Caring for Your Child with Atopic Dermatitis
What is atopic dermatitis?
Atopic dermatitis is a common non-contagious skin condition that affects children predominantly. Atopic dermatitis affects about 10% of the population, and is becoming more prevalent in recent decades for reasons that are not well known.
Atopic dermatitis runs in families, so if you or your partner has had atopic dermatitis in the past or present, your child is at increased risk of developing the condition. Other related illnesses are hay fever (allergic rhinitis) and asthma, which together with atopic dermatitis form the atopic triad.
Typical symptoms of atopic dermatitis are itchy dry skin in affected locations which may develop rashes during flares and when scratched.
The location of the rash are usually fixed-the face, the diaper area, the legs and the arms in infants, and at the back of the knees and elbows in older children.
What is the itch-scratch cycle?
Atopic dermatitis can be frustrating for the child, but it can take a toll on the caretakers, particularly if the condition is severe. Parents need to take extra precautions to minimize their child's itching.
Itching is one of the main symptoms of atopic dermatitis, but it also plays a crucial role in worsening the condition itself in a negative behavioral cycle called the itch-scratch cycle. The itch-scratch cycle starts when the child scratches in response to severe itching.
This is a reflex that can be very difficult to control, and can also occur unconsciously during sleep. Scratching provides temporary relief and a pleasurable sensation, but damages the skin, worsening the condition, and prompting a stronger urge to scratch later.
This negative loop can quickly deteriorate the condition, leaving the skin severely damaged and prone to infection.
Preventing the itch-scratch cycle
Prevention involves making life-style changes that minimize exposure to irritants and allergens which trigger the initial flare.
- Use moisturizers on a regular basis, and remember to moisturize immediately after every shower or bath while the skin is still moist.
- Use thick creams as they restore hydration better, and also help to keep irritants and allergens from penetrating the skin. Moisturizing is a critical part of atopic dermatitis management as it reduces the frequency and severity of flares.
- Although hand-washing and cleaning is absolutely critical, soaps are notorious for drying out the skin, and triggering flares. Choose mild cleansers that are fragrance free to minimize reactions to soap. While this will not guarantee that flare-ups will not occur, it will reduce the chances of this occurring. Some experimentation with different products may be required as every skin is individual and unique.
- Allergies often trigger the initial about of flares. This can include foods exposure to plants, or certain metals. Have your child tested for common allergies as atopic dermatitis and allergies often occur at the same time.
- Looking at your child's flare patterns will often expose the source of the irritation. For example, many children are sensitive to strong detergents used in laundry. This can be seen if a laundry detergent has changed, or if a load had too much detergent.
- Despite a parent's best efforts, flares will occur from time to time. When they occur it is important to treat your child appropriately to minimize damage and control the condition before it worsens.
- Flares will occur from time to time despite a parent's best efforts and intentions. It is simply a part of atopic dermatitis, and for especially sensitive children, the most common and minor irritants such as pollen or soap can trigger flares.
- The key to controlling flares is to manage itch quickly and aggressively. Itching will prompt scratching especially in children, which will quickly deteriorating skin.
- If the itch-scratch cycle is left untreated, the skin will become cut and damaged, leaving it exposed to infection. Repeated scratching can also harden and dry the skin, in a process called lichenification which takes considerable time to recover from.
- Scratching can become addicting as it leaves a pleasurable sensation in the short-term.
- Treating itch will often require medication such as topical steroids or antihistamines. While these are poor long-term solutions, they work well to control the initial itching and the flare.
- Delay in controlling itching will likely make the condition worse, which will be harder to recover from.
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