General skin care

Hydration of the skin is paramount in keeping the integrity of the skin. A dry skin results in itching and scratching leading to the formation of rash and secondary skin infection which in turn can aggravate the skin symptoms. Therefore, the following measures are recommended Short, tepid showers for 10 minutes once or twice daily are recommended. Prolonged baths, especially bubble baths are discouraged as they may cause irritation and further drying of the skin. After the shower, the skin should be pat-dried gently using a soft towel and not rubbed vigorously.

Emollients should be used generously all over the body and especially over exposed areas of the body. This will keep the moisture in the skin. It does not matter what kind of emollient is used. It is not necessary to use expensive emollients to get good results. The amount and frequency of use of emollient are more important than the type. Some patients have very dry skin and thicker emollients such as Vaseline or Eucerin are better suited for such patients. Patients who have allergy to perfume and other chemicals in emollients should use products such as Vanicream or hypoallergenic and fragrance free products such as Cetaphil, Aveeno, etc.. Crisco shortening is equally effective and does not cause any significant staining of the clothes and does not smell. Emollients keep the skin well hydrated. They also protect the skin by acting as additional barriers. Emollients do not last for 24 hours. Therefore repeat application is necessary several times during the day especially during winter months when the air is dry and cold. The use of room heaters during winter months also aggravates dryness of the skin. Use of cold humidifiers and use of short and tepid showers followed by liberal application of emollients all over the body before going to bed will help minimize this problem.
If a steroid cream is used on the skin for the rash, it should be used sparingly, only over affected areas and only for short periods of time. Prolonged application of strong steroid creams especially over large surface areas, especially over the face, axillae or groin, and over highly inflamed areas could result in absorption of the medication and systemic toxicity from steroids. Therefore, such use should be avoided. It also could lead to thinning and bruising of the skin, and this could be a permanent effect. 1% hydrocortisone ointment is safer in this regard.

Medications such as Protopic and Elidel have been approved for treating mild to moderate atopic dermatitis in both adults and children. However, in January of 2006, the US Food and Drug Administration issued a black box warning on these compounds about possible concerns of increased long-term malignancy risk due to systemic immunosuppression. To date, studies of clinical trials, systemic absorption, and post-marketing surveillance show no evidence for this systemic immunosuppression or increased risk for any malignancy. We do not recommend using them until more information is available.

100% cotton clothes and sheets are preferred over synthetic materials such as nylon, polyester, and wool. The cotton clothes allow the skin breathe better and cause less irritation. Patient’s clothes and sheets should be washed using dye and perfume free liquid detergents such as All Free and Clear and Tide free. Double rinsing is preferred to remove traces of detergent from the clothes. We recommend avoiding Clorox, bleach, Bounce and Downy for the patient’s clothes and sheets as they may cause irritation of the skin.

Mild soaps such as hypoallergenic and fragrance-free Dove, Cetaphil, Vanicream or Aveeno should be used to bathe. In patients with extreme dry skin, it is preferable to use soap sparingly perhaps no more than three times a week and the rest of the time the patient could take a shower without soap. Similarly, we recommend using Free and Clear shampoo for the scalp. This can be used once or twice a week.

For patients with cutaneous fungal infections such as tinea versicolor that could aggravate atopic dermatitis, we recommend using Nizoral shampoo. It is applied topically all over the body, the lather is created with water and left for 10 minutes. Then the patient takes a thorough shower. It is to be repeated three times a week for two weeks. For patients with the flaky and itchy scalp, use of Selsun Blue shampoo may also be beneficial. This can be used twice a week as well.

It is important to keep the fingernails trimmed. Dirty fingernails could lead to secondary skin infection from scratching especially at night, and this could result in exacerbation of eczema. Use of mittens and long pants may also be appropriate in small children in this regard.

Antihistamines can be used to minimize itching. First-generation antihistamines such as Benadryl, Chlor-Trimeton or hydroxyzine work better in reducing itching in patients with atopic dermatitis due to higher sedating potential when compared to newer antihistamines such as Allegra, Claritin, Clarinex or Zyrtec. Antihistamines could cause significant sedation, tiredness and slow down of reflexes. Therefore, the patients should not drive, operate heavy machinery or drink alcohol when they are taking first-generation antihistamines. Use of topical Benadryl or doxepin is not recommended as it may lead to sensitization and cause allergic reactions from these medications in future.
Vigorous activities that increase the body heat and sweating have the potential to aggravate itching and rash and should be minimized. Environmental temperatures below seventy-five degrees Fahrenheit is soothing to the skin and should be maintained.

Before trying new makeup items (Note: only products that are applied and left over can be tested in this manner and irritants such as shampoos, soaps, detergents, etc. cannot be tested like this. Before carrying out the procedure, you should carefully follow instructions from the manufacturer of the product.) On the skin, apply a small portion of the product on an area of the skin about the size of a postal stamp near the outer aspect of one of the elbows twice daily for five days. If you do not see any irritation, itch or rash on the site, such products could be used safely in other areas. This process is known as Repeat Open Application Test (R.O.A.T.). This process could be especially useful for patients who have Allergic contact dermatitis but could be used by anyone.