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Atopic eczema (Atopic Dermatitis)

This condition is sometimes called infantile eczema or baby eczema, although these terms are inappropriate since the condition can begin after infancy and can certainly be a problem in later childhood and even in adult life. The terms “eczema” and “dermatitis” mean the same thing.

Atopic dermatitis is a condition which runs in families and is essentially a genetic disease. Very often there is a family history of eczema, or of related diseases such as asthma and hay fever.

Atopic dermatitis can begin at any age, but three-quarters of patients will show the first signs by six months of age.

The skin is dry and itchy. The dermatitis can occur anywhere but there are particular patterns that are more common at certain ages. In very young children the face, over the knees and the fronts of ankles are often involved. In older children the main areas of involvement are the insides of the elbows and behind the knees. The dermatitis may be moist and weeping, or may be thickened and dry.

Bacterial infection may occur on top of the eczema. You may see pus, golden crusts or simply a worsening of the eczema. A swab may be taken by the doctor. Antibiotic ointments/tablets/syrups may be prescribed, along with the eczema treatment.

Children with eczema may have difficulty in dealing with the herpes simplex or cold sore virus. They can develop severe infections with this virus. Anyone with an active cold sore should be very careful not to have close contact with a child with eczema. The usual childhood immunizations commenced at two months are quite safe in children with eczema.

The management of Atopic Dermatitis

It is important to appreciate that these people have been born with a dry, irritable skin. This skin will remain dry throughout the patient’s life. The degree of irritability may lessen with time. Various things will aggravate this irritable skin. When this happens, whatever the age of the patient, dermatitis will occur. Although the tendency to dermatitis is lifelong, it can usually be cleared and kept under control with appropriate treatment, provided you continue with the measures outlined. The important thing to grasp is that this skin may have to be understood, moisturised regularly and cared for, for life.

The following should be avoided as they irritate the skin

  1. Wool and nylon in direct contact with the skin. Apart from the patient’s own clothing, remember the carer’s clothes, lounge coverings, furniture coverings, carpets, car seat and stroller covers, blankets, toys and so on. Protective cotton/polycotton clothing prevents contact with carpets etc.
  2. Sand. Playing in a sandpit can be very irritating. Always take a non-sandy towel to dry the child at the beach. A pair of dry pants to put on when the child comes out of the water will prevent the irritation of wet sand inside a wet swimming costume.
  3. Water without oil in it. The child can have as many baths as desired provided there is oil in the water. Eg; Oilatum, QV oil or Keri Oil (from the chemist) in the bath.
  4. Soap. It is preferable not to use soap or a soap substitute. If you must use something, then use a soap substitute such as Cetaphil lotion, Dove unscented soap or QV wash to “dirty” areas only (may also be used to shampoo hair).
  5. Perfumed products: should be avoided.
  6. Medicated products: eg. Pinetarsol, tea tree oil, Savlon and Detol: should be avoided.
  7. Bubble Baths: should be avoided.
  8. Chlorine pools may irritate the skin. Silic 15 (or other moisturisers) applied before swimming may be helpful (500g tub from the chemist, over the counter). Rinse off the chlorine water as soon as you get out of the pool and apply more moisturiser.
  9. Over heating: avoid overheating in summer. Use fan or air conditioning.
  10. Animal fur/dander
  11. Abrasive surfaces.
  12. House dust mites.

It is important to understand that these agents may irritate the skin. Not all may be a problem in your case. However if you know what can cause irritation, you can assess its relevance.

REGULAR USE OF A MOISTURIZER HELPS PREVENT ECZEMA

Moisturizers should be used all over at least twice a day, even when there is no active eczema. This helps prevent the eczema.

The greasier the moisturizer the better. In school aged patients, they may prefer to use the greasy moisturizer at night and a lighter one in the morning.

Greasy moisturizers… Dermeze, QV kids Balm, QV Intensive, Emulsifying ointment (see below on how to make up Emulsifying ointment).

Less Greasy moisturizers … QV cream, sorbolene (see below), Aqueous cream.

Emulsifying ointment. Buy a 500g “tub” from the chemist. Tip into large mixing bowl, add one “tub” of hot water and mix. If a thicker moisturizer is necessary then only add ½ “tub” of hot water. If too difficult, ask doctor for a prescription for the Chemist to make one up for you, although this may be more expensive.

Sorbolene + 10% glycerine. This is available in supermarkets or chemists. The “TUBS” are better than the “PUMP pack,” as the latter are watered down. Avoid ones with other added agents eg. Vitamin E, Evening Primrose Oil, Aloe Vera. Sometimes sorbolene and glycerine can sting active eczema and if this occurs use emulsifying ointment (see above).

TOPICAL STEROIDS

These are safe when used according to the doctor’s instructions. Your doctor will prescribe different ointment/creams according to type and site of dermatitis. If used continually, or incorrectly without supervision, these may cause side effects such as thin skin, broken blood vessels, stretch marks, pimply rashes, etc. These are used to treat and clear the active eczema. They should be used until the eczema is “gone”, then ceased. If eczema recurs start again. OINTMENTS (clear) are generally better than creams (white). Cortisone tablets should be avoided.

WET DRESSINGS

Severe eczema that is not responding to treatment can be treated with the use of wet dressings at home or in hospital.

  • Topical steroids are applied only to the eczema.
  • Moisturizer is applied to whole body either on top of the topical steroids or before the steroids.
  • Cotton long sleeve tops and pants, or PJ’s,or “skintite”cotton suits (skintite.com) are wet with tepid tap water (+ wet white cotton gloves/socks if necessary) are then put on. Crepe bandages hold these in place or just put tracksuit pants/sloppy joe on top. Leave on for 30-90 minutes then remove.
  • This is done 3 times a day. Put more moisturiser on after coming out of wet dressings.
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Drummoyne Dermatology is a long established and well regarded dynamic dermatology centre which has provided state-of-the-art dermatology care in Sydney for over a decade. Our expertise is in the early detection and treatment of skin cancer and in the accurate diagnosis and optimal management of other diseases of the skin.
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