Latest advice on managing atopic dermatitis

The bad news is that office visits for atopic dermatitis are on the rise; the good news is that the condition usually responds to topical therapy and vigilant skin care, according to a clinical report from the American Academy of Pediatrics.

The report recommends “skin-directed” care as first-line treatment in light of new data suggesting that atopic dermatitis arises from primary abnormalities of the skin barrier.

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The 4 components of skin-directed care are: maintenance care to repair and preserve a healthy skin barrier; topical anti-inflammatory medications to manage the inflammatory response; control of itching; and recognition and treatment of infection-related flares. Educating patients and family is also crucial.

Skin hydration with lukewarm baths and moisturizers while avoiding irritants and triggers is key to maintenance care. Low- and moderate-potency topical steroids are the safe and effective mainstay for managing active disease, although some parents may be leery of using them. Oral, but not topical, antihistamines can help relieve itching. In addition to appropriate antibiotic therapy, dilute bleach baths can help manage recurrent infection and flares.

Pediatricians and other primary care providers need to be well versed in caring for children with atopic dermatitis, the clinical report notes, because they diagnose and manage as many as 80% of children with the condition in the absence of sufficient specialists (pediatric dermatologists and allergists).

They’ll likely see more children with eczema because office visits for atopic dermatitis are increasing, as is its prevalence. A National Health Interview Survey published by the Centers for Disease Control and Prevention in 2011 found a rise in the prevalence of eczema and skin allergy in non-Hispanic white, non-Hispanic black, and Hispanic children aged 17 years and younger between 2000 and 2010.

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