DR. RAJIV CHHABRA

Diseases

Atopic Eczema

Atopic eczema or dermatitis is quite a common disease in children. It used to be a disease of Caucasians but with changing lifestyle, many Indians are affected with this illness. It is more common in children and as age advances it has tendency towards remission. The main symptom of this disease is pruritus (itching) which flares up in between normal periods.

It is diagnosed by examination of the child and there aren’t any confirmatory laboratory tests. As mentioned the main symptom pruritus is quite disturbing leading to persistent scratching which again leads to dryness and thickening of skin. Dry skin is susceptible to crack down, therefore, predisposes to secondary infection. The distribution of dryness/redness of skin is very characteristic. In younger age group scalp, faceand extensor surface of arms are much more involved while in older age group, the propensity of involvement of flexor surface, neck, wrists and ankles is much more.

Other things by which one can recognize that a child has atopic disease is presence of Dennie Morgan folds (prominent folds of skin under lower eyelids). As with any other allergic disease, having 1 allergy predisposes to other allergies which includes asthma, rhinitis etc.

Treatment of atopic eczema lies in treating the symptoms as mentioned earlier. Parents have to realize that treatment should be ongoing as long as symptoms are present. Any discontinuation of treatment may result in relapse of symptoms.

They can take bath n a daily basis. There are few soaps available especially meant for atopic kids with acidic pH. Immediately after giving bath, moisturizers should be applied to maintain hydration. Medicated moisturizers are considered superior as compared to freely available ones.

We need to break the vicious cycle of itching-dryness-itching by giving antipruritic medication which are normally antihistaminics. The doctor may decide the type of antihistaminic which is suitable for your child.

If the disease is still not under control, next step would be to add topical corticosteroids. These are not to be used in isolation but should be added on to moisturizers. One should be aware of the side effect of topical corticosteroids which include thinning of skin, striae, hypopigmentation, acne. Also I would start with lowest potency steroids before escalating to stronger ones if there is no response.

If the disease is still not under control, involvement of a skin specialist is needed to start further treatment like tar preparations, immunosuppressants etc.