Skin rashes (atopic eczema)

My four-month-old daughter, Miranda, was diagnosed with atopic dermatitis. Our pediatrician recommended we use Eucerin lotion and Aveeno bath soap. She also told us give Miranda a bath every two to three days. Two hours after her bath, her skin seems to be really dry. Sometimes I have to apply the lotion to her skin four to five times in 24 hours to keep it from cracking and feeling rough. Is this normal for infants with atopic dermatitis? Is there something my husband and I can try besides what our pediatrician told us to use?
Amy

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Robert Steele

Robert W. Steele, MD, is a board certified pediatrician at St. John's Regional Health Center in Springfield, MO. He graduated from medical... Read more

Atopic dermatitis, also known as atopic eczema, is a common skin condition in infants and children. The symptoms include reddish, sometimes crusty or weepy skin which tends to itch quite a bit. In infants, the most common places for this to occur is the face, neck, abdomen and the backs of arms and front of legs. As the child gets older, the more common places for this to occur are the creases of the arms and legs. This condition tends to run in families, usually subsides by age five years and is not contagious.

The biggest problems with the condition involve keeping the skin adequately moisturized and keeping a watchful eye out for infection. Treating this skin condition may be done in a stepwise fashion depending on how severely the skin is affected:

  1. The first step is to be aggressive with moisturizing lotions. The best ones to use are thick and contain no perfumes. Aquaphor is my personal favorite, but there are many others. These lotions should be applied liberally and very often (four to five times per day).
  2. Use a mild soap. This is good advice for any infant but is particularly important for the infant with atopic dermatitis. Dove is my personal favorite, but again, there are others, including more expensive, milder cleansers such as Cetaphil, which work very well. Use the soap only in the dirtier areas such as the diaper area and try to limit the number of baths per week. After giving the bath, pat the infant dry, then lock in the moisture by immediately applying the thick lotion.
  3. The above two steps will go a long way to controlling the skin. However, many infants and children will require topical medication to help the skin heal by decreasing the inflammation or swelling of the skin. This medication comes in the form of steroid creams and ointments. There are many types of medications in varying strengths of steroids. Most are prescription strength, with the exception of one percent hydrocortisone, which may be purchased over the counter.
  4. Lastly, the skin affected by atopic dermatitis may be more prone to infection when it is cracked and scaly. Infections of the skin will look quite red and tend to be even more itchy than the rest of the skin. If significant enough, the infection may cause fever in the infant. These infections need to be treated with antibiotics.

What you are doing for Miranda's skin management is excellent. From your description, it sounds as though your use of the Eucerin cream has helped and this should be continued. Your frequent use of Eucerin is exactly what Miranda needs and may be all that she requires. It may be, however, that she will require occasional use of a hydrocortisone or some other steroid ointment. I would discuss this with your doctor. In addition, when her skin gets cracked, keep an eye out for areas which appear particularly reddened or oozy. This may be the sign of infection and should be examined by your physician as well.

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