Eczema - Dermatologist in Ithaca and Cortland, NY
Atopic eczema is a chronic (long-term) skin condition that runs in families. As many as 1 in 5 children develop itching dry, inflamed patches of skin on cheeks, neck, arms and legs. It can be the first sign that a child may go on to develop allergic rhinitis, asthma or food allergies. With atopic dermatitis, the skin does not act as an effective barrier, allowing moisture to escape, allergens and irritants to activate immune cells within the skin and microbes such as Staphylococcus aureus to colonize the skin. The skin develops inflamed patches that often itch, especially at night. Scratching further damages the skin barrier and sets up a chronic “itch-scratch cycle”.
The chronic itching of atopic dermatitis often disturbs children’s sleep and affects the quality of life for both the child and their family. Consistent use of the following skin care techniques will keep everyone in the family happier:
- Skin Hydration:
- A lukewarm bath for 10-20 minutes is a good way to hydrate the skin. Pat the skin dry, rather than rub, then apply enough non-fragrance cream (Eucerin, Cetaphil) or ointment (Aquaphor, Vaseline) to “Soak and Seal” the skin.
- Controlling Itching:
- Anti-histamines such as cetirizine (Zyrtec) before bed time will help with night-time itching. Topical hydrocortisone or triamcinolone twice daily can be used for up to 2 weeks at a time. Long sleeved pajamas can protect the skin from scratching.
- Controlling Microbes On The Skin:
- Twice a week, add 2-4 ounces of bleach to the bath to bring the chlorine level up to typical swimming pool concentration. This will reduce colonization of pathogens like Staph aureus. Topical anti-biotics such as mupirocin (Bactroban) ointment 2-3 times per day may be applied to crusted or infected patches.Some parents are concerned that bleach baths will damage the skin. By controlling microbes that lead to infection and skin inflammation, eczema patches have a better chance to heal.
- Food and Environmental Allergies:
- Food allergies are often a suspected trigger when eczema does not improve with skin hydration and topical creams or ointments. Eczema that improves while on the same diet is less likely to be caused by a food allergy. With infants, the earlier eczema appears and the more area it covers, the more likely a food allergy is a trigger. But that is not all. Most children with food allergies are also sensititized to environmental allergens. Sensitivity to perennial allergens such as house dust mites often contribute to difficult to control eczema. A thorough history of eczema, allergies and asthma with a detailed physical examination before testing is the best approach.