For Your Patients: Skin Care to Control the Symptoms of Atopic Dermatitis in Children

About 15% of children in the United States develop atopic dermatitis. Almost all these pediatric patients are diagnosed by age 5, but more than half develop atopic dermatitis or "eczema" in the first year of life.

Atopic dermatitis can be mild, moderate, or severe, with symptoms ranging from very dry, itchy skin to painful, itchy rashes. Although treatment varies depending on severity, every child should be treated, even those with mild disease.

Without adequate treatment, atopic dermatitis can get worse, leading to other health problems -- both now and in the future. Scratching can lead to skin infections, for instance, and nighttime itch can interfere with sleep, affecting performance at school.

Untreated atopic dermatitis can also increase the risk of developing other allergic diseases, specifically allergic rhinitis (hay fever), asthma, and food allergies.

In addition, experts suspect that lack of adequate disease control in childhood may pave the way for adult atopic dermatitis, which is associated with other serious diseases such as osteoporosis, depression, and heart disease.

Parents are an essential member of their child's treatment team, working closely with the pediatrician or pediatric dermatologist to get and keep the child's symptoms under control.

Regarding skin care, the doctor will create a treatment plan tailored to the child's specific needs, addressing four key areas:

• Skin care

• Trigger avoidance

• Medications

• Coping strategies

Although good skin care can be time-consuming, it is a very important first step towards getting the symptoms under control and may even reduce the need for further treatment.

Moisture is key. Hydrating the skin will keep it from becoming dry and cracked, which can open it up to germs and lead to infection. Moisturizing the skin also helps reinforce the skin's role as a barrier against everyday substances that can be irritating, making itchiness worse and causing symptoms to get worse or flare up.

The following are the recommendations from the American Academy of Dermatology:

• Bathe the child in warm (never hot!) water for 5 to 10 minutes every day if possible, or at least most days. This will help relieve dry skin and itch, and reduce bacteria that can get into cracks in the skin caused by scratching. The water should never be hot, since that can dry out the skin even more, worsening symptoms.

• Soap can be drying, so use a fragrance-free cleanser; be aware, however, that "unscented" products are not the same as "fragrance-free" and should be avoided.

• Similarly, don't add oil or bubble bath to the bath water, since both can irritate the skin, exacerbating symptoms.

• Adding colloidal oatmeal to the bath water can help relieve dry, itchy skin, and may feel soothing.

• The hands and feet can be sources of bacteria, so make sure they are submerged in the water.

• Wash the child's skin gently with a small washcloth, without scrubbing.

• Gently wash the child's head and neck to reduce bacteria there, being careful to avoid any of the rashy areas.

• Once out of the bath, gently pat the skin, leaving it damp; this is the moisture that will be sealed in with cream or ointment; if a medicated cream has been prescribed, apply it as directed and then follow immediately with a generous layer of moisturizer.

• Regarding the type of moisturizer, choose a thick cream or ointment rather than a lotion. Creams and ointments do a much better job of sealing moisture into the skin. Always choose a moisturizer that is gentle and "fragrance-free." Products that are "unscented" still contain fragrance, but the smell is masked.

If you're feeling overwhelmed by the selection of moisturizing creams and ointments at your local drugstore, remember that petroleum jelly is always an excellent choice. It's inexpensive, fragrance-free, and works well for many children.

For best results, moisturize at least twice a day. If the child has a bath in the evening, moisturizing the skin before you dress him or her in the morning may be a good option. Alternatively, if you bathe your child in the morning, consider moisturizing again in the evening.

Read previous installments in this series:

Part 1: For Your Patients: Atopic Dermatitis 101

Part 2: For Your Patients: How Will My Doctor Diagnose Atopic Dermatitis?

"Medical Journeys" is a set of clinical resources reviewed by physicians, meant for the medical team as well as the patients they serve. Each episode of this 12-part journey through a disease state contains both a physician guide and a downloadable/printable patient resource. "Medical Journeys" chart a path each step of the way for physicians and patients and provide continual resources and support, as the caregiver team navigates the course of a disease.