The Itch That Rashes

Myths, Misconceptions, and Education in Eczema Management

Jeanne Findlay, CPNP, CCRP, DNP; Bernard A. Cohen, MD

Disclosures

February 02, 2011

Patient Education

Treatment should first and always address restoring and maintaining an intact skin barrier. Good skin care is essential for the effective management of pruritus. Due to its increased permeability, AD skin hyperreacts to common airborne allergens and humidity; heat; cold; pollutants; and fabrics, such as wool and nylon. There is a pervasive myth that daily bathing is contraindicated for children with AD. In fact, daily bathing for no more than 15 minutes in plain lukewarm water, followed by patting the skin until it is damp and applying a bland emollient, are recommended to help maintain an intact skin barrier because water hydrates and cleanses the skin.

In terms of moisturizing emollients, ointments are more efficacious than creams, which in turn are more efficacious than lotions at helping to maintain an intact skin barrier. Emollients should be applied at least once a day and more often with skin flares. This is an important teaching point because the application of moisturizing emollients should be part of the child's daily routine whether prescribed topical medications are also used. Too often, the practice of applying bland emollients falls by the wayside in lieu of reliance on prescription topical medications.

The National Eczema Association provides a helpful family education tool for Bathing & Moisturizing.

The hallmark symptom of pruritus can also be alleviated by keeping skin covered, but not smothered, with breathable fabrics, such as cotton. Maintaining a cool ambient temperature is also helpful in promoting more restful sleep. These are key teaching points for parents of infants with AD because they contradict the popular practice of swaddling infants for sleep at night.

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