Atopic Dermatitis is a rash typically in children with a preference for the flexures.

ATOPIC DERMATITIS

Atopic dermatitis (AD) is a common eczematous rash affecting children with an inherited tendency toward dry skin, allergies, asthma and hay fever. It is caused by both a defective skin barrier function and allergy to a wide variety of environmental and dietary allergens. IgE levels tend to be high.

• AD often disrupts sleep. Poor sleep is the key factor in poor quality of life. It may also correlate with poor mental health, e.g. anxiety, stress, depression. Improving sleep should be a key goal of therapy.
• Daily use of an emollient started within 3 weeks of birth reduces development of atopic dermatitis in high-risk infants.
  
• California wildfires cause a significant increase in visits for atopic dermatitis and itch.

Treatment, Brief Overview

• Moinsturize, moisturize, moisturize!
• Topical prescription medications.
• Pills
• Shots

There are many excellent therapies for atopic dermatitis. Below is information that may be used in conjunction with visits to a dermatologist.

Skin Routine

What follows is the typical regimen for clearing and maintaining eczema in a 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.)

• Give your child a bath once daily for anywhere from 5-20 minutes. Do this safely under supervision as it is good to have most or all of the eczema skin immersed in water for this time. Use warm but not hot water.
• Do not put any additives in the bath. No oils, no bubbles, etc. Use a soap/cleanser/shampoo at the very end of the bath (e.g., Cetaphil cleanser or Dove bar soap unscented--and certainly nothing with fragrance), but rinse your child's skin off well.
  
• After your child exits the bath, pat the skin dry and immediately apply the steroid to any active areas, e.g., rough, red, itchy skin. Lighter-colored or white skin does not need the medication. It just takes a little longer for the color to return to normal.
  
• Apply a moisturizer to the rest of the skin. Do this while the skin is still hydrated and "sticky"--always within three minutes of getting out of the bath. (If you don't have a prescription medication, you can try hydrocortisone 1% ointment OTC but it may not be strong enough). Do not overlap the moisturizer with the steroid. This only serves to dilute the steroid.
• Repeat the steroid and moisturizer application 8-16 hours later (but no need to repeat the bath.)
  

Notes

• Sometimes, the doctor will give you a mild steroid for the face and a slightly stronger steroid for the body.
• If your child's eczema is doing well, you may just need to apply the moisturizer only, or just apply the steroid once a day.
• If the eczema is doing well, a shower is fine instead of a bath.
• This approach is highly appropriate for adults as well.

Won't steroids thin my child's skin?

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. And stop immediately if you see stretch marks! Luckily, there are some new non-steroid medications that are excellent for AD. Ask your dermatologist if this is a concern.

Other Suggestions for Atopic Dermatitis

Allergen Avoidance

Minimizing exposure to skin products with perfumes or other possible irritants/allergens is recommended. See allergen avoidance.

Clothes

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.

Environment

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.

Antihistamines

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

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.

Are Bleach Baths helpful?

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.

Is it infected?

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.

Work With a Dermatologist

There are many good treatments for atopic dermatitis and almost every patient can can find success working with a dermatologist.

Pictures

Glazed cheeks

Hertoghe Sign. Loss of the lateral eyebrow from rubbing (Hertoghe's sign) is one of the stigmata of AD. Chronic scratching is the cause.

Atopic Dermatitis of the body in a child.

Atopic Dermatitis on the neck of an adult.

Thickened skin from scratching AD in the popliteal fossa of a child.

Atopic Dermatitis of the neck.

RegionalDerm

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