GENERAL MEASURES :
β’ Decrease stress if possible
β’ Avoid agents that may cause irritation (e.g., wool, perfumes)
β’ Minimize sweating
β’ Lukewarm (not hot) baths
β’ Minimize use of soap (superfatted soaps best)
β’ Frequent systemic lubrication with thick emollient creams (eg, Eucerin) over moist skin
β’ Sun exposure may be helpful
β’ Humidify the house
β’ Avoid excessive contact with water
β’ Avoid lotions that contain alcohol
DIET There is controversy regarding the role of food allergies and exacerbations of atopic dermatitis. The
most common suspicious foods are eggs, milk, wheat and peanuts. Consider elimination diets (e.g., for 3-4
weeks) and food challenges. Also consider delaying introduction of the common suspicious foods until an
infant is 6 months old.
PATIENT EDUCATION :
β’ Goal is control, not cure (although many patients will outgrow their disease)
DRUG(S) OF CHOICE :
β’ Topical steroids achieve good control in 90% of patients
β’ In infants and children, use 0.5-1% topical hydrocortisone creams or ointments
β’ In adults, may use higher potency (over 1%) topical corticosteroids in areas other than face and skin folds
β’ Use short courses of higher potency corticosteroids for fl ares, then return to the lowest potency (creams
preferred) that will control dermatitis
ALTERNATIVE DRUGS :
β’ Topical immunomodulators (tacrolimus or pimecrolimus) are 2nd line agents for episodic use for children
over age 2
β’ Antihistamines for pruritus (e.g., hydroxyzine, 10-25 mg at bedtime and prn)
β’ Plastic occlusion - in combination with topical medication, this promotes absorption
β’ For severe atopic dermatitis, consider systemic steroids for 1-2 weeks, e.g., prednisone 2 mg/kg/day po (max 80 mg) initially, tapered over 7-14 days.
β’ Topical tricyclic doxepin as a 5% cream may decrease pruritus
β’ Evening primrose oil, includes high content of fatty acids, believed to decrease prostaglandin synthesis,
believed to promote conversion of linoleic acid to omega-6 fatty acid
β’ Modified Goeckerman regimen (tar + UV light)
β’ Immune modifiers (methotrexate, azathioprine, cyclosporine)
PATIENT MONITORING: Individualize, depending on severity of disease
PREVENTION/AVOIDANCE :
β’ Smallpox vaccine should be avoided because of risk of eczema herpeticum (see Possible Complications)
POSSIBLE COMPLICATIONS:
β’ Cataracts are more common in patients with atopic dermatitis
β’ Skin infections (usually Staphylococcus aureus ); sometimes subclinical
β’ Eczema herpeticum - generalized vesiculopustular eruption caused by infection with herpes simplex or
vaccinia virus. Patients are acutely ill and require hospitalization.
β’ Atrophy and/or striae if fl uorinated corticosteroids are used on face or skin folds
β’ Systemic absorption may occur if large areas of skin are treated, particularly if high-potency medications and
occlusion are combined
EXPECTED COURSE/PROGNOSIS :
β’ Chronic disease that tends to burn out with age. 90% of patients have spontaneous resolution by puberty.
β’ Some adults may continue to have localized eczema, e.g., chronic hand or foot dermatitis, eyelid dermatitis,
or lichen simplex chronicus