SKIN BARRIER DEFECT
Patients with atopic dermatitis have genetically impaired skin barrier function with increased water loss leading to dry skin. This impaired skin barrier also allows irritants and allergens access into the skin, initiating an immune system response.
- Ideal gentle cleansers would include properties such oil based for hydration or non-soap based. Antiseptic cleansers be added on to avoid repeated skin infections. We suggest short baths with tepid or slightly warm water, followed by immediate moisturizing. We should avoid strong soaps, chemical or bubble baths to prevent further skin barrier damage.
- Moisturizers are an integral part in the treatment of atopic dermatitis as they aid with repair of the skin barrier. Moisturizers should be applied frequently and liberally (even on normal looking skin). It is best to apply moisturizers after a bath, and as often as needed throughout the day whenever the skin appears dry or itchy. Different children / skin condition would require different moisturizing needs.
- Anti-itch measures include oral antihistamines, wet wraps and anti-pruritic ingredients such as menthol found in some creams. We suggest to keep the fingernails short to minimize damage to the skin during scratching.
Anti-inflammation topicals includes steroids and nonsteroidal creams. Topical steroids are used to reduce the inflammation of the skin. The strength of steroids will depend on the site and severity. Topical steroids should be applied to red, itchy, bumpy areas, once to twice daily. The strength and frequency of topical steroids should decrease when the skin has improved and stopped when the rashes have resolved. Side effects of topical steroids include skin thinning, easy bruising, stretch marks, increased hair growth, systemic absorption etc.
Topical calcineurin inhibitors are non-steroidal based anti-inflammatory creams and are used in a similar manner to topical steroids. The advantage of topical calcineurin inhibitors is the absence of steroids in these creams. Some patients may experience burning or stinging sensation after application of the cream in the initial few weeks of use. The efficacy and safety has been assessed in clinical trials and post marketing studies. Safety concerns arose in a small number of patients with oral calcineurin inhibitors. Many professional organisations still support and recommend its use.
Oral antibiotics and / or topical antibiotics / antiseptics may be prescribed if your child has any signs and symptoms of infection.