Atopic Dermatitis for Pediatric Dermatology
“Dermatitis” is inflamed skin. Atopic dermatitis is marked by dryness, itching, and a certain type of rash on the body. It is fairly common, and may occur in as many as 10% of children.
The exact cause is unknown. In many patients, there is a family history of hay fever, asthma, or atopic dermatitis itself. Rarely, in infants it may be linked to a food or milk sensitivity. This is often hard to pinpoint and manage. In most cases though, no allergic triggers can be found.
Atopic dermatitis often starts in infants from the ages of 2 to 6 months. The skin is dry and the rash is quite itchy. This may cause infants to be restless. The rash may involve the face or it may cover a large part of the body. As the child gets older, the rash may become confined to a small area. Early on, it is common for the rash to be on the legs, feet, hands, and arms. It is often seen at the bend of the elbows, knees, on the back of the hands, feet, and on the neck and face. After the rash has been present for some time, the dry itchy skin may become thickened, leathery, and sometimes darker in color. The more the child scratches, the worse the rash is, and the thicker the skin gets. Many children with atopic dermatitis outgrow it before school age. Yet, some children keep having problems as a teen or even as an adult
Many things may affect how severe the condition becomes. All patients have sensitive and dry skin. Many will find that during the winter months when it is not humid, the dryness and itching will be worse. On the other hand, some patients are bothered by sweat. These people will find that they have more problems during the summer. Most patients note an increase in itching at times when there are sudden changes in the weather. Other irritants are likely to affect the skin of a patient with atopic dermatitis. Use of harsh soaps and detergents and exposure to wool are common problems. Sometimes atopic dermatitis may become infected by bacteria, yeast, or viruses. This is called a “secondary infection.” Bacterial infections are the most common, and often occur as the result of scratching. The rash gets very red with pus filled pimples and scabs. If this happens, your doctor will prescribe an antibiotic which will help to control the infection. A more serious problem can be caused by certain viruses. The “cold sore” virus (Herpes simplex) may cause a severe rash. Contact your doctor right away if you suspect this. The virus that causes molluscum also tends to spread quickly in patients with atopic dermatitis.
What can I expect from treatment?
Sadly, there is no magic cure that always works. The main aim in treatment is to decrease skin outbreaks and relieve itching. There are a number of medicines that are used. Those that are best suited to control the problem will be chosen. Topical medicines (applied to the skin) are given most of the time. Because the skin is often too dry, lubricants will be prescribed that work well to decrease the dryness. If soap is tolerated, it should be one with surfactant. Using this type of soap will decrease the drying effect. Frequent bathing is known to result in increased water loss through the skin. On the other hand, bathing is a useful way to get water into the skin. Therefore it is important to keep bathing time brief (no more than 10 minutes). Lubricants can be used right after the bath and shower to trap moisture on the skin.
Cortisone-derived ointments or creams and newer non-steroidal ointments or creams may also be used. They work well to decrease the itching and control the inflammation. Your doctor will suggest a treatment that is best for the severity and location of the dermatitis that is to be treated. When the site is clear, it is best to stop using the cortisone or non-steroidal ointment. Keep using lubricants to try to prevent new sites of dermatitis. Of course, if itching or a new rash begins, the cortisone or non-steroidals may have to be started again.
Certain oral medicines (antihistamines) may help control itching. They mainly help with the itching by making your child drowsy and helping the child to sleep at night.
1. Avoid contact with substances you know cause itching. These may include soaps, detergents, certain perfumes, dust, grass, weeds, wools, and other types of scratchy clothing. In the winter, for instance, cotton underwear or a cotton shirt may be worn under sweaters. Do not use fabric softeners.
2. Try to bathe every two to three days. But if you bathe your child daily, always use a lubricant right after bathing. Avoid very hot or very cold water and bubble baths. When drying with the towel, pat, do not rub. Use a mild soap (such as unscented Dove® or Cetaphil®) only where needed.
3. Try to keep the temperature and humidity in the home fairly constant. Use a bedroom air conditioner in the summer. Use a vaporizer or humidifier in the winter. These must be cleaned well and often. Cleaning is needed to prevent molds that may grow and cause allergic symptoms.
4. Try to avoid scratching. Atopic dermatitis is often called “the itch that rashes”. It is known that scratching plays a key role in making the rash worse. Keeping the nails short and well-filed, and using other measures to help to keep the child from itching are helpful.
5. The National Eczema Association is a very good group. It sends out a quarterly newsletter that offers a lot of good information. Think about getting in touch with them.
National Eczema Association for Science and Education, 4460 Redwood Highway, Suite 16D, San Rafael, California 94903; 415.499.3474 / 800.818.7546; Fax: 415.472.5345
UW Dermatology Department
1 S. Park St7th Floor
Clinic: 608 287-2450
American Family Children’s Hospital
Pediatric Dermatology Specialty Clinic
1675 Highland Ave.
Madison, WI 53792
Clinic: 608 263-6420
Spanish version of this HFFY #6584
The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Any duplication or distribution of the information contained herein is strictly prohibited.
Last Updated: 06/24/2013
Copyright © 06/24/2013 University of Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#6495
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