical guidance.
Common Indications
Some of the most common skin conditions treated with topical steroids include:
– Atopic dermatitis (eczema): A chronic inflammatory rash that causes redness, itching, dry patches, and skin lesions. Topical steroids are standard eczema treatment.
– Psoriasis: An autoimmune skin disorder causing silvery scales and itchy, inflamed plaques. Topical steroids can reduce plaque severity and control flares.
– Contact dermatitis: An itchy, irritated rash from allergic reactions or irritants. Topical steroids help repair the skin barrier and reduce inflammation.
– Seborrheic dermatitis: A common scalp condition causing flaky, greasy, and itchy patches. Topical steroids clear lesions and control flare-ups.
– Lichen planus: Inflammatory skin sores and rashes on the wrists, ankles and genitals. Topical steroids improve sores and relieve itching.
– Rosacea: A chronic facial rash that causes redness and pus-filled bumps. Topical steroids reduce inflammation during flare-ups.
Important Safety Considerations
While considered highly safe when used appropriately, topical corticosteroids require caution to avoid potential side effects from prolonged or improper use:
– Thinning of the skin (atrophy): Long-term use in the same area can lead to fragile, thin skin that bruises easily.
– Rebound dermatitis: Stopping use abruptly without physician guidance can worsen existing rash or induce a new flare.
– Allergic reactions: Some individuals develop contact allergies to topical steroids ingredients over time.
– Suppression of the HPA axis: Very high potency use over large body surfaces for extended periods risks systemic side effects by suppressing the body’s own corticosteroid production.
– Cataracts or glaucoma (with long-term eye area use): Special topical steroids formulated for eye areas minimize this risk.
Proper application technique, only using as directed for the specified duration, and not exceeding weekly potency limits minimize safety risks with topical steroids. Consulting a dermatologist is recommended, especially for children or pregnant/breastfeeding individuals. With appropriate medical oversight and correctly following treatment plans, topical steroids offer a very safe and effective option for long-term management of many skin conditions.
Topical corticosteroids are a mainstay of dermatological treatment due to their potent anti-inflammatory and immunosuppressive properties. By reducing skin inflammation, topical steroids effectively clear lesions and control flare-ups for a wide variety of inflammatory and autoimmune skin conditions. With correct application as prescribed, topical steroids have a strong safety profile when used properly under medical guidance. They remain one of the most useful classes of medication for long-term management of chronic dermatological diseases.
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