atopic dermatitis

Atopic dermatitis is also commonly known as eczema. It is a very common skin condition of children and adults. Usual symptoms include excessively dry and sensitive skin, and rashes that erupt after excessive washing, during periods of low humidity, and in response to certain foods or other allergens. Atopic dermatitis may mimic other types of rashes, but in general, initial treatment for all of them is pretty much the same - apply some over the counter 1% hydrocortisone and you'll probably cure it.

Specific suggestions for atopic dermatitis:

Soaps - avoid them, especially Ivory® and any adult deodorant soap. Use only baby soap or unscented Dove®, Basis®, or a similar lotion bar. Lever 2000® is very good because it is basically a very mild soap with an antibacterial agent. Soap removes the protective oils from the skin, causing excessive drying and increased rash. It is by the way perfectly OK to bathe just in water without soap at all. Sometimes your doctor or dermatologist may have you skip baths entirely and "bathe" with Eucerin cream - slather it on, wipe it off. Gets 'em clean without removing the skin's protective oils.

Bathing frequency - we have in the past said "not everyday and not the whole body. Reduce your child's bathing as much as you can when the skin is bad." There is now some evidence that at least for mild to moderate eczema, daily bathing with a moisturizing soap is not harmful at all. Since bathing is usually such a fun time with little kids, and involves touching and bonding as well as cleansing, I would really not be opposed to a daily bath unless the rash were really bad.

Lotion - and lots of it. Apply a good lotion such as Moisturel® or similar right (meaning within three minutes - before the skin drys and hardens enough to keep the lotion from penetrating really deeply) after bath and several times a day if the rash is bad. Consider Vaseline® for severe cases, or at bedtime. Vaseline contains no fragrances for the child to get allergic to and no water to aggravate the rash.

Topical steroid creams - 1% hydrocortisone is over the counter and works great if applied frequently - especially right after the bath (three minutes, remember). Put this cream on all the red areas two or three times a day including after bath. After application of the steroid, wrapping or covering the rash with cloth or even plastic wrap can be done to make the less potent cortisone preparations work much better (occlusive dressing). If the over the counter cream doesn't work, you'll need to see your doctor about stronger preparations, preferably the ointments - they work better.

Humidity (or the lack of it) is the key. When there's a lack of it, the skin breaks out worse. In the really humid part of the year, the skin generally does well. When the relative humidity drops below about 60%, due to cold dry winter air and warm dry artificial heat, your child will have more trouble and you'll need to watch the skin closer. A humidifier in your child's room or in your house may be helpful.

The nonsteroidal "immune modulators" Protopic® and Elidel® offer better relief of eczema symptoms while being free of possible steroid side effects such as skin thinning, stretch marks, or permanent reddening that can happen with the use of more potent topical steroid preparations (these side effects are very rare with the over the counter strength hydrocortisone, by the way). Children two years and older with moderate to severe eczema are candidates for these medicines. These "calcineurin inhibitors" have made the news in early 2005 because of some concerns that the drugs might cause increased risk for some skin cancers or lymphoma. The FDA is considering revisions to the product labelling of these medicines. The risk, if it is confirmed, will likely be very low. As is usually the case in medicine, the relative risks of the various forms of treatment will have to be balanced by the physician and parents working together.

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