Managing Childhood Atopic Dermatitis

Atopic dermatitis is extremely common in children, and it can be frustrating for parents as well as the child. While there will certainly be ups and downs with this chronic condition, with proper preparation, it can be managed effectively.

What is atopic dermatitis?

Although it’s often used interchangeably with eczema, atopic dermatitis is actually a type of eczema, the type in children. It’s a chronic condition that is immunological, causing the skin’s barrier function to become weakened. Symptoms include rashes, and intractable itching that can be triggered by various factors like temperature changes or even food sensitivities. The itching can be extremely frustrating for the child and for the parent and can restrict a child’s activities and can affect quality of life.

How common is atopic dermatitis?

Atopic dermatitis is extremely common in children. Approximately 20% of children in North America have this condition. In adults, the prevalence is around 2%. There is a lot of variation in these statistics depending on ethnicity as well as geographic location, suggesting that there are both environmental and genetic factors involved. Both males and females are equally affected.

How long does atopic dermatitis last?

Atopic dermatitis is often thought of as a “childhood disease.” The vast majority of children with atopic dermatitis will clear their condition by adulthood. 75% of children will see significant improvement by the age of 14. Finally, it’s important to know that some people will still carry this skin condition through their adult lives--the good news however, is those who do are a minority of people, and even in this group, the severity of the problem is often reduced significantly in adulthood. It’s also important for parents to know that the way that atopic dermatitis presents, and where on the body it affects is also likely to change with age.

What are the major indicators of atopic dermatitis?

Itching, chronic rashes, and family history of atopic conditions (hay fever, asthma, atopic dermatitis), and the flexural areas (inside of knees and elbows) being affected in children, are the major indicators of atopic dermatitis. Your doctor should be able to evaluate your child’s skin condition visually in most cases, although in some cases, there may be some simple tests to confirm the diagnosis.

What body parts are typically affected?

The typical affected parts are age dependent. Atopic dermatitis often follows a pattern, and gradually becomes less severe, and in most cases resolve before adult age. It’s important to remember that presentation is still individual, and not everyone will follow this pattern.

  • 1 to 7 months: Before crawling, infants often show atopic dermatitis on the face and scalp areas only.
  • 7 months to 6-10 years: Trunk, face, neck, and outer surfaces of the knees and elbows.
  • Adolescent: Neck, wrists, ankles, hands, inside of knees and elbows. Often reduced severity.
  • Adults: Often limited to hand or foot.

What should I do as a parent besides taking my child to the doctor when the atopic dermatitis gets out of hand?

Atopic dermatitis is a chronic condition, and daily management through behavior modification is crucial. One of the most concerning aspects of atopic dermatitis is the itch/scratch cycle. Dry skin which is one of the defining symptoms of atopic dermatitis can trigger itching, which causes scratching, damaging the skin, and further drying and causing itching. Rehydrating the skin, and minimizing itching should be the focus when it comes to living with atopic dermatitis. This cuts off the itch/scratch cycle at the earliest opportunity.

Why is bathing an important topic?

Bathing properly can make a big difference in atopic dermatitis, as it is a regular behavior that influences moisture levels in the skin, and can potentially worsen itching, redness, and dryness of the skin if done incorrectly.

  • Keep the water temperature low. Bathe and shower in lukewarm water, and no longer than 20 minutes. High temperatures strip the skin of natural oils, and also contributes to itching.
  • Opt for mild and unscented soaps. For very young children, simply opting for no soap is also an option. Traditional soaps are often too drying and harsh for atopic skin, and it’s important to talk to your doctor about bathing products.
  • Applying moisturizing products immediately after bathing is important. After bathing, pat the skin with a towel, but don’t rub. A moisturizer should be applied while the skin is still moist. Within 3 minutes after bathing the skin begins to dry and moisture is lost due to evaporation. It’s important to seal this moisture in.

How do I manage flare-ups?

The key to controlling flare-ups is to control the itching quickly. Most symptoms will eventually subside, but itching leads quickly to active worsening of the condition, as the patient scratches the skin, quickly damaging it and making the atopic dermatitis flare worse. You should have a treatment ready at hand (usually topical steroids) for flare-ups, that your child’s doctor has prescribed.

Can diet influence atopic dermatitis?

There are many studies that show a relationship between food allergies and atopic dermatitis. Called the atopic triad, people with a tendency for asthma and/or hay fever, also tend to have atopic dermatitis more frequently, so it isn’t surprising that there is a correlation with other types of allergies. The evidence for a direct link is still inconclusive, however. Currently there are no universal guidelines on foods to avoid. If you see a pattern where your child’s skin flares up in response to certain foods, don’t dismiss it as a coincidence. Reactions are individual, and do what makes sense--avoid that food as much as possible, and talk to your doctor about a strategy to minimize disruption.

How can I stop my child from scratching?

  1. Control the itch, fast. The first priority should always be to control the itch rather than controlling the scratch. Even an adult’s willpower is often helpless against relentless itching. In fact, almost everybody scratches an itch in their sleep unconsciously, so it’s important to tackle the source of the problem. Use topical creams or the treatment of choice that your doctor has prescribed.
  2. Moisturize the skin regularly. This is especially important, immediately after bathing or showering.
  3. Lower the temperature. Cold compresses can help bring down the lower temperature. Also, lowering the temperature of the room can help children get to sleep.
  4. Cover up itchy skin. Often having itchy skin covered helps children fight the urge to scratch.
  5. Distractions. Never a great long term solution, but every parent knows that distractions help, at least for the time being.
  6. Cut the nails short. Scratching will happen; it’s a near automatic response and cutting the nails can at least help minimize the damage.