Atopic Dermatitis / Eczema

Atopic dermatitis (AD), also referred to as eczema, is a highly pruritic, chronic, relapsing and inflammatory skin disorder (Leung & Bieber 2003). It is the most common inflammatory skin disease in children, affecting up to 20% of children worldwide (Flohr & Mann 2014).

First manifestations of AD usually appear early in life and can be the initial step to the so-called ‘atopic march’ - preceding other allergic diseases such as asthma or allergic rhinitis (Nutten S 2015).

The symptoms of AD in infants include patches of skin that are red or brownish, dry, cracked, scaly or itchy skin, especially at night (Nutten S 2015). It can appear almost anywhere on the body, however in infants, AD usually appears as tiny bumps on the cheeks and primarily involves the face, the scalp, and the extensor surfaces of the limbs (Nutten S 2015).

It is typically an episodic disease of exacerbation (flares, which may occur as frequently as 2 or 3 per month) followed by remissions, but can also be continuous (NICE. Atopic Eczema 2021). It may have a genetic component that makes the skin susceptible to trigger factors, including irritants and allergens, which can make the eczema worse (NICE. Atopic Eczema 2021).

Eczema & CMPA

What causes atopic dermatitis/eczema in infants?

Around 50–70% of children with an early onset of AD are sensitised to one or more allergens (Nutten S 2015). These are mainly food allergens, e.g., cow’s milk/dairy proteins ((Eigenmann et al 1998; Pourpak et al 2004), which was responsible for AD in 20–80% cases (Nutten S 2015; Pourpak et al 2004).

Could it be a symptom of Cow’s Milk Protein Allergy?

Atopic dermatitis (AD) in infants is one of the most common cutaneous symptoms of Cow’s Milk Protein Allergy (CMPA) (Pourpak et al 2004; Novembre et al 2001).

However, when considering the diagnosis of CMPA, it’s important to consider that the majority of infants with CMPA have at least two symptoms affecting at least two different organ systems (Lifschitz C. and Szajewska H 2015; Høst & Halken 1990; Høst et al 1994).

Therefore, it is important to consider the individual child as well as the magnitude of their symptoms. This can be achieved using an awareness tool such as the Cow’s Milk Related Symptom Score (CoMiSS®) which will help you determine if CMPA might be indicated (Vandenplas et al 2015;Vandenplas et al 2022).