Clothes, fabrics, bath detergents, moisturizing creams for the daily protection of the skin and cleaning of the home environment: all the “tricks” to alleviate the symptoms of atopic dermatitis in newborns and pediatric age and reduce the frequency of manifestations.
Atopic dermatitis can also affect adults, since it is a chronic inflammatory disease with an autoimmune basis, linked to a genetic predisposition, which persists throughout life. However, it is mainly infants and children under 10-12 years of age who have to endure the symptoms.
In all cases, atopic dermatitis (also called atopic eczema) is recognized by the appearance of red, thickened and scaly patches on the skin surface, generally associated with burning, discomfort and a more or less intense itchy sensation. The appearance and location of skin reactions change, however, depending on the age and activity of the disease.
In infants with atopic dermatitis, one of the first signs may be the appearance of “cradle cap”: a short-lived seborrheic eczema, characterized by yellowish scales and itching, localized on the scalp. Subsequently, reddened and “wet” skin lesions may develop, which concentrate on the face (especially at the level of the cheeks, eyes, mouth and forehead) and on the ears, distributing themselves variably over the rest of the body.
This picture persists until about two years. In children with larger atopic dermatitis, the spots are always reddened, but characterized by greater dryness and flaking (which gives it a “dusty” or flake appearance), and are located mainly at the level of the folds of the elbows and knees, in the area of the wrists and ankles.
| Early childhood (up to two years of age) | Red, moist skin lesions, which usually begin on the face and, only later, extend to the trunk, elbows and knees |
| Second childhood | Greater lichenification and extension of skin lesions in the neck, folds of limbs, wrists, back of hands |
| Adults | Desquamated and thickened patches mainly on the neck, nape, chest, shoulders, folds and extremities of the limbs, with a predominantly lichenified appearance |
Although always present, atopic dermatitis manifests itself in an oscillating way, with acute phases in which skin lesions are present alternating with phases of remission substantially free of symptoms. Exacerbations can develop for very different causes, but the main one concerns exposure to environmental triggers that improperly stress atopic skin. These include:
- the use of inadequate/aggressive detergents that damage the skin barrier
- use irritating fabrics in direct contact with the skin (for example, wool)
- the lack of hydration of the epidermis after bathing with a specific cream for the child with atopic dermatitis, free of irritants or sensitizing.
In children with atopic dermatitis, both to decrease the risk of triggering an acute phase, and to alleviate any symptoms already present and ensure maximum well-being, it is important to act on environmental factors that can be added to the genetic factors at the origin of the disease. In particular, it is necessary to respect some hygienic and practical precautions that help the skin recover the right balance and avoid situations that, on the contrary, can destabilize it.
Short bath and warm water
Atopic skin is very delicate and hypersensitive. To avoid favoring the onset of dryness and skin lesions, daily hygiene must stress it as little as possible.
The time of immersion in water and cleansing must be minimal. The bath of the child with atopic dermatitis should not last more than 10-15 minutes and lukewarm water should be used (temperature 32-34 ° C), since prolonged contact with water and heat damage the protective skin barrier and dehydrate the skin, facilitating the development of irritation and itching.
If the water is very calcareous, the addition of an emollient product (or simple starch) reduces its hardness, mitigating the dehydrating action of limescale on the skin.
Soap not soap, in small quantities
The choice of detergents to use during the bath is fundamental. The ideal is to opt for products without soap (fluids, gels or dermatological bread), with slightly acidic pH (5.5-6.0) similar to that of the skin, hypoallergenic or specific for atopic skin.
Regardless of the particular detergent chosen, small quantities should be used (in case of atopic dermatitis in newborns, you can also alternate washing with water only), remembering to gently massage the baby’s skin with your hands and avoiding using sponges that, although apparently soft, still rub the skin.
Another important warning is to rinse the entire epidermis very well at the end of the bath, because even the best detergent can be irritating if residues remain in contact with the skin for a prolonged time.
Emollients and thermal waters
After drying it well, dabbing lightly with soft cotton sheets, the skin of the child with atopic dermatitis should always be “nourished”. To do this, it is sufficient to apply small amounts of a good quality emollient product, possibly after spraying a little thermal water that helps to promote hydration, reduce itching and facilitate the subsequent application of creams or gels.
When there are skin lesions typical of the acute phase, instead of a common moisturizing and emollient cream, it is preferable to opt for more specific topical preparations, containing compounds able to protect and actively restore the skin barrier.
For this purpose, formulations based on lipids very similar to those naturally present in the epidermis (glycerin, ceramides, etc.) and panthenol (pro-vitamin B5) have proven useful. Panthenol, in addition to moistening and rehydrating the stratum corneum of the skin, once penetrated deeply, is transformed into vitamin B5 and helps to support the multiplication of cells (keratinocytes) that will replenish the physiological skin barrier.
A cream of this type can be used in all serenity on skin lesions, even in younger children still breastfeeding, as it is extremely well tolerated and completely free of corticosteroids. However, care must be taken not to apply these preparations on injured skin.
Against itching
Preventing rubbing of skin lesions typical of atopic dermatitis in infants and children is very important to avoid serious complications of the disease, including bleeding wounds, crusting and infection.
If, despite proper hygiene/hydration, the itchy sensation is intense and the child tends to scratch, it is useful to repeat the application of thermal water and emollients on the affected areas several times a day and before night rest.
In addition, you can take advantage of the anti-itching action of the cold, using pack-gel (never in direct contact with the skin), compresses with gauze impregnated with fresh thermal water or spraying thermal water kept in the refrigerator.
Keep an eye on your nails
It is useless to repeatedly ask the child with atopic dermatitis not to scratch: especially if he is small, it is an instinct that he cannot control and continuing to emphasize the problem only generates additional frustration, completely counterproductive.
Instead, it is important to take care of the nails regularly, keeping them short and without sharp edges. Smoothing and rounding the edges with a file may be enough to limit unintentional damage to the epidermis. Infants with more agitated atopic dermatitis can also wear light and soft cotton gloves, but only if they do not create further discomfort to the child.
Clothing is important
Sweat sensitizes the skin and promotes irritation, redness and itching. The child, therefore, should not be covered too much and, in the hot season, should be dressed in garments in natural, soft and breathable fibers, changing it often (cotton and silk in light colors are ideal).
An additional tip is to check the body temperature and moisture of the baby’s skin while sleeping or playing (for example, sticking a hand under the shirt for a few seconds) and vary the clothing and coverage level accordingly. The baby’s epidermis should be fresh and soft, but always perfectly dry.
In summer the sun is ok, but…
Despite the heat and increased sweating, summer is generally the best season for children suffering from atopy.
Skin less covered by clothing and exposed to the sun (in moderation, in the less hot hours of the day and after applying adequate sunscreen) recovers a better balance, becoming more tolerant to external stresses.
A nice shower after the sea or the pool
Swimming and playing in the pool or at the sea are not contraindicated to the child with atopic dermatitis, as long as you rinse the skin well with fresh water immediately after bathing to prevent chlorine or salt from dehydrating it excessively. If the skin is extremely sensitive, it can be protected with a barrier cream.
If exuding skin lesions are present, however, it should be remembered that contact with sea water can cause burning.
At home you need a lot of hygiene
The home is a melting pot of allergens and sensitizing substances that can greatly worsen the symptoms of atopic dermatitis in infants and children.
- To reduce its concentration it is necessary:
- ensure good home hygiene, regularly removing dust (and related mites) and mold
- ventilate all rooms at least twice a day (morning and evening, even in winter)
- no smoking in the house
- remove the hair of any pets from sofas, rugs, blankets, pillows etc. every day.
- For household cleaning use effective detergents, but in the minimum amount necessary, rinsing well at the end and keeping the windows open while doing household chores.
Pets, better not
The hair of dogs and cats is in itself a powerful allergenic, as well as a source of irritants and sensitizers collected outdoors in parks and gardens during daily walks, which are then spread in domestic environments frequented by animals. If there is a child with atopic dermatitis at home, it is a good rule to avoid hosting animals with hair inside the house, opting (where possible) for a covered and comfortable kennel in the garden or in another suitable outdoor space. This indication does not only apply to dogs and cats, but to all furred animals, including rabbits, hamsters, guinea pigs, squirrels, etc.
Joycelyn Elders is the author and creator of EmpowerEssence, a health and wellness blog. Elders is a respected public health advocate and pediatrician dedicated to promoting general health and well-being.
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