Eczema is a chronic condition that causes inflammation of the skin. There are several types of eczema. The most common form is atopic dermatitis which can be triggered by foods, skin irritants, or environmental exposures. Eczema normally appears during infancy and often resolves by the teenage years. It most often affects the face, hands, feet, inner elbows and the back of the knees and causes an itchy rash to develop.
While it is believed to be genetic, eczema is also more common among infants who are formula-fed or received solid foods prior to 6 months of age and those with a family history of asthma or allergies. Atopic dermatitis, is thought to be due to a deficiency of a skin protein. Without this protein, the skin becomes more sensitive to environmental factors and irritants.
Patient will be free of rash and pain; patient’s skin will be free from excoriation and infection
Assess patient’s skin, noting open areas, drainage, or signs of infection; observe for effectiveness of interventions
Bacterial skin infections are common due to excoriation from scratching. Crusting of broken blisters may be present.
Routinely monitor skin to determine effectiveness of interventions.
Obtain history from patient and parents/caregivers to determine triggers
Most flare-ups are related to sensitivities to foods, items that contact the skin, hygiene products, changes in weather and immune response.
Encourage proper skin care including bathing and regular use of emollient creams (petroleum jelly, etc.)
Overwashing and using harsh soaps can make symptoms worse. Dry skin is prone to cracks and infection.
Assist with allergy testing, including patient/parent education
Allergy patch testing may be done to determine allergens and triggers for atopic dermatitis. Education should be provided on how to prepare for the patch test (no lotions, creams) and when to return to be evaluated.
Apply topical medications and bandages as appropriate.
Topical corticosteroids are the first line of treatment for eczema flare ups.
Wet-wrap bandages are sometimes used for more severe cases of childhood eczema, but must be done carefully to avoid serious side effects.
Administer oral medications as required
Oral antihistamines may be given to help relieve symptoms of itching and manage allergies. Be mindful of sedative effects of antihistamines.
Oral steroids may be given short-term for severe symptoms.
Provide resources and referral information and education for prevention
Parents must be educated to be aware of triggers (often foods) and avoid them.
Diligence must be given to ridding the home of other allergens such as pet dander and dust mites.
Make sure child’s nails are short and clean; use mittens or socks on infants hands
Itching is the most prevalent symptom. Long, sharp or dirty nails can cause secondary infections to develop on the skin.
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