Atopic Dermatitis In Children

GENERAL INFORMATION:

What is atopic dermatitis? Atopic (ah-TOP-ic) dermatitis (der-mah-TI-tis), also called eczema, is a very common skin disease. This occurs when too many cells in the skin overreact and cause inflammation (swelling). Swelling is the skin's reaction to things that irritate it or that it has an allergy to. Children with atopic dermatitis are born with overly sensitive cells. These cells do not turn off when exposed to allergens (substances that cause an allergic reaction) or irritants (something that causes irritation). Instead, they continue to overreact and cause symptoms. Atopic dermatitis usually affects babies and young children, and may last until they are fully grown up.

What are the causes of atopic dermatitis? The exact cause of atopic dermatitis is not known. Caregivers do not know why cells overreact and cause a lot of swelling. Atopic dermatitis is more likely to occur if another family member has eczema, hay fever, asthma, or allergies. The following conditions and substances may trigger a flare-up of your child's atopic dermatitis:

• Allergens:
  
  
  • Animal dandruff: Dogs, cats, hamsters, mice, and birds usually shed dander (old skin cells) from their skin, fur, or feathers.
    
    
  • Dust mites: These are tiny insects (bugs) that pass feces (stool or BM) which may cause atopic dermatitis to flare-up. Dust mites are found on almost every surface in homes, including carpet, furniture, bed sheets, blankets and pillows.
    
    
  • Food: The most common food allergies come from cow's milk, eggs, peanuts, wheat, soy, seafoods, and processed foods. If your child has a food allergy, even a very tiny bite of that food can make him sick.
    
    
  • Pollens or molds: Pollen and molds are at their highest during the afternoon or spring season.
  
  
• Irritants:
  
  
  • Chemicals or scented products: Some bath soaps, detergents, perfumes, perfumed makeup, hair products, and other cleaning products are harsh on the skin.
    
    
  • Clothing: Wool fibers, or rough or tight-fitting clothing may irritate your child's skin.
    
    
  • Dry skin: The skin of children with atopic dermatitis does not stay moist, especially during winter. Your child's skin may also dry out from too much bathing, showering, or not staying moisturized.
    
    
  • Extreme temperatures: Atopic dermatitis may happen during very hot or very cold weather. Sudden changes in temperature may also cause irritation. Sweating from heavy exercise and wearing too many warm clothes may also trigger atopic dermatitis.
    
    
  • Infections: Your child may get a rash after he has a cold, flu, or skin infection, such as athlete's foot or cold sores.
    
    
  • Smoke: Cigarette or tobacco smoke may trigger a flare-up.
    
    
  • Stress: Children with atopic dermatitis often react to stress by getting flushed and itchy all over. Emotional stress may come from many situations, such as crying or laughing hard, feeling upset or angry, or fear.

What are the signs and symptoms of atopic dermatitis? The most common sign and symptom of atopic dermatitis is an itchy, dry, red skin rash. The rash may be pimpled or blistered, or may feel hot or tender. The rash may look very different from one child to another.

• In babies, the rash often starts on the face or scalp (skin on the head). Other areas that are easy to scratch and rub, such as over the elbows and knees, may also be affected. The rash may spread over any area of the body, except the diaper region.
  
  
• In older children, it is more commonly seen on the hands, feet, and areas that bend or flex. These include eyelids, ankles, wrists, armpits, elbows, and backs of the knees. Scratch marks are often seen, along with dry, scaly skin. The skin may become infected and show yellow crusts or little pinpoint bumps that contain pus. The skin may also get very thickened from long-term scratching and rubbing.

How is atopic dermatitis diagnosed? Caregivers will take your child's past and current health history. They may also want to know if other family members have eczema, asthma, or hay fever. Your child may need one or more of the following tests:

• Blood tests: Different blood tests may be done to check for certain allergens that trigger your child's atopic dermatitis.
  
  
• Challenge tests: These tests expose your child to suspected allergens, such as those found in foods or in the air. This type of test may lead to severe allergic reactions. This test may only be done in the presence of your child's caregiver.
  
  
• Patch tests: This test uses a patch (small pad) that has a suspected allergen, such as dust or dyes, on it. The patch is placed on your child's skin and your child's caregiver checks to see if his skin reacts to it.
  
  
• Prick skin tests: Suspected allergens are injected with a needle into the skin to see if your child has allergies to them.

How is atopic dermatitis treated? Avoiding allergens or irritants and relieving symptoms are the main focus of treatment. Proper skin care by keeping the skin moist and decreasing inflammation is also important. Your child may have one or more of the following:

• Biofeedback training: Biofeedback is a special way to control how your child's body reacts to things like stress or pain. He will learn how to control body changes, such as slowing his heart rate, when he becomes upset.
  
  
• Immunosuppressants: These medicines stop your child's body from overreacting to allergens or irritants for a short time.
  
  
• Steroids: Steroid medicine may be given to decrease inflammation. There are many different reasons to take steroids. This medicine can help a lot, but may also have side effects. Be sure you understand why your child needs steroids. Do not stop giving this medicine to your child without his caregivers OK. Stopping on your own can cause problems for your child.
  
  
• Tar preparations: These medicines decrease your child's itching and help heal his rashes. They may come in the form of shampoos, creams, or bath oils.
  
  
• Ultraviolet light treatment: Your child may need ultraviolet (UV) light treatments if his atopic dermatitis is very bad.
  
  
• Other medicines: The following medicines may be given to your child to ease his symptoms:
  
  
  • Antibiotics: Antibiotics may be given to help your child fight an infection caused by a germ called bacteria.
    
    
  • Anti-itching medicine: This medicine is also known as an anti-histamine. Caregivers may give your child an anti-histamine to help keep his skin from itching. This medicine may be given in an IV, as a shot, by mouth, or as a skin lotion. Sometimes this medicine can make your child sleepy.
    
    
  • Ibuprofen or acetaminophen: Ibuprofen or acetaminophen are over-the-counter medicines that may help your child's pain and fever. Ask your child's caregiver to tell you the right amount of medicine to give to your child, and how often to give it.
    
    
  • Moisturizers: These will prevent dryness of your child's skin and keep it moist.

What are the risks of having atopic dermatitis?

• Atopic dermatitis may cause severe itching if not treated properly. Frequent scratching may cause problems, such as skin infections, bleeding, and swelling. He may have problems sleeping because of the itchiness. Your child's life may be limited by the troubles of caring for his skin. His friends may avoid him and he may be prevented from doing certain activities, such as sports. Your child may feel afraid or ashamed because of the distress, anxiety, or discomfort it might cause him.
  
  
• Treatment for atopic dermatitis may also cause unpleasant side effects. Some medicines may make your child very sick if not used correctly. They may cause mild burning, redness, or stinging of his skin. Other medicines may cause drowsiness, abdominal (belly) pain, high blood pressure, and kidney or liver problems. With treatment, such as medicine and biofeedback, complications can be prevented and your child's atopic dermatitis may be controlled. Ask your child’s caregiver if you are worried or have questions about your child’s skin disease, medicine, or care.

Where can I find support and more information? Accepting that your child has atopic dermatitis may be hard. You, your child, and those close to you may feel scared, sad, or angry. These are normal feelings. Talk to your child’s caregivers, family, or friends about your and your child’s feelings. You may also want to contact the following for more information:

• American Academy of Allergy, Asthma, and Immunology
  555 E. Wells St, Suite 1100
  Milwaukee, WI 53202-3823
  Phone: 1-800-822-2762
  Web Address: http://www.aaaai.org
  

• American College of Allergy, Asthma, and Immunology
  85 West Algonquin Road, Suite 550
  Arlington Heights, IL 60005
  Phone: 1-847-4271200
  Phone: 1-800-8427777
  Web Address: www.acaai.org
  

• National Eczema Association for Science and Education
  4460 Redwood Hwy, Suite 16-D
  San Rafael, CA 94903-1953
  Phone: 1-415-499-3474
  Phone: 1-800-818-7546
  Web Address: www.nationaleczema.org
  

CARE AGREEMENT:

You have the right to help plan your child's care. To help with this plan, you must learn about your child's health condition and how it may be treated. You can then discuss treatment options with your child's caregivers. Work with them to decide what care may be used to treat your child.

Copyright © 2008 Thomson Healthcare Inc. All rights reserved. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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