(Eczema)
Atopic
Dermatitis, also known as eczema, is a chronic allergic condition of the skin.
The severity of the dermatitis can vary from mild to severe and may even
clear at times. Many
patients experience flares in their eczema after exposure to allergens such as
pollens, animal dander, dust mites, and foods to which they are allergic.
Management should be approached in a step-wise fashion depending on the severity
of dermatitis. Avoid
use of oral/systemic steroids for this chronic illness. The ointment form of
topical medications are often more effective than creams or lotions. Cream,
rather than ointment, may be appropriate during humid weather.
1.
Mild Atopic Dermatitis or
Maintenance Care:
A. Bathe
once or twice each day using warm, but not hot, water for at least 15 to 20
minutes.
B. Soaps
should be avoided except in areas where they are needed.
A mild soap, such as unscented Dove or Oil of Olay sensitive Skin Formula
should be used as needed.
C. Gently
pat away water and immediately apply a moisturizer or skin medication such as a
topical steroid, to damp skin. Applying
topicals in this manner will seal the water in and make the skin less dry and
itchy. Moisturizers or sealers,
such as Vanicream or Vaseline, should not be applied on top of topical steroids.
D. Hydrocortisone 1% or 2.5% ointment, Elidel, or Protopic should be applied to areas of mild eczema anywhere on
the body after baths. They may be
applied one additional time during the day.
E. Moisturizers,
such as Aquaphor ointment, Eucerin Cream, or Vanicream, should be applied
generously to clear areas immediately after the bath.
They may be applied anywhere on the body and should be used at least
twice daily. Moisturizers should
not be applied over topical steroids.
F. T/Sal
or other medicated shampoos should be used minimally twice a week to control
flaking in the hair. This may need
to be used daily.
2.
Moderate Atopic Dermatitis:
A. Bathe
twice daily for 20 minutes each in warm water morning and evening.
B. Hydrocortisone 2.5% ointment, Elidel or Protopic to less severely affected areas on face, groin, and underarms
after bath.
C. Triamcinolone
0.1% to the severely affected areas on the body and DesOwen ointment 0.05%, Elidel or Protopic to less severely affected areas on the body after bath.
D. Vanicream
or Vaseline ointment should be applied to the unaffected areas after bath and to
the entire body mid-day bath.
E. Wet
socks covered by dry socks during the sleeping hours over hands and feet when
involved.
F.
Consider Bactroban ointment to localized superinfected lesions
three times daily.
3.
Severe Atopic Dermatitis:
A. Baths
three times daily for 20 minutes each in warm, not hot, water, occurring
morning, mid-day, and at bedtime. Wet
face cloth (with eyes/mouth cut out) for rash involving face.
B. DesOwen
0.05%, hydrocortisone 2.5% ointment, Elidel or Protopic applied to the affected areas
on face, underarms, and groin after the morning and bedtime bath.
C. Triamcinolone
0.1% ointment to other areas of skin eczema involvement after the morning
and bedtime bath.
D. Vaseline
or Vanicream should be applied to the unaffected areas after morning and bedtime
bath and to the entire body after the mid-day bath.
E. Wet
pajamas or wet underwear followed by dry pajamas after each bath for a minimum
of two to three hours.
F. Wet
socks followed by dry socks to hands and feet after each bath leaving on a
minimum of two to three hours.