Atopic Dermatitis (Infantile Eczema)
Atopic dermatitis or eczema is a common disease of infants, occurring as early as the second or six months of life. It is of unknown origin but speculations are noted that it may be related to food allergies and genetic factors. Heat and humidity (sweating), tight clothing, soap and other skin irritants may also trigger the onset of the illness.
Eczema is a chronic disease, possibly lasting until one (1) to two (2) years of age. It is neither a contagious nor an infectious disease but infection may occur as a complication due to prolonged scratching that allows the bacteria to get through the skin.
The word “atopic” denotes to a condition when an individual is highly sensitive to a particular thing (allergen) such as food, pollen, dust and molds. “Dermatitis” refers to skin inflammation.
Incidence
Prevalence appears to be high among:
- Formula fed infants
- Infants fed with solid food before 6 months
- Family history with asthma and allergies
Signs and symptoms
With infantile eczema, an increase in capillary permeability occurs allowing more serous fluid to be extravasated out into the tissues. As a result, the baby will develop pink to red bumps or papules that may contain fluid (vesicles). The vesicular eruptions may rupture and releases sticky and yellowish secretions. As the exudates dry, they form crusts on the infant’s skin.
Extreme pruritus is one major characteristic of the eruptions that causes the child to scratch the lesion, thereby, further irritating and tearing the skin. Infection may occur due to uncontrolled scratching that forms open lesions. The child may have a fever (first sign of infection) and swollen wound.
Aside from secondary infection, the child may exhibit irritability and may be overly noisy and restless. Generalized discomfort causes infant not to eat leading to poor nutritional intake.
As the papulovesicular lesions are healing, the child’s skin may become shiny (lichenified), dry and flaky. The common eruption sites are the following:
- Scalp and forehead
- Cheeks
- Neck
- Behind the ears
- Extensor surfaces of extremities (outer part of arms and skin)
In most infants, the fist location of lesions is the cheek area. The palms of the hands and soles of the feet are not affected by the eruptions.
Treatment
Conservative Management
- Preventing allergen exposure, if allergens can be identified.
Studies reveal that the most allergenic foods to infants are milk, eggs, wheat, chocolate, fish, tomatoes, and peanuts.
One to two weeks (1-2) weeks interval when introducing solid foods is one way to determine the food that may cause eczema.
- Reducing pruritus to prevent secondary infections.
Skin hydration is done by bathing the infant or applying wet dressing with tap water or Burrow’s solution for 15-20 minutes.
Hydrating emollient application can be used like petroleum jelly (Vaseline) or vegetable shortening.
Select cotton fabrics for the infant’s clothing. Tight clothing increases pruritus.
- Preventing secondary infection
Keep the infant’s fingernails short and clean. Use infant mittens.
Monitor for signs of infection (e.g. fever) to promote prompt treatment.
Medical Management
- Antihistamines (reduces itching)
- Topical steroids – 1% hydrocortisone cream to reduce inflammation and pruritus.
- For dry lesions – use a corticosteroid ointment with an occlusive dressing overnight.
- For moist lesions – use a lotion with an occlusive dressing overnight.
- For infected lesions – hydrocortisone mixed with antibiotic (Neomycin)
image from pennmedicine.org
Daisy Jane Antipuesto RN MN
Currently a Nursing Local Board Examination Reviewer. Subjects handled are Pediatric, Obstetric and Psychiatric Nursing. Previous work experiences include: Clinical instructor/lecturer, clinical coordinator (Level II), caregiver instructor/lecturer, NC2 examination reviewer and staff/clinic nurse. Areas of specialization: Emergency room, Orthopedic Ward and Delivery Room. Also an IELTS passer.
