Eczema medically known as Atopic Dermatitis or AD:
Children often get eczema during their first few years of life. Initially, dry and red scaly patches appear on the scalp, forehead, and face. Over time, thick patches of skin from repetitive rubbing and scratches may form. Scratching and breaks in the skins barrier can lead to viral or bacterial skin infections. Extremities are often involved, with the extensor surfaces most commonly involved in infants and flexural areas involved in older children.
No matter where it appears, eczema is often very itchy. Infants may rub their skin against bedding or carpeting to relieve the itch. Because atopic dermatitis can be long lasting, it is important to learn how to take care of the skin. Treatment and good skin care can alleviate much of the discomfort. In children of all ages, the itch can be so intense that a child cannot sleep.
Features of Atopic Dermatitis (Eczema) :
The primary symptom is pruritus (itch).
- AD is often called “the itch that rashes.” Scratching to relieve AD-associated itch gives rise to the ‘itch-scratch’ cycle and can exacerbate the disease
- Patients experience periods of remission and exacerbation(worsening of eczema) Other Factors include: Dry Skin, Genetics, Skin Barrier Dysfunction, Impaired Immune Response, Environment/Allergens
1) Maintenance of moisturization of the skin can prevent flares. We recommend emollients, ointments or thick creams for dry skin (no watery or alcohol based lotions). Examples: Petrolatum/Aquaphor, Cetaphil Restoraderm, Hylatopic Cream/Foam.
- Apply two to three times daily to whole body (within a few minutes of bathing for optimal occlusion). At Bedtime apply moisturizers under long cotton pajamas for occlusion of moisture.
2) Topical Glucocorticoids for flares: STEROIDS CAN CAUSE SYSTEMIC SIDE EFFECTS IF USED FOR PROLONGED PERIODS OF TIME. Use as directed by your physician.
- Vanos Cream BID
- Diprolene AF Cream BID
- Topicort Cream BID
- Triamcinolone 0.1% Crm BID
- Cordran Cream/Locoid Cream/Westcort Cream BID
- Desonate Gel/ DesOwen Cream BID
3) Topical Calcinuerin Inhibitors for maintenence:
- Tacrolimus (Protopic 0.03 or 0.1%) Apply to affected areas twice daily.
- Elidel (Pimecrolus) Apply to affected areas twice daily.
4) Topical Antibiotics to control secondary bacterial infections:
- 2% Mupirocin Ointment
- ThinkCLean Body Wash or Dilute Beach Baths (1/4 cup bleach per half bath)
5) Antihistamines for relief of itching:
- Atarax, Claritin, Benadryl
6) Recommend gentle skin care: Avoid rubbing or scratching. Keep fingernails short.
7) Lukewarm baths without washcloths or brushes. Hot water will dry the skin out even more.
8) Mild soaps and detergents. Ex: “Free and Clear” or “pH Balanced.” Colloidal Oatmeal/Aveeno.
9) Pat skin dry, in the direction of hair growth.
10) Apply other prescribed topical medication and the skin repairing moisturizer immediately after bathing and at other times of the day as directed.
11) Identification and avoidance of triggers and irritants (Environmental Allergens and Contact Allergens- Ex: Pet Dander, Pollen, Dust Mites, Grasses, Chlorine, etc).
12) Dress to avoid overheating and wear comfortable cotton clothing, avoiding wools and synthetics that can irritate the skin.