In this episode, we will discuss everything you need to know before seeing your first pediatric patient with eczema. We will review its pathogenesis, who gets eczema, what to look for on exam, and potential differential diagnoses. We will also elaborate upon the most recent AAP guidelines for treatment of eczema, which focuses on skin care maintenance, topical steroids, and avoidance of triggers. 

Show Outline:

• Introduction to Eczema
  • Description of dermatologic terms
  • Defining eczema and atopic dermatitis
• Pathogenesis
  • Immune dysfunction
  • Histological differences
  • Involvement of filaggrin
  • Racial disparities
• Who gets eczema?
  • Age of onset
  • Demographics of patients with eczema
  • Atopic disease & “The Atopic March”
• Clinical Presentation / Diagnosis
  • Characterization of eczematous lesions
  • What to look for in people of color
  • Most likely locations of eczema based on patient age
  • Differential diagnoses
  • Sleep disturbances
  • Utilizing the Patient-Oriented Eczema Measure (POEM)
• Treatment
  • AAP recently updated treatment guidelines
  • The basic triad for eczema treatment
    • Skin care maintenance
    • Topical anti-inflammatory medications
      • The 5-10-15 Plan
    • Avoidance of triggers
  • Side-effects of topical steroids (very rare)
    • Skin atrophy
    • Steroid withdrawal 
• Complications
  • Secondary infections
    • Tinea
    • Impetigo
    • Eczema herpeticum
• Closing statements

Resources/Links:

1. POEM Eczema Questionnaire: https://www.rchsd.org/documents/2020/08/madp-poem.pdf/
2. Roduit C, et al. (the PASTURE study group). Phenotypes of Atopic Dermatitis Depending on the Timing of Onset and Progression in Childhood. JAMA Pediatr. 2017 Jul 1;171(7):655-662. doi: 10.1001/jamapediatrics.2017.0556. PMID: 28531273; PMCID: PMC5710337.
3. Schoch JJ, Anderson KR, Jones AE, Tollefson MM; Section on Dermatology. Atopic Dermatitis: Update on Skin-Directed Management: Clinical Report. Pediatrics. 2025 Jun 1;155(6):e2025071812. doi: 10.1542/peds.2025-071812. PMID: 40383540.

Links:

https://www.rchsd.org/documents/2020/08/madp-poem.pdf/

About the Speaker:

Host: Carly Pierson, MD – Carly Pierson, MD is a pediatric resident in the Primary Care Track at UVA Health. She graduated from the University of the Incarnate Word School of Osteopathic Medicine and has interests in allergy and immunology.

Clerkship Ready: Pediatrics is a podcast aimed at medical students doing their clinical clerkship in Pediatrics. The views expressed are the speakers' own and do not constitute medical advice.