Atopic dermatitis

Kohala Coast, HI

- Treatment of atopic dermatitis in children involves an almost cookbook-like approach, but attention to many details is important for achieving the best results, said Elaine C. Siegfried, M.D., at the Winter Clinical Dermatology Conference.

Providing some pearls, Dr. Siegfried noted that it is important at all visits to try to identify possible exacerbating factors so that parents can recognize these agents and avoid or minimize their child’s exposure to them. As parents have generally already thought about common irritants, Dr. Siegfried noted that she spends more time focusing on allergens, and particularly topical allergens. At every visit, parents are asked to bring in all of the products they are using on the skin, and they are provided with educational handouts to improve their awareness of possible sources.

Concentrating on the skin barrier and its repair is also important, and that involves hydration with frequent bathing followed by application of an appropriate bland ointment emollient, Dr. Siegfried said.

"Getting into the tub helps in debriding and hydrating the skin as well as relaxes the patient, and it makes a huge difference," said Dr. Siegfried, professor of pediatrics and dermatology, Saint Louis University, St. Louis, MO.

Adding bleach to the bath is also very helpful. Not only does it offer broad-spectrum antimicrobial effects, but it may have other physiologic benefits that are not yet well understood, such as enhancement of keratinocyte proliferation.

Topical corticosteroids are a mainstay in the management of atopic dermatitis, but it is important to be specific about the amount to be applied and to monitor adherence with those directions, Dr. Siegfried explained.

"Examining the medication tubes is second to examining the patient, as it tells you a lot about the nature of the disease and the nature of compliance," she added.

Corticosteroid potency is matched to the degree of inflammation, but attention is also paid to the allergenic potential of different corticosteroids. Ointments are preferred, and an effort is made to schedule regular corticosteroid holidays. However, if the disease is steroid-dependent, a corticosteroid-sparing agent is prescribed as an adjunctive therapy, Dr. Siegfried said. DT