Atopic dermatitis in South African children: Experience from a tertiary-care centre

Background. Atopic dermatitis (AD) is a chronic, pruritic condition with significant morbidity and some variation in clinical characteristics across different populations. Objectives. To describe the characteristics and management of AD in a paediatric cohort. Methods. A cross-sectional, descriptive study of paediatric AD patients attending the skin clinic at the King Edward VIII Hospital in Durban, South Africa, is described. Results. The observed prevalence of AD was 60.1%. A preponderance of male patients (55.6%) was seen across the cohort. An onset of AD by 1 year of age was reported in more than half (53.5%) of the patients. Slightly more than a third of the patients presented with severe disease, as determined by affected body surface area (>= 50). The head, neck and limbs were the most involved areas. Eczema herpeticum was the most common co-existing dermatosis (2.4%). Bleach baths (2%), wet wrap therapy (3.6%) and systemic immunosuppressants (4.8%) were used in the management of recalcitrant cases. Conclusion. The observed prevalence of AD is one of the highest documented among paediatric skin diseases in hospital-based studies in Africa. Predominance in children of preschool age, onset of disease by the age of 5 years, co-existing eczema herpeticum and recalcitrant disease requiring systemic immunosuppressants are consistent with trends in patients from European or Asian descent, while the level of severe disease and head and neck involvement are more consistent with reports from Africa. Further studies in a local context are needed to better understand the disease and its presentation in different populations.