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Eczema - Atopic Dermatitis

The Asthma Center, Allergic Disease Associates, P.C.
Professional Arts Building
205 North Broad Street, Ste 300
Philadelphia, PA 19107

215-569-1111
http://www.asthmacenter.com/

Atopic dermatistis or eczema, is a drying condition of the skin which results in intense itching and scratching, scaling of skin, and sometimes infection. It often begins as an itching red rash which when scratched, results in the spread of further irritation. A cycle of itching and scratching is set up which must be broken. The primary aim of treatment is to prevent the irritation by keeping the skin moist and soft. The preventative measures for doing this are listed below:

  1. Wear light cotton clothing and underwear. Avoid tight fitting clothes e.g. around the wrist, ankles, waist, neck. The skin should not be exposed to rough clothing or bedding. Wool is especially irritating and should be avoided.
  2. Keep nails clipped short.
  3. Clothing and bedding should not be washed with soaps containing “Bioenzymes”. All clothing should pass through a second rinse cycle to remove residual detergent.
  4. Avoid over-heating and sweating. Air conditioning is strongly recommended during the summer. The patient’s bedroom temperature should be maintained so that a light blanket is all that is needed.
  5. The most important step is to prevent drying of skin. This can be accomplished by applying a moisturizing cream 2-3 times a day (Eucerin cream, Alpha Keri lotion, Lubraderm).
  6. Avoid irritating soaps such as Ivory and all deodorant soaps containing hexachloraphene (Dial, Irish Spring, Zest etc) We recommend Dove, Neutragena or Lowella.
  7. Bathing in warm water should be brief (5-10 minutes) and should not occur more htan once per day. Try adding Alpha Keri bath oil or baby oil to the water just prior to emerging from the bath. Pat the patient dry rather than rubbing with a towel. Apply a moisturizer (Eucerin) directly to the skin following bathing. This traps the moisture in the skin.

For Acute Exacerbation of Atopic Dermatitis

Occasionally, even a well controlled atopic dermatitis can flare up. When this occurs, the following steps should be taken where appropriate:

  1. Steroid Cream – Apply the cream (Synlar) sparingly to the inflamed areas 3-4 times a day.
  2. Itching - If the child starts to itch and scratch, give Atarax every 6 hours. It is very important that the child not be allowed to scratch. In addition to clipping the nails, the following will help:
    - Mitten the hands, especially when sleeping
    - Splint the arms (and legs of infants) with padded pieces of wood or heavy cardboard
    - Compresses - In an area of dermatitis which is weeping and crusted, the following steps are to be taken:
  3. Soak the area with clear water of saline solution at room temperature, on a dripping soft cloth e.g. diaper, man’s handkerchief.
  4. Apply the compress for 5 minutes then remove, re-wet, and re-apply. Do this for 15 minute periods, four times a day as long as the weeping and crusting persist.
  5. Slight mechanical movement of the cloth on the skin while removing it gently debrides the area.
  6. Apply the steroid cream immediately after the above steps are completed.
  7. Scalp Treatment- If the scalp is scaly and crusty, you will be instructed to use Pragnatar 3 times a week. Part hair and massage Pragnatar into affected areas before going to bed. Remove with a light shampoo in the morning.
  8. Antibiotic - If it appears that the skin is infected, an antibiotic will be prescribed: Erythromycin ½ - 1 - 11/2- 2 teaspoons every 6 hours for at least 10 days.
  9. Balnetar and zetar baths may be prescribed. Add 3-5 capfuls to lukewarm bath water, once a day, every other day.
  10. Continue to keep the rest of the body moisturized with Eucerin cream.
  11. After the flare up has been brought under control, resume the preventative measures described above.

Printed with permission from The Asthma Center, copyright 2008.