Atopic dermatitis - self-care

  • Description
    • Eczema is a chronic skin disorder that involves scaly and itchy rashes. Atopic dermatitis is the most common type.

      Atopic dermatitis is due to a hypersensitive reaction (similar to an allergy), leading to long-term inflammation of the skin. People with atopic dermatitis also are missing certain proteins from the surface of the skin. As a result, the skin is more easily irritated.

      Taking care of your skin at home may reduce the need for medicines.

  • Alternative names
    • Eczema - self-care; Skin rash - atopic dermatitis

  • Help for Itching and Scratching
    • Try not to scratch the rash or your skin in the inflamed area.

      • Relieve the itch by using moisturizers, topical steroids, or other prescribed creams.
      • Keep your child's fingernails cut short. Consider light gloves if nighttime scratching is a problem.

      Antihistamines taken by mouth may help with itching if you have allergies. Often you can buy them over-the-counter. Some antihistamines can cause sleepiness. But they may help with scratching while you sleep. Newer antihistamines cause little or no sleepiness. These include:

      • Fexofenadine (Allegra)
      • Loratadine (Claritin, Alavert)
      • Cetirizine (Zyrtec)

      Benadryl or hydroxyzine may be taken at night time to relieve itching and allow for sleep.

  • Day-to-day Skin Care
    • Keep the skin lubricated or moisturized. Use ointment (such as petroleum jelly), cream, or lotion 2 to 3 times a day. Moisturizers should be free of alcohol, scents, dyes, fragrances, or other chemicals. Having a humidifier in the home may also help.

      Moisturizers and emollients work best when they are applied to skin that is wet or damp. After washing or bathing, pat the skin dry and then apply the moisturizer right away.

      Different types of emollients or moisturizers may be used at different times of the day. For the most part, you can apply these substances as often as you need to keep your skin soft. Avoid anything that makes your symptoms worse. This may include:

      • Foods, such as eggs in a very young child. Always discuss with your health care provider first.
      • Wool, lanolin, and other scratchy fabrics. Use smooth, textured clothing and bedding, such as cotton.
      • Sweating. Be careful not to over dress during warmer weather.
      • Strong soaps or detergents, as well as chemicals and solvents.
      • Sudden changes in body temperature and stress, which may cause sweating and worsen your condition.
      • Triggers that cause allergy symptoms.

      When washing or bathing:

      • Bathe less often and keep water contact as brief as possible. Short, cooler baths are better than long, hot baths.
      • Use gentle skin care cleansers rather than traditional soaps, and only on your face, underarms, genital areas, hands, and feet.
      • DO NOT scrub or dry the skin too hard or for too long.
      • After bathing, it is important to apply lubricating cream, lotion, or ointment on the skin while it is damp. This will help trap moisture in the skin.

      The rash itself, as well as the scratching, often causes breaks in the skin and may lead to infection. Keep an eye out for redness, warmth, swelling, or other signs of infection.

  • Medicines From Your Doctor
    • Topical corticosteroids are medicines used to treat conditions where your skin becomes red, sore, or inflamed. "Topical" means you place it on the skin. Topical corticosteroids may also be called topical steroids or topical cortisones. You may need other prescription medicines such as barrier repair creams. These help to replenish the normal surface and the skin and rebuild the broken barrier.

      Topical steroids contain a hormone that helps "calm" your skin when it is swollen or inflamed. Your provider will tell you how much of this medicine to use and how often. DO NOT use more medicine or use it more often than you are told.

      Your provider may give you other medicines to use on your skin or take by mouth. Be sure to follow the directions carefully.

  • When to Call the Doctor
    • Call your health care provider if:

      • Eczema does not respond to moisturizers or avoiding allergens.
      • Symptoms worsen or treatment is ineffective.
      • You have signs of infection (such as fever, redness, or pain).
  • References
    • Habif TP. Atopic dermatitis. In: Habif TP, ed. Clinical Dermatology. 6th ed. St. Louis, MO: Elsevier Saunders; 2016:chap 5.

      James WD, Berger TG, Elston DM. Atopic dermatitis, eczema, and noninfectious immunodeficiency disordersIn: James WD, Berger TG, Elston DM, eds. Andrews' Diseases of the Skin: Clinical Dermatology. 12th ed. Philadelphia, PA: Elsevier; 2016.

      Wollenberg A, Schnopp C. Evolution of conventional therapy in atopic dermatitis. Immunology and Allergy Clinics of North America. 2010 Aug;30(3). PMID: 20670818