Atopic dermatitis (AD) is a common red, scaly, itchy rash classically associated with a tendency toward dry skin, allergies, asthma and hay fever. For most, it starts in infancy/childhood and improves over time. However, it may persist into adulthood and for some, it may start in adulthood. It is caused by both a defective skin barrier function and allergy to a wide variety of environmental and dietary allergens.
There are many excellent therapies for atopic dermatitis. Below is information that may be used in conjunction with visits to a dermatologist.
What follows is the typical regimen for treating diffuse eczema in an infant or child. It involves a bath, mild cleanser, topical prescription medication (usually a steroid) and a moisturizer. (I will use the term steroid, but various non-steroid medications may be recommended by your doctor. If you don't have a prescription medication, you can try hydrocortisone 1% ointment OTC but it may not be strong enough).
The skin should be dramatically better in 5-7 days. If not, call your dermatologist. Once the skin starts to improve, you will be able to use more moisturizer and less steroid each time. Eventually, you will be able to use mostly the moisturizer and just a little bit of steroid for any "hot spots".
The daily use of a topical steroid for 7-14 days will not significantly thin the skin. But 1-2 months may--especially in areas of thin skin like the inner elbows, the groin, the face and neck. So avoid using the steroid in the same areas daily for more than a week or so at a time. Give the skin periodic breaks. "One week on, one week off," or "two days on, two days off," etc. Call your doctor if you seem to need to use the steroid too often. Luckily, there are some new non-steroid medications that are excellent for AD. Ask your dermatologist if this is a concern.
Minimizing exposure to skin products with perfumes or other possible irritants/allergens is recommended. See allergen avoidance.
Wash all new clothes before wearing. This removes potentially irritating chemicals which are used during production and packing. Use dye and fragrance-free detergent. Wear garments that allow air to pass freely to the skin. Open weave, loose-fitting, cotton-blend clothing may be most comfortable. Avoid wearing wool.
Work, sleep and play in comfortable surroundings. Don't let your child get too hot or too cold. If the house is very dry, consider buying a humidifier.
At night, for sleep, consider diphenhydramine (e.g. Benadryl). It does not improve the skin, but can help with sleep. Note, benadryl is not appropriate for babies and infants. Oral antihistamines that aren't sedating, such as Claritin (loratadine), generally aren't useful for itching but may be helpful for allergic symptoms. Topical antihistamine creams, or creams that contain anesthetics, should be avoided. They can further irritate the skin.
Swimming is okay. In fact some have noted swimming can help eczema, perhaps by reducing bacterial counts. Just shower off well afterwards to remove any residual chlorine and then apply the steroid and/or moisturizer.
Probably not. A recent study showed that a four-week, twice-weekly regime of diluted bleach baths was not any more useful than water baths alone in improving atopic dermatitis.
Watch for increased redness, pain, oozing, wetness, pus, honey-colored crust, cold-sores, or blisters on the skin. If you suspect infection, contact your doctor immediately.
There are many good treatments for atopic dermatitis and almost every patient can can find success working with a dermatologist.
See atopic dermatitis for pictures and dry skin and eczema for a modified version for adults.
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