Advice For Managing Atopic Dermatitis (AD) (For Professionals)

Advice For Managing Atopic Dermatitis (AD) (For Professionals)

• Infection prevention

1. avoid rubber, toys: risk of GRAM – folliculitis

• Baths

1. in saline 9g Nacl in 1lt (raise to 30-36g NaCl)
2. in KMnO4 1/10000: not on the head (effective, increases pH very slightly (paradoxical) but reduces St Aureus)

• Moisturization of the skin

1. “stay less in water”
2. “drink more water”

• Applying the adequate quantity of cream/ointment

1. 2mg/cm2 are needed
2. for the whole body this corresponds to 36g/day in an adult
3. easy practical rule=the fingertip unit: 0.5g=2 adult palms=2% of the total body surface area (TBSA). Ointments are not very different, The main reason for differences are the tube opening sizes. This rule is calculated for an opening of 5mm in diameter.

• Passive protection against scratching

1. bandaging
2. stockings on upper limbs
3. special socks (Japan) prevent friction and intertrigo

• Which textile to choose:

1. favour silk (Ricci, BJD)…
2. … and silver (Gauger).

• Best emollient for AD. It varies:

1. for a given patient (geography…)
2. for a given phase of dermatitis (acute, chronic, infected)
3. for a given area

• Allergy prevention:

1. some washing machines can reduce allergens even without detergent
2. Devices killing House Dust Mites (“HDM killer”) : no proof it can reduce the signs and symptoms of AD.
3. Some vacuum cleaners are Atopy friendly

• Common practical problems

1. perioral dermatitis in AD patients: “cover with zinc oxide” (not steroids !)
2. Cod liver oil? Vitamin D regulates tight junctions, gap junctions… (keratinocyte integrity therefore barrier function of the epidermis). Oral administration do DA patients would be effective.

Contributors:

Dr Christophe HSU – dermatologist. Geneva, Switzerland

Source of information: Gelmetti C. Tips for Management of atopic eczema. 19th Congress of the European Academy of Dermatology and Venereology (EADV) – Gothenburg (Göteborg), Sweden (Sverige)