By Dr Ananya Mandal, MD
One of the main modalities of treatment of atopic dermatitis is prevention of exacerbations or flare ups of the condition. Some of the general and specific measures include:-
In severe itching stages of the condition bathing should be preferred to showering. Showering may be opted in cases where the skin condition has improved with little itching and skin redness.
For bathing the patient should be immersed in the bath for 20 minutes until the finger tips become pruned.
To ease itching and soften the skin, some water emollients may be added to the bathing water. Some of these include oat-derived colloids or mineral or vegetable oils.
For washing a sponge or terrycloth may be used that does not cause irritation or friction of the skin.
Use of soap
The soaps used should be of an acidic pH. Harsh soaps tend to be alkaline. The soaps should be devoid of irritant and sensitising substances.
Soaps cannot be avoided altogether since they also possess antibacterial property preventing Staphylococcus aureus infections. For this purpose chlorhexidine soaps or preparations may be useful.
After bathing the skin should be dried carefully with soft towels and no rubbing. An emollient cream needs to be applied to maintain the skin moisture. This should be applied a few minutes later. The ones that contain fatty acids including primrose oil, linoleic and/or linolenic acid or ceramides should be preferred.
Choice of clothing
Clothing should be light and not tight fitting. There should be neither wool nor synthetic textile fibres against the skin as much as possible.
Cotton and linen should be recommended. Labels need to be removed so that they cannot rub against the skin and cause irritation.
Exercise routines should be moderate and there should be plenty of rest and fluids during exercise. Vigorous exercise in hot and dry weather should be avoided.
The adequate environmental conditions for these patients are 18ºC temperature and 50% relative humidity.
Avoidance of triggers
Avoidance of known triggers can prevent flare ups.
Avoidance of foods that trigger allergies also help keep flare ups at bay.
Avoiding secondary infections
To avoid secondary infections due to itching and resultant scratching of the areas, some measures may be taken. With scratching over time the skin becomes rough and thickened as well.
The measures include keeping fingernails very short, smooth and clean, applying moisturizer when feeling itchy and keeping hands elsewhere when feeling itchy. There are medications that can reduce the itchiness.
Emotions and stress may bring about flare ups by increasing itching and scratching. Management of stress helps cope better with atopic dermatitis.
Reviewed by April Cashin-Garbutt, BA Hons (Cantab)