Atopic Dermatitis

Atopic dermatitis

Atopic dermatitis presents differently depending on age. In infancy, an erythematous, patchy, pruritic, papular skin rash may first appear on the cheeks and chin and progress to red, scaling, oozing lesions. The rash affects the malar region of the cheeks, forehead, scalp, chin, and behind the ears while sparing the nose and paranasal creases. Over several weeks, lesions may spread to extensor surfaces of the lower legs (due to the infant’s crawling), and eventually the entire body may be involved except for the diaper area and nose.

Treatment

Nonpharmacologic measures for infants and children include the following:

✓ Give lukewarm baths

✓ Apply lubricants/moisturizers immediately after bathing

✓ Use scent-free moisturizers liberally each day

✓ Keep fingernails filed short

✓ Select clothing made of soft cotton fabrics

✓ Consider sedating oral antihistamines to reduce scratching at night

✓ Keep the child cool; avoid situations that cause overheating

✓ Learn to recognize skin infections and seek treatment promptly

✓ Identify and remove irritants and allergens

• Topical corticosteroids are the drug treatment of choice. Low-potency agents (e.g., hydrocortisone 1%) are suitable for the face, and medium-potency products (e.g., betamethasone valerate 0.1%) may be used for the body. For longer-duration maintenance therapy, low-potency corticosteroids are recommended. Use midstrength and high-potency corticosteroids for short-term management of exacerbations. Reserve ultra-high and high-potency agents (e.g., betamethasone dipropionate 0.05% and clobetasol propionate 0.05%) for short-term treatment (1–2 weeks) of lichenified lesions in adults. After lesions have improved significantly, use a lower potency corticosteroid for maintenance when necessary. Avoid potent fluorinated corticosteroids on the face, genitalia, and intertriginous areas and in infants.