Atopic dermatitis

(ATOPIC DERMATITIS)
see below for basic dry skin care

DEFINITION:
• Red, extremely itchy rash • Often starts on the cheeks at 2 to 6 months of age • Most common on flexor surfaces (creases) of elbows, wrists, and knees • Occasionally, neck, ankles, and feet are involved • Rash is raw and weepy if scratched • Chronic condition with constant dry skin • This diagnosis must be confirmed by a physician Eczema is an inherited type of sensitive skin. A personal history of asthma or hay fever or a family history of eczema makes it more likely that your child has eczema. Flare-ups occur when there is contact with irritating substances (e.g., soap or chlorine). In 30% of infants with eczema, certain foods cause the eczema to flare up. If you suspect a particular food item (e.g., cow's milk, eggs, or peanut butter) is causing your child's flare-ups, avoid it for 2 weeks and monitor your child’s skin. If it improves, this may be a contributing culprit. For most foods, you can then rechallenge with a small amount of the food, and watch for a flare within the next few hours. If the eczema flares, call us to discuss options for food substitutes. However, if you suspect peanut allergy, contact us directly for allergy testing, since you should never try rechallenging with peanut if you suspect allergy. HOME TREATMENT (you may also use most of these, except the prescription
creams, for basic “Colorado dry skin”):
1) Soak the skin for 5-10 minutes once to twice a day in a shower or tub until wrinkly.
The myth that frequent bathing makes eczema worse only applies if you use harsh soap
or allow the water on the skin to evaporate without lotion/cream afterward.
2) Towel off beads of water leaving skin damp and quickly apply any prescription
preparation (hydrocortisone, Elocon, Cutivate, Desonide, Elidel) to damp skin as
directed, usually once or twice daily.
3) Apply the prescription sparingly and only to areas of the skin affected by the eczema.
In general, try to limit use of topical steroid creams (such as hydrocortisone or
prescription steroid creams) to a few days at a time. Chronic daily use may lead to
permanent skin changes/side effects. Never apply to large areas of the body unless
directed by your physician.
4) Apply a lubricant cream (Eucerin, Lubriderm, Aquaphor, Aveeno) to the entire body
immediately after the topical prescription. The lubricant may be applied over the
medication. The lubricant should be applied while the skin is still damp at least once to
twice a day.
5) Use antihistamines (Benadryl, Claritin, Zyrtec, Atarax) at bedtime as necessary for
itching.
6) Use a mild unscented soap for cleansing skin such as Cetaphil, Dove, or Aveeno.
7) Reapply the lubricant throughout the day if the skin appears dry.
8) As the skin improves, continue the lubricant cream twice daily or more frequently.
9) Decrease the topical prescription as able. You may also be able to decrease the
potency of the topical prescription. (i.e. taper from a prescription strength to 1%
hydrocortisone over the counter)
10) With further improvement, the frequency of wetting the skin and lubrication can be
decreased, but should be continued on a regular basis.
11) Keep your child’s fingernails cut short.
12) Remember: early treatment of any itching is the key to preventing a severe rash.
PREVENTION (again, most are useful for basic dry skin):
1) Wool fibers and clothes made of other scratchy, rough materials make eczema worse.
2) Cotton clothes should be worn as much as possible.
3) Use a dye-free and frangrance-free laundry detergent.
4) Avoid triggers that cause eczema to flare up, such as excessive heat, sweating,
excessive cold, dry air (use a humidifier), chlorine, harsh chemicals, and soaps.
5) Never use bubble bath.
6) Keep your child off the grass during grass pollen season (May and June).
7) Keep your child away from anyone with fever blisters since the herpes virus can cause
a serious skin infection in children with eczema.
8) Try to breast-feed all high-risk infants. Otherwise, consider using an elemental
formula (Nutramigen, Alimentum). Also try to avoid cow's milk products, eggs, and fish
during the first year of life, and all nut products in the first three years of life.
CALL OUR OFFICE IMMEDIATELY if:
• The rash looks infected (yellow pus or scabs, spreading redness, red streaks).
• The rash flares up after contact with someone who has fever blisters (herpes).
• Your child starts acting very sick.
Call during regular hours if:
• The rash becomes raw and open in several places. • The rash hasn't greatly improved after 7 days of using this treatment. • You have other concerns or questions.

Source: http://www.arvadapeds.com/docs/Atopic%20Dermatitis.pdf