Child with Atopic Dermatitis
A five-year-old male was being treated atopic dermatitis that started when he was a year old. Over time, the rash became worse and extremely itchy. The child would awaken at night in order to scratch his legs which is where the rash was localized.
He was started on a four-course medication management plan of prednisone for one week. His mother reported temporary relief with this treatment, but the rash reoccurred soon afterward. The boy was then started on cyclosporine for one month with no improvement reported by his mother.
What do you recommend for medication management for this patient and why?
1) soak wraps (onsie pajamas or something similar)
2) bathe in warm water for 15 minutes (gentle cleanser only)
3) lightly pat skin with towel
4) apply TAC .1% ointment within 3 minutes (can also do same with aquaphor)
5) wring out excess water from wrap and immediately dress child in damp wrap to seal moisture
6) apply dry later clothing on top
*do this for 3-5 days*
If bacterial colonization is present I actually like dilute bleach baths. Easy, cheap and not giving the kid antibiotics. Let him/her sit in bath tub for 3-5 minutes (1/4 cup bleach to full bath tub water) then rinse after.
Of course everything else should follow normal care we recommend (unscented soaps, thick moisturizing emollients - eucerin, cerave, aveeno etc). All free and clear detergent. Humidifier in bedroom. No scratching. Etc.