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Atopic Dermatitis

more about Atopic Dermatitis


Eczema



  • This skin disorder is generally attributed to a malfunction in the body's immune system.  It tends to occur in people who have a family history of allergies.  Many children who get this disease outgrow it at puberty, but later develop dermatitis of the hands as adults.  Risk factors may include exposure to tobacco smoke, Skin Infections, changes in climate, irritating chemicals, food allergies, and stress.
  • About 10% of children will develop atopic dermatitis.
  • It is important to remember that your child cannot "catch" atopic dermatitis.  It is not an infection or contagious.

  • Skin (all or some may occur)
    1. Dry scaly skin
    2. Thickened skin
    3. Red patches with weepy or thickened skin
    4. Tends to occur on face, neck, upper trunk, wrists, hands, in the folds behind the knee and elbow
  • Itching -- may be severe

  • Atopic dermatitis is an allergic disorder which gets worse with exposure to certain triggers

- Each child has different triggers, but some common ones include:

    1. Irritants: These are natural and man-made chemicals that cause burning, redness, itching, and dryness of the skin.  Dyes and the perfumes found in many detergents and fabric softeners are common triggers for children.
    2. Stress: Stress and anxiety can come from many places, including school, work, and families.
    3. Sweating

  • Skin biopsy if diagnosis is unclear
  • Food challenges to see if certain foods are causing the condition
  • Increased eosinophils may be present in the blood
  • Increased level of IgE antibodies may be present

  • Children with other allergic diseases, such as Asthma, are at a greater risk for developing atopic dermatitis.

  • General:
      1. Avoid drying or irritating the skin
      2. No more than one shower or bath per day, and do not allow your child to sit in a soapy bath.
      3. Only use soap on armpits, groin, and feet.
      4. Uses soaps that do not dry skin, such as Dove, Aveeno, Basis, or Cetaphil.
      5. Pat skin dry after shower/bath -- do not rub.
      6. Before skin is completely dry, cover with an agent that helps hold in moisture, such as Eucerin, Vaseline, or mineral oil.
      7. Avoid scratchy clothes (often cotton is the best)
    • Purchase clothes made of cotton.  Avoid wool, nylon, or other synthetic fabrics.  Always wash clothes before your child wears them for the first time.
    • Wash clothing in detergents free of perfumes and dyes.  Remember to wash your clothes in the same kinds of detergents, too, since your child will be exposed to any dyes or perfumes attached to your clothes every time he/she touches you.
    • Use light bedclothes, and layer clothing during the day so you can adjust to changes in temperature.
    • Think about things that can cause stress, and plan for them.  Review these events with your pediatrician.  Make the therapy of atopic dermatitis part of your child's daily routine, so he becomes comfortable with the treatments.
    • Avoid foods that tend to trigger (do challenges to determine which ones may trigger -- most common are wheat and dairy).  Only 30% of those affected are worsened by certain foods.
    • In severe cases, some children may require topically applied steroid medications, but these should not be overused, since they can cause increased wrinkle formation later in life.
    • Medication options (choices depend on type of lesion, e.g., scaly or weeping):
      1. Corticosteroid creams
      2. Doxepin cream
      3. Antihistamines such as Zyrtec to treat itching
      4. 5% Aquaphor or Fototar cream
      5. Oral corticosteroids for 2-4 weeks
      6. Kenolog (steroid) injection
      7. Antibiotics such as Keflex if there is Staphylococcus infection
      8. Phototherapy
    • For weeping lesions: Saline, bicarbonate or Domeboro tablets in water, colloidal oatmeal (Aveeno) -- can use two to four times per day for 10-30 minutes

    • Herpes simplex infection (appears as blisters or crusty scabs) may occur in areas that have been treated with corticosteroid creams.  This can be treated with acyclovir or similar medication.




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