One of the most common skin disorders seen in infants and children is atopic dermatitis, a very frustrating disease for the children it affects as well as the parents. Atopic dermatitis affects 10-15% of the pediatric population. Children with atopic dermatitis are also more susceptible to acquiring asthma, and allergic rhinitis. There is no known cause of atropic dermatitis. It begins as dry skin that becomes very itchy and inflamed, and the skin can then start to weep, crack, and peel. Infants and children are the most commonly affected, as children age the disorder does usually improve however some patients continue to have problems into adulthood.
Most children go through periods of “flares” and “remission” during these times the skin disorder inflames and gets worse then calms down and clears up. There are many triggers for the flares; a few examples are changes in weather, stress, changes in laundry detergent or body lotions/soaps, and an upper respiratory infection. Sixty-five percent of patients develop symptoms of atopic dermatitis in their first year of life, with 90% developing symptoms by age five.
The most common areas of the body affected by atopic dermatitis in infants are the face, arms, and legs. In older children the neck and folds of the elbows and knees are the most common areas. The itch-scratch cycle is the hardest to control in atopic dermatitis patients. This cycle starts with an itching sensation then the child scratches the area, once the scratching starts the child has more aggressive sensation of itching and this cycle continues until the cycle is broken. A secondary problem with this cycle is the increase chance of a secondary infection from the scratching. A secondary bacterial infection is the most common complication seen in children with atopic dermatitis.
What are the treatment options for atopic dermatitis?
The treatment of atopic dermatitis is dependent on the management of dry and itching skin. The rash is usually worse during the winter with a combination of cooler weather, low humidity, and by using heat in the house all exacerbates the rash. All patients should avoid prolonged bath time and use luke warm water. Directly after bathing the patient should immediately apply a moisturizer head to toe while the skin is still a little moist, this helps lock in the moisture. In more extensive disease or in times of flares a topical steroid ointment may be needed to calm the exacerbated area. Topical steroids should be used under the direction of a physician since there are side effects that can be associated with them.
The newest products on the market are prescription strength moisturizers, which are safe to use on a daily basis and on any part of the body. They are used to prolong the time in which steroid topical are used. Oral antihistamines are also a great treatment option to decrease the itching that is associated with the rash. The better control we have over the scratching we are decreasing the chances of secondary bacterial infection as well as making the child more comfortable. Oral steroids are also a treatment option in very severe situations; however they should be avoided if possible secondary to potential side effects and complications.
If your child has a problem with scratching and needs relief, call Dr. John Kayal a board certified dermatologist who specializes in skin care for all ages. 770-426-7177