Dry, itchy skin? It could be atopic dermatitis

Symptoms of atopic dermatitis may vary, however, there are some universal patterns to the areas of the body characterised by dry skin and itchy rash. PHOTO | FILE

What you need to know:

  • Persistent scratching can lead to bleeding, infection and blistering as well as a lot of discomfort for the child. Here is how to soother the condition.
  • atopic dermatitis is a chronic inflammatory condition that is caused by a combination of factors which include genetic, environmental and immunological factors. The condition interferes with the ability of the skin to retain moisture causing the skin to get dry and itchy.
  • Atopic dermatitis normally affects children with ‘atopic tendency’. This means that a child is prone to getting allergies such as allergic rhinitis, allergic conjunctivitis and asthma.

Atopic dermatitis is a common skin condition that usually develops in early childhood.

According to Dr Carol Ndarathi, a dermatologist, atopic dermatitis is a chronic inflammatory condition that is caused by a combination of factors which include genetic, environmental and immunological factors.

The condition interferes with the ability of the skin to retain moisture.

This causes the skin to get dry and itchy. A child can inherit the condition from the mother or father, with chances of inheriting from the mother higher.

Atopic dermatitis normally affects children with ‘atopic tendency’. This means that a child is prone to getting allergies such as allergic rhinitis, allergic conjunctivitis and asthma.

A family history of asthma and other allergies puts a child at a greater risk of developing atopic dermatitis. Most cases of atopic eczema starts before five years and it is rare for the condition to develop during adulthood.

 

Dear Doc,

What are the common symptoms of atopic dermatitis and when should one see a doctor?

Marriam.

 

Dear Mariam,

Symptoms of atopic dermatitis may vary in different children due to several factors which include the age of the child. However, there are some universal patterns to the areas of the body according to the age of the child. Normally the condition is characterised by dry skin and itchy rash.

The rash may weep (ooze fluid) and the area may appear red and inflamed. Itching is a major sign of atopic dermatitis and causes scratch lacerations and disruption of sleep. You may find a child rubbing the affected area against bedding, shawls, or other things around so as to scratch the itch.

Also, the affected area looks darker than normal. In children below 18 months, the rash is usually on the cheeks, inside the elbow, and the neck. As the child grows older, the rash often starts to affect the outer of the joints, especially the elbows, ankles, knees, and wrists. The affected part of the skin becomes dry and thick as a result of continuous rubbing and scratching. The severity of symptoms may vary from mild to severe.

See a doctor if the child is irritable, not sleeping well, if there is an infection — the affected area is oozing blood or crusted, or there are tender, small blisters on the affected area. These symptoms may signify an infection.

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Dear Doc,

My 14 month old daughter had a rash on the cheeks. After diagnosis, the doctor said she had atopic dermatitis. Can the condition be completely cured.

Mama Daisy

 

Dear Mama Daisy,

Atopic dermatitis is a chronic condition that requires management. It is important to understand that the condition improves as the child grows.

Usually, there is no way of telling if a child’s atopic dermatitis will clear or be a lifetime condition, hence treatment is essential to ease discomfort and at the same time  prevent  the condition from getting worse.

Some children outgrow the condition with time (usually by age five). However, in some children the condition can progress into adulthood.

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Dear Doc,

One of my children has atopic dermatitis. I am worried that she may spread the condition to other siblings.  Please advise.

Vincent

 

Dear Vincent,

Thanks for the question. But you need not to worry as atopic dermatitis is not contagious at all unless an infection occurs. When the affected area becomes infected by either a virus or bacteria, then the infection can be passed to another person but not the eczema itself.

An infection may occur because when a child has eczema, the skin barrier is usually compromised hence there is a high risk of contracting viral or bacterial infections. Frequent scratching and rubbing is a common culprit for skin infections.

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Dear Doc,

My child was treated for atopic dermatitis a few months ago but had flare -ups last week. What could have caused this? Thanks, Ndwiga.

 

Dear Ndwiga,

Atopic dermatitis usually evolves in the form of repetitive inflammatory flare-ups (an abrupt outburst of symptoms). A flare-up can cause mild inflammation in only some parts of the skin or can be severe lasting for some time and affect many parts of the skin. These flare-ups may be as a result of various triggering factors which may include the following;

  1.  Viral or bacterial infections

  2.  Skin contact with irritants such as medicated soaps, detergents or rough fabrics

  3.  Sweating as a result of applying effort or heat can cause the skin to itch

  4.  Changes in weather such as too cold or too hot temperatures

  5.  Use of water that has high mineral content

  6.  Wearing synthetic (non-absorbent) clothing

  7.  Emotional stress and changes in some daily routines can also cause itching and flare-ups. Stress may include anxiety, change of environment like moving to a new house, problems in the family, change of schools, or bullying.

  8.  Food allergies can at times (but not in all cases) cause a flare-up of atopic dermatitis.

Moisturise the child’s skin regularly and not just twice a day to prevent the skin from drying and cracking.  Dry skin can contribute to flare-ups or an urge to scratch which can cause infection. PHOTO | FILE

KNOW YOUR BODY

Tips to help a child cope with atopic eczema

Atopic eczema has no cure but there things a parent or caregiver can do to help the child feel as comfortable as possible. Most cases of atopic eczema get better with good skin care which is important in getting control over your child’s condition.

Observe the following to help reduce the frequency and severity of flare-ups;

  •  Avoid use of harsh soaps and detergents. Bathe the child with a mild and perfume-free soap. Do not wash a child’s clothes with too much laundry detergent or fabric softeners as they can contribute to skin irritation. Use just enough detergent and make sure to rinse the clothes thoroughly. Wash new clothes well before a child wears them to get rid of excess fabric finishers, dyes and other chemicals as they cause irritation to the skin.

  •  Bathe the child in warm (not hot water) and limit the time a child spends in water. After bathing the child, do no rub but rather gently pat the skin partly dry. Rubbing may irritate the skin.

  •  Dress the child in light and breathable clothing. Cotton is usually the best for children with eczema. Synthetic clothing such as nylon can trap heat and increase sweating hence making itching worse by constantly irritating the skin.

  •  Moisturise the child’s skin regularly and not just twice a day to prevent the skin from drying and cracking.  Dry skin can contribute to flare-ups or an urge to scratch which can cause infection.

  • A moisturiser may be in form of cream or ointment. It works by creating a thin film on the skin’s surface hence preventing loss of moisture. Consider using a non-scented moisturiser such as petroleum jelly, which works well for most children. You may need to try different moisturisers before finding the best for your child’s skin.

  •  Always keep the child’s fingernails short and even. This helps reduce the chances of a child scratching and puncturing the skin. It may also be beneficial putting cotton gloves on the child’s hands when they are sleeping to prevent scratching. Long nails can also trap dirt and germs which can cause infections if the child scratches the skin. If the child is older, encourage him or her to rub the itchy area with fingers instead of scratching with nails.

  •  Keep the humidity and temperature at a comfortable level. Keep the child from environments in which the air is very dry, or situations where the child may overheat or sweat. High humidity and temperature is often common trigger of itching and scratching in eczema.

  •  If a food allergy is suspected to cause eczema, talk to a doctor. This is important so that necessary tests are done and the food in question eliminated from the child’s diet. However, it is also important that alternatives are made to ensure that the child does not miss out on essential nutrients.

  •  If you suspect that a child may be stressed, talk to them yourself or ask someone they trust to do it in order to identify the source of stress.

  •  Apply topical steroids (ointments or creams) as prescribed by the doctor to reduce inflammation of the skin.  Ointments may work well for thick and dry areas while creams are usually good at treating areas of the skin which are oozing.

  • Use the topical steroid until the time when the flare-up has completely cleared. Apply the topical steroid by gently rubbing a thin film of the cream evenly on the areas of the skin with inflammation, rub until the ointment or cream disappears.  Antihistamines may be recommended to help a child sleep which minimises itching.

  •  Antibiotics may be prescribed ONLY when an infection occurs.