A Comprehensive Management Guide for Atopic Dermatitis

Jennifer D. Peterson, MD; Lawrence S. Chan, MD

Disclosures

Dermatology Nursing. 2006;18(6):531-542. 

In This Article

Prevention

It is imperative to distinguish between the kinds of prevention of atopic dermatitis: primary prevention and secondary prevention. Primary prevention involves an intervention that prevents a disease from occurring in individuals at risk of a disease; secondary prevention decreases the likelihood of a disease reoccurring. In the case of primary prevention of AD, there is no conclusive evidence that exclusive breastfeeding, infant avoidance of aeroallergens, early introduction of solid foods, or mother avoidance of aeroallergens or certain foods will prevent the development of AD. Evidence does show that treatment with probiotics, particularly Lactobacillus, during pregnancy or infancy may delay the onset of AD in infants and children; however, more studies are needed (Hanifin et al., 2004).

Secondary prevention of atopic dermatitis involves avoiding and/or reducing the identifiable triggers in AD and maintaining a good skin care regimen. The prevention program must be tailored to each patient. Elimination of foods should be based on the results of a double-blind, placebo-controlled food challenge (Niggemann, 2004). Patients whose disease is exacerbated by dust mites can employ several measures to decrease household dust mite burden including adequate household ventilation, mattress covers, pillow covers, avoiding wall-to-wall carpeting, removing dust with a damp sponge, vacuuming floors and upholstery at least once a week, washing linens in hot water every 7 to 10 days, and decreasing indoor humidity levels with air conditioning (Darsow et al., 2005; Leung et al., 2004). In the Winter, patients should be advised to increase emollient use.

Avoiding irritants is a large portion of secondary prevention of atopic dermatitis. If a patient's disease is worsened by sweating, he/she may need a progressive adaptation to exercise (Darsow et al., 2005). Other options include water sports, such as swimming, but patients must shower and moisturize immediately after getting out of the swimming pool. Household temperature and humidity are also important to patients whose disease is worsened by sweating (Leung et al., 2004). Clothing made of synthetic fibers and wool should be avoided and fabrics such as cotton used instead. Loose-fitting clothing is preferable to tight clothing (Darsow et al., 2005; Leung et al., 2004). Liquid laundry detergents should be substituted for powder detergents and a second rinse cycle can be added, as residual laundry detergent can be irritating. Patients sensitive to enzyme-rich detergents should use nonenzymatic detergents. Mild soaps with a neutral pH and minimal defatting capabilities should be used for bathing in all patients with AD (for example Dove®, Cetaphil®, Basis®, Aveeno®, and Neutrogena® (Leung et al., 2004). Patients should bathe in warm water once a day for 5 to 10 minutes, pat dry, and immediately apply emollients (Bardana, 2004; Correale et al., 1999). Finally, nails should be trimmed to decrease abrasions to skin (Correale et al., 1999).

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