Atopic Dermatitis

Parenting in the Early Years

Atopic Dermatitis

Health Facts for You

Atopic Dermatitis

Atopic dermatitis, sometimes referred to as eczema, causes the skin to be dry, scaly, inflamed, and itchy. Areas involved are the face, behind the ears and the creases of the arms and legs.

Atopic dermatitis is an inherited skin disorder that can begin in infants or appear during childhood. It may disappear during adolescence or remain throughout life. There is often a family history of allergies. The course of atopic dermatitis may be acute or chronic. Adequate treatment will usually keep the condition under control.

Food allergy may be found in some cases of atopic dermatitis.

The symptom of itching (followed by intense scratching) is characteristic of this disorder and signals the need to begin steroid medications. Chronic rubbing of the skin causes it to thicken, roughen and bleed.

Atopic dermatitis is not contagious.

Things that Makes Eczema Worse

  • Soaps and detergents
  • Solvents and cleaners
  • Perfumes and cosmetics
  • Heat and sweating
  • Skin infections
  • Emotional stress

Management: General Measures

Controlling environmental factors that cause itching will help, since scratching results in flare-ups of the inflamed skin. Patients should avoid excessively hot, cold and windy weather. Rapid changes in temperatures can cause dryness resulting in itchiness and painful chapping and cracking of the skin. Temperature and humidity extremes can be modified by air conditioners in the summer and humidifiers during the winter.

Soft, lightweight cotton fabrics are preferred clothing. Wool and tight synthetic fabrics will promote sweating and itchiness. Rough fabrics act to irritate the sensitive skin.

Strenuous activities that cause considerable perspiration will cause itching and may need to be modified, if it bothers the child. Swimming is usually all right. However, the child should shower following pool swimming and then apply a skin lubricant.

Steps should be taken to minimize stress, which has been shown to aggravate eczema.

Management: Specific Measures

Since there is no cure for atopic dermatitis, therapy is primarily directed at improving symptoms and limiting flare-ups.

Bathing 

Mild bath soap or a non-soap cleansing agent in tepid water should be used sparingly and thoroughly rinsed away.

Do not use bubble bath, detergent soaps or anti-bacterial soaps.

Several products can be added to the bath such as colloid (Aveeno®) or bath oil, which is not heavily perfumed.

Shampooing using a mild shampoo, such as Johnson's® Baby Shampoo, is best done separately from the bath. It is the soap that irritates atopic dermatitis.

Water is needed to rehydrate dry skin. It should be tepid (at body temperature). Bathing with soap should be infrequent, but frequent brief bathing, five minutes, in water alone is useful. When using soap, choose a gentle form such as Basis® or Dove® or use a soap substitute, Cetaphil®.

Skin Lubricants 

Following the bath, gently pat the skin to remove excess water. Before the child is thoroughly dry, apply a skin lubricant (emollient) to the skin. Vaseline® or petroleum gel works great and is inexpensive. Other products include Aquaphor® or Eucerin® cream. These preparations should be used liberally. You will notice the skin tends to be drier during the cold winter months when the air is dry.

Topical Steroids 

Topical steroid ointments are the mainstays in the treatment of atopic dermatitis. They control the itching and act as anti-inflammatory agents. The mildest products are the hydrocortisones which come as 1/2%, 1% and 2 1/2% creams.

More potent steroid products are available and may be prescribed for more severe eczema.

It should be remembered that long-term use of the more potent steroid preparations can result in skin degeneration, skin thinning, color changes and acne and therefore should never be used for prolonged periods and not on the face or genitals.

It is very important to follow your doctor's instructions on appropriate use to avoid complications. Steroid medications are available as both creams and ointments. The ointment is preferred because it more effectively treats dry skin.

Topical immunosuppressant such as pimecrolimus or tacrolimus are sometimes prescribed for difficult to control eczema but can have serious side effects.

Scale Removers

These are products used only in the chronic phase when the skin becomes thickened and fissured. They may burn when applied to the fissured skin. They assist in removing the heavy skin scaliness, allowing the steroid medication to work more effectively.

Antihistimines

These are taken orally and reduce itching. The most well known is Benedryl®. Antihistamines are especially useful when itching is severe or constant. It is important to break the itch-scratch cycle because scratching flares the eczema and intensifies the itching.

Antibiotics

Atopic dermatitis is easily infected and will worsen any dermatitis flare. An antibiotic will be prescribed when this occurs.

Once atopic dermatitis has been diagnosed, you need to pay particular attention to these preventive steps and see that the skin is continuously well moisturized, even between flare-ups. At the onset of the itch/scratch cycle, begin steroid ointments promptly according to your doctor's instructions.