Atopic dermatitis is one of the most common skin problems today. A form of eczema — a condition which causes skin to become red, swollen, and painful — this disorder causes chronic itching eruptions or breakouts. Though there is no cure, about 50% of children outgrow the disorder and treatment plans are available that make the ailment manageable while symptoms persist.

Symptoms

Atopic dermatitis usually begins during infancy or early childhood. Symptoms include itchy, red patches on the skin that may crust, scale, or ooze. These can develop as early as between the ages of two to 12 months and generally appear on the face, torso, and outside of the arms and legs.

When the child reaches two or four years of age, the rash may affect the elbow and knee creases, neck, wrists, ankles, and feet. Clusters of red or flesh-colored bumps or scaly patches will appear in these areas. Skin may also become drier, thicker, and more noticeably creased.

Once the patient reaches adolescence, the rash may become more predominant on the sides of the neck, hands, feet, and face. Accentuated creasing of the skin is also more common at this stage.

Bacterial infections frequently occur with this disorder during all of its stages. These infections produce redness and itching and may cause crusting, oozing, and ulcers to develop on the skin.

Treatment

The main goal of treatment is to eliminate the itching which provokes the other symptoms and causes the most discomfort. Itching makes the sufferer scratch the irritated skin, causing outbreaks to occur and bacterial infections to develop.

Itching is minimized by keeping the skin moist. This can be accomplished by applying emollient or moisturizers after bathing and two to four times during the day. Tepid rather than hot water is recommended for bathing, as hot water may induce itching.

Soap is very efficient at removing oils — avoid soap except in the underarm and skin fold areas. Try super-fatted soaps, which are not as efficient at removing oils, or use soap substitutes. Examples of soap substitutes or super-fatted soaps include Basis, Oilatum, Keri, Purpose, Dove, and Neutrogena. Soap substitute bars include Aveeno, Emulave, and Lowila. Some liquid skin cleansers are also effective, such as Cetaphil Lotion.

The rinsing action of a shower removes more oil from the skin than a bath. A bath is a more effective method for allowing the skin to soak up water. Bath oils and oilated oatmeal products — for example, one-half to one cup of Aveeno added to bath water — may be soothing. To trap the water absorbed during bathing, apply an occlusive ointment, cream, or lotion to still-damp skin. Washable or vanishing creams do not work as well as oils; occlusive ointments often yield the best results. Avoid "medicated" and scented preparations, as they may contain ingredients that irritate dry skin.

Clothing and Environment

Soft cotton fabrics are advised for clothing. Wools, polyesters, and other scratchy materials should be avoided. Mild soaps and detergents (such as Ivory Flakes or Dreft) should be used for washing, and clothing should be rinsed well. Fabric softeners should be avoided as they can be irritating to the skin. Children should have their fingernails kept short. Mittens or socks may be used on the hands of small children.

The ambient temperature should be maintained between 68 and 72 degrees. Dry heat may need humidification during the winter.

Oral antihistamines may also be taken as part of this regimen.

Flare-Ups and Ongoing Care

If a flare-up occurs or a secondary infection develops, medications such as cortisone cream can be prescribed to treat them. An allergist can help the patient develop a systematic treatment program to keep skin moist and alleviate itching. Even though there is no cure for atopic dermatitis, there is no reason why patients should suffer from its symptoms.

If you have any questions, contact our office: Omaha: 402-391-1800 Lincoln: 402-464-5969