The following brochure is personally written by my daughter’s allergy specialist. My daughter severely suffered though eczema for almost 10 years. Then, by Allah’s Mercy, I found this doctor for her. Alhamdullilah, Allah has blessed him with much knowledge and experience in his field. He is the head of the research department of Allergy and Immunology at Alferd I. Dupont Hospital for Children. This brochure is very very useful for all those who know the pain of eczema, both for the child and the parents!
What is it?
Atopic dermatitis is a chronic skin disease. It is not contagious, and cannot be passed from one person to another. “Atopic” refers to a group of diseases where one has an inherited tendency to develop allergic conditions, such as asthma or hay fever. “Dermatitis” means inflammation of the skin.
Eczema is a general term used to describe inflammation of the skin. Atopic dermatitis is the most common type of eczema. In atopic dermatitis, the skin becomes extremely itchy. Scratching leads to redness, swelling, cracking and weeping of clear fluid from the area. The skin ultimately crusts and scales.
What can you expect in future?
In most cases, there are periods of time when the disease is worse (called exacerbations of flares) followed by periods when the skin improves or clears up entirely (called remissions).
As some children with atopic dermatitis grow older, their skin disease improves or disappears altogether, but their skin may remain dry or easily irritated. In other children, atopic dermatitis continues to be a significant problem into adulthood.
How can we treat atopic Dermatitis?
There are two major goals in atopic dermatitis management:
1. Prevention of inflammation
2. Treatment of inflammation
PREVENTION OF SKIN INFLAMMATION:
We need to prevent factors that lead to skin inflammation such as:
- Strictly avoid any food to which you child is allergic. Also avoid any airborne allergen (pollen, dust) that he/she is allergic to.
- Avoid a smoking environment.
- Prevent skin dryness (see instructions below)
- Prevent or immediately treat skin and other infections. Use bactroban on any broken skin, under the nails and around nostrils.
- Avoid extreme hot or cold temperature, especially overheating since this causes sweating and may make the AD worse. (See Table 1)
- Avoid flare-ups of asthma and seasonal allergies.
- Prevent scratching (see Table 2)
TABLE 1: How to Avoid Overheating
- Wear 1-2 thin layers of clothing only.
- Try to wear summer clothing throughout the year.
- Keep bed covers to a minimum (one sheet in summer, an extra cotton blanket in winter)
- Avoid heaters in the bedroom and keep the house cool (around 68 F)
TABLE 2: How to Prevent Scratching:
- Be aware of the scratching. Keep a record in a diary/calendar of times and situations when this is the worst. Try to limit your exposure to such situations.
- Change clothes as quickly as possible.
- Control itching without damaging the skin by teaching your child to press a finger or thumb into the skin.
- Keep their hands occupied while they are watching TV or changing clothes.
- Never leave the child unsupervised in the first 4 days of a flare-up.
- Remember to reward your child by praising him/her for not scratching their skin.
- Never say “stop scratching”. All interventions should be positive.
- If your child starts to scratch, try to actively distract him/her by talking and playing. This is most important after applying medicated creams. Play with you child intensively for next 10 minutes.
- Night time scratching diminishes as scratching stops during the day.
Why skin dries so badly in Atopic Dermatitis?
Children with atopic dermatitis have increased water loss and decreased ability to bind water in their skin. This leads to skin stretching, which makes children want to scratch. Scratching causes further itching, dryness & damage to the skin.
How can we Prevent Dry Skin?
The goal is to restore the water content of the skin and prevent further water loss.
- This is achieved by:
Daily lukewarm bath for 10-15 minutes (cleanses & moisturizes the skin).
- Add 8 teaspoons of salt, baking soda or aveeno to the bath water. Keep the water out of the eyes.
- Use mild, low acidity cleansers (like Cetaphil). Do not use cleansers or moisturizers with alcohol.
- DO NOT allow the skin to become dry after bathing. Pat the skin lightly and gently with a towel. While the skin is still DAMP, immediately apply the moisturizer to avoid water loss. Aquaphor or Crisco are good initial choices.
How do I Apply the Moisturizer or Prescription Creams?
LIGHTLY: pressure or rubbing can stimulate further inflammation.
GENTLY: reddened, cracked skin is brittle and dry- DO NOT RUB.
THINLY: a thick layer can trap heat and cause inflammation
FREQUENTLY: emollients prevent dryness, not treat dryness.
Remember: apply medicated cream BEFORE the moisturizer (to seal the skin with the medicated cream)
How often should my child be bathed?
Bathing, followed immediately by applying moisturizers, not only helps reduce skin dryness, but also lowers the level of germs in the rash area. Bathing also allows you as a parent or caregiver to take a little time out from a busy day to inspect your child’s skin. Not to mention that bath time is a fun time to interact with your child. It may take some time to settle on a bathing routine that fits in with your schedule and to determine which moisturizers and medications work best. Be patient.
Remember, when you control the itch, it makes the eczema so much easier to manage!
What else should I Remember about Skin Care?
- Avoid large containers of moisturizers. They can eventually harbor bacteria.
- Use unscented, mild, liquid laundry detergent. Avoid ALL types of fabric softeners.
- Rinse clothing and bedding twice to remove detergent residue.
- Wash new clothes/beddings prior to using
- Avoid irritants, such as smoke or heavy perfumes
- Keep well hydrated- your child should drink water during the day, especially before and after exercise, or when experiencing a fever.
- Use air conditioning in hot weather and keep your child indoors as much as possible to prevent sweating and the itchiness it causes.
- Use sun screen
- Avoid skin contact with rough materials such as wool and sand. The skin is very sensitive and reactive to these. Your child should wear soft, thin cotton materials. Do not wear wool if you are holding your child. Place a cotton diaper over your shoulder. You may notice that your child itches more after crawling around on a wool rug.
- Saliva is the main irritant in childhood eczema. To avoid this irritation, regularly apply a thick moisturizer such as soft and liquid paraffin, especially before eating food.
TREATMENT OF SKIN INFLAMMATION:
1. Stop the Itch:
- Itching is a vicious cycle that must be broken.
- Scratching stimulates a type of cell in the skin called “Keratinocytes” that produces chemicals that causes FURTHER itching and inflammation. To break the cycle, skin must be restored to the texture of normal skin. (PREVENTION IS THE KEY!)
- Anti-itch medication by mouth also help, like Atarax, Peractin or Benadryl.
- Medications sometimes loose their effectiveness after 6-12 weeks of usage. If this occurs, rotate the medications for maximum benefit.
- Medicated Creams:
Method of medicated cream application: Steroid creams should not be applied more than twice daily (only once a day for the newer preparations). Cover the area of eczema evenly with a fine film of ointment so that the surface of the skin glistens in the light. The amount to apply is in ‘fingertip units’. The amount of strong topical steroid applied on a small child should nto be more than 20g in a wekk. If more is used, the natural steroid production in the body will be suppressed.
ATOPOIC DERMATITIS FLARE:
How is this treated?
3 level treatment:
1. Skin care as described above
2. Use of antibiotics by mouth or applied to the skin, as prescribed by the doctor.
3. Use of steroids prescribed by the doctor.
What About Follow-ups?
- After the acute flare-up completely stops, continue with regular skin care measures along with low potency anti-inflammatory medication cream for some time.
- Beware of relapses.
- Recently healed chronic eczema remains unstable for several weeks.
- Therefore, look at and feel the skin daily for
- When an acute flare-up is identified, consult doctor and treat IMMEDIATELY.
- The sooner you begin aggressive treatment, the sooner the skin will heal and less steroid will be required.
- As time progresses the skin becomes more stable.