Atopic Dermatitis and the Care of Sensitive Skins
The terms dermatitis and eczema are synonymous. Confusion should not arise when they are used interchangeably.

Atopic dermatitis is an itchy rash which sometimes affects people with sensitive skins.
It is a familiar condition with those who have a personal or family history of asthma and hay fever.
Atopic dermatitis may begin at any age, but 75% of people show the first signs by age six months.

Clinical Picture
The skin is dry and irritable all over. The dermatitis affects any area but the main areas of involvement can vary at different stages. In early childhood the face and over the knees and fronts of the ankles are commonly involved. In older children, the predominant area of involvement is often the inside of the elbows and behind the knees. The dermatitis may be of an acute weeping type or chronic and thickened. Scratch marks are always seen.

Complications
Impetigo, a bacterial infection, can commonly complicate atopic dermatitis. Everyone has organisms on their skin and these organisms are introduced by scratching thus allowing the infection to be established. This infection shows itself as a pus formation or sometimes just a worsening of the eczema. Antibiotics are required. A swab should always be taken before the antibiotics are prescribed.

Patients with atopic dermatitis are also more at risk of developing severe widespread infections with the herpes simplex (cold sore) virus, so anyone with an active cold sore should be very careful not to have close contact with an atopic dermatitis person.

Management of Atopic Dermatitis
There is unfortunately no miracle cure. A good skin care maintenance programme is very important.

It is also important to appreciate that these patients have been born with a dry, irritable skin. This skin will remain irritable often throughout the patient's life. The degree of irritability may lessen with time. It must be appreciated that if certain environmental factors act upon the skin, whatever the age of the patient, eczema will ensue. Therefore the tendency to eczema is life long but the fact of the eczema may not be life long. The important thing to grasp is that this skin will have to be understood and cared for, for life. If this is done often, the development of eczema remains a rare event.

The patient then has a dry, irritable skin on which various environmental precipitants will impinge to produce itching. The itching provokes scratching and this in turn helps to produce eczema. The eczematous skin is itself itchy, so that further scratching sets off the vicious cycle.

Care of the Irritable skin and Avoidance of Precipitants
The following should be avoided:

1. Rough clothing - as in coarse materials or unfinished seams.
2. Wool and nylon in direct contact with the skin. As well as the patients own clothing, remember the mother's clothes, carpets, blankets, toys and so on.
3. Dusty conditions
4. Sand. Especially for children, playing in a sandpit or sand at the beach can be very irritating. The mother should always have a non- sandy towel to rub the child down with. A pair of dry pants put on when the child comes out of the water will prevent the irritation of wet sand inside a wet swimming costume.
5. Water without oil in it. Chlorine in pools occasionally will irritate but often if the child is rinsed off as soon as they come out of the water, this can be tolerated.
6. Use of Soap. This is important. Normal soaps, shampoos and biological cleansers found in the household are high in alkaline pH value, and they will upset the normal balance of the skin, which should be slightly acidic, and also strip the skin of its protective oils. A quality soap substitute such as "Dermasoft" is recommended.
7. Use of perfumed products.
8. Use of household antiseptic products (liquids, creams).

All this should be tempered with letting the child have as normal life as possible. Not all of these things may irritate the skin of each child but if parents are aware of the possible sources of irritation, then they can assess their relevance to their own child.

Patch Testing for Sensitive Skins
When using a skin care product for the first time, wether it is a bath oil, moisturiser, cleanser, or shampoo etc., do a patch test first. Just apply a little of the product to an area of sensitive skin about the size of a ten cent piece. If the skin is sensitive, it will normally react with redness within the first two to three hours. Do this patch test twice over a period of 24 hours to be sure.

Dealing with Dryness

1. Bath Oils
   "Dermasoft" Bath Oil is a useful preparation. This oil should be used in every bath, usually one in the morning and one if required at night. Baths should preferably be tepid, as a hot bath can make the child scratch. Baths should be for at least 20 minutes to help let as much oil as possible be absorbed. Caution: Be careful as the oil may cause the bath to become slippery.
   An alternative way to use the oil (but not as effective),is to wet the child's skin and apply the oil directly.
2. Moisturising.
   Use emollients such as 10% Glycerin in Sorbolene Cream - "Dermasoft" Sorbolene cream is an example. The moisturiser should be used on a long- term basis. It should be used after the bath, and at the other end of the day. Moisturising the skin should be regarded as long-term maintenance treatment, even when there is no active eczema.
3. Antipruritic (Anti itching) Creams.
   A few creams and lotions have soothing antipruritic or anti itching qualities. "Dermasoft" Sorbolene Cream has a mild soothing agent.
   "Dermasoft" Dry skin Lotion (pH 5.5) has a higher level of this agent to relieve itching.

Cortisone Preparations (Steroids)

If it is necessary to use these preparations, then Cortisone ointments are better than Cortisone creams. Nothing stronger than Hydrocortisone should be used on the face, under the arms or in the groin.

Cortisone preparations should be used only where there is active eczema and only until the eczema settles. After this they should be ceased.

Wet Dressings
If a child has very severe eczema that is not responding to treatment at home, they can be treated in hospital with the use of wet dressings. Here the patient has an oil bath and moisturiser / emollient is applied all over. A steroid preparation (in this case a cream because it mixes better with water) is applied to the areas of eczema. Sheeting soaked in tap water is applied and held in place by crepe bandages and outside this a net material that holds the bandages in place. The whole procedure is repeated three times a day.

Sedation
For affected young children night sedation is sometimes necessary. It is always best to consult your GP or specialist.

Dietary Considerations
Dietary factors are usually of no significance, and it is quite exceptional for a food allergy to cause atopic dermatitis lesions directly. Unless there is a history of hives with food, a normal diet is indicated.

Some research however, points to cow's milk being linked to eczema. Using a soy milk for a few months may be worth trying. However there are nutritional hazards in putting a growing child on an elimination diet. There is also the possibility of an increased reaction when a food is reintroduced to the diet, and dietary changes should be closely supervised.