It was a hot summer, many years ago, and the red-faced toddler was screaming bloody-murder. She was in to see the pediatrician I was following because of an intense rash occurring on her forearms, neck, and around her eyes. It was making the child miserable and appeared to be only worsened by her incessant scratching. I remember my teacher saying the words “eczema” and “atopic dermatitis,” as I looked on at that uncomfortable child and sympathetically suffering mother.
The term eczema is from the Greek “to boil over,” and generally is a broad term to describe a dry, scaly, itchy, and red skin inflammation or dermatitis, the cause of which is often undefined.
When eczema a broader term is more specifically called atopic dermatitis it usually starts in children under five and is something with which they will suffer all their lives. It is an allergy-type condition, which runs in families, often affects those troubled with asthma or hay fever, and can break-out over the wrists, in front of the elbows, around the eyes, on the neck, behind the knees, and on the ankles.
Whether or not an allergy is identified, the primary cause of the rash lies with skin protein defects leading to dry skin, an itch, and then scratching. This results in inflammation, cracks in the skin, invasion of bacterial or fungal infection, more inflammation, which in turn intensifies the itching, causes more scratching, and thus a vicious cycle.
Too often people worsen the inflammation with excessive scrubbing and cleansing, too-hot water, harsh soaps, and rubbing alcohol; or with creams and salves saturated with allergy triggering perfumes and chemicals.
The treatment starts with cutting fingernails and providing something to control the itch; avoiding any trauma, perfumes, or toxins; gentle cleansing without soap or by using a body wash; turning off the inflammatory cycle with topical steroid creams or ointments and/or oral steroids; and after the shower capturing the moisture while restoring and protecting the skin with a barrier such as a ceramide cream (e.g. CeraVe.) Once the rash is controlled, allergy testing might be considered.
Those years ago that red-faced toddler with atopic dermatitis was provided a similar treatment that proved very helpful. I remember when we saw the child back a few days later how the rash was almost gone, and how the child AND the mother were so relieved!
Dr. Rick Holm wrote this Prairie Doc Perspective for “On Call,” a weekly program where medical professionals discuss health concerns for the general public. “On Call” is produced by the Healing Words Foundation in association with the South Dakota State University
Scratching is the culprit