This is a common skin disease in children associated with a classic “itch that rashes”. It is also known as eczema, dermatitis and atopic eczema.
The diagnosis is usually made on the clinical history of itching and the distribution of the rash. Relatives often have AD, asthma or hayfever.
Treatment cannot cure AD, but it can control AD. Treatment is important because it can prevent the AD from getting worse, calm the skin, prevent secondary infections and stop the skin from thickening. Thickened skin often itches all of the time even when not flaring. Atopic dermatitis often waxes and wanes and treatment can vary depending on what point of flare you are in.
AD often becomes milder with age. Adults who had atopic dermatitis as a child may be prone to hand dermatitis or eyelid dermatitis as an adult.
Most children’s eczema does not have a clear cause, such as an allergy, but most eczema will improve with good skin care.
Bathe in warm water and limit time in bath to 5-10 minutes. Use soap free cleanser only when needed such as Cetaphil or Cereve. Children’s AD often can become infected and sometimes we will recommend twice weekly bleach baths. After bathing, gently pat skin partially dry. If the skin is flared apply Rx medicine skin is almost dry to the red itchy areas. Apply moisturizer on top of the medicine and to the rest of the skin to prevent flares.
Tips for choosing a moisturizer
Always use a fragrance free moisturizer, consider choosing a thick cream or ointment. Even petroleum jelly can benefit some patients.
Tips to ease discomfort
For best results, apply moisturizer at least twice a day. This prevents dryness and cracking. It also can decrease the need for Rx medications. Keep your child’s fingernails short and smooth. This decreases the likelihood that scratching will puncture the skin. Keep temperature and humidity levels comfortable. Avoid situations in which the air is extremely dry, or where your child may sweat and overheat. This is the most common trigger of the itch/scratch cycle.
Use only fragrance/dye free detergents and no fabric softeners or dryer sheets Buy clothes without tags because tags can rub against the skin, causing irritation. Wash your child’s new clothes before wearing.
Generally topical steroids are used for flares for 2 week periods at a time to the worst skin. Steroid free products for chronic AD dermatitis such as Elidel and Protopic can also be useful for milder flares and to prevent flares. Antihistamines both over the counter and Rx may also be used for itching and to help sleep for severe itching at nighttime. If there is evidence of infection oral and topical antibiotics play a role in AD. Rarely if severe enough we use oral prednisone for severe flares. In very chronic, severe and recalcitrant cases there are other systemic medication options as well as ultraviolet light treatments that can be used.