Atopic Dermatitis - Allergic Disorders

ATOPIC DERMATITIS

Atopic dermatitis is a type I immediate hypersensitivity disor-der. A family history is common. The incidence of atopic der-matitis is highest in infants and children. Atopic dermatitis (eczema) affects 10% to 20% of children in Western populations (Kay, 2001b). Most patients have significant elevations of serum IgE and peripheral eosinophilia. Pruritus and hyperirritability of the skin are the most consistent features of atopic dermatitis and are related to large amounts of histamine in the skin. Excessive dryness of the skin with resultant itching is related to changes in lipid content, sebaceous gland activity, and sweating. In response to stroking of the skin, immediate redness appears on the skin and is followed in 15 to 30 seconds by pallor, which persists for 1 to 3 minutes. 

Lesions develop secondary to the trauma of scratch-ing and appear in areas of increased sweating and hypervascularity. Atopic dermatitis is chronic, with remissions and exacerbations. This condition has a tendency to recur, with remission from adolescence to age 20 (Tierney et al., 2001). Treatment must be individualized.

Medical Management

Guidelines for treatment include decreasing itching and scratch-ing by wearing cotton fabrics, washing with a mild detergent, humidifying dry heat in winter, maintaining room temperature at 20°C to 22.2°C (68°F to 72°F), using antihistamines such as diphenhydramine (Benadryl), and avoiding animals, dust, sprays, and perfumes. Keeping the skin moisturized with daily baths to hydrate the skin and topical skin moisturizers is encouraged. Topical corticosteroids are used to prevent inflammation, and any infection is treated with antibiotics to eliminate Staphylococ-cus aureus when indicated. Use of low doses of cyclosporine(Neoral, Sandimmune), an immunosuppressive agent, may be effective (Kay, 2001b).

Nursing Management

Patients who experience atopic dermatitis and their families re-quire assistance and support from the nurse to cope with the dis-order. The symptoms are often disturbing to the patient and disruptive to the family. The appearance of the skin may affect the patient’s self-esteem and may affect the patient’s willingness to interact with others. Instructions and counseling about strate-gies to incorporate preventive measures and treatments into the lifestyle of the family may be helpful.

Patients and family members need to be aware of signs of sec-ondary infection and of the need to seek treatment if infection oc-curs. The nurse also teaches the patient and family about the side effects of medications used in treatment.