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CAAC/dmc 08/10 Instructions for the Management of Atopic Dermatitis

Instructions for the Management of Atopic Dermatitis

Name:

DOB:Date:

Physician:

1.Bathing Instructions:

  1. Fill tub with tepid water (85F). Hot water causes skin to mast cells to release histamine. This histamine reaction causes increased redness, itching and scratching. Use mild soap such as Dove or Neutrogena.

B.Soak for 30 minutes. Wet towels maybe draped over the shoulders and head while sitting in the tub. It is important to soak the entire body. Bath oils are not recommended because they make the tub very slippery and interfere with water absorption by the skin.

1) If the child has infected looking lesions, or complains of stinging or burning when exposed to water:

a) ½ cup of table salt or four packets of Domeboro powder may be added to the bath water. OR

b) Bleach baths can be used. Add one cup of bleach per one full tub of tepid water. Soak for thirty minutes.

  1. When the bath is completed, quickly pat the skin with a soft towel. Do not rub skin. Application of the creams or ointments is easier if the skin is still moist.

D.Apply the triamcinolone or______ointment to red areas of the child’s skin. Never use this ointment on the face or genitals. Apply sparingly to affected areas. AND/OR

E.Apply hydrocortisone ointment or to the red areas of the face only and/ or if inflammation is mild, to other parts of body. Apply sparingly to affective areas.

  1. Apply the occlusive substances such as Aquaphor, Vaseline, Vanicream,

or Acid Mantle to the parts of the body that are covered with steroid ointment and/or that are dry. This must occur within three minutes after soaking bath, preventing water evaporation from the newly dehydrated skin. This occlusive barrier will help seal the moisture in the skin. Apply very heavily.

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CAAC/dmc 08/10 Instructions for the Management of Atopic Dermatitis

2.Soaking Wraps:See page 3

3.For dryness: Lubricate the skin______a day. Apply moisturizer to dampened skin.

Use: ______as moisturizer.

4.Medications to reduce inflammation (topical steroids)

a)Strong:______(Ointment, cream)

b)Moderate:______(Ointment, cream)

c)Mild :______(Ointment, cream). Only one to be used on the face.

5.For itching: a must if you are going to stop the rash.

For mild itching use______as often as necessary.

For more extensive itching use: ______2 3 4 times per day.

6.For infection:

For mild localized infection use: ______2-3 times per day.

For more extensive infection use: ______2-3 times per day.

General Principals

  1. Avoid: wool, harsh clothing, detergents, bubble baths, and other irritants. No feather pillows and limit exposure to lots of fuzzy stuffed animals.
  1. Washing clothes: Use Ivory snow, Dreft, no fabric softener, use double rinse.
  1. Foods: Avoid acidic foods such as citrus fruits or juices, tomatoes, tomato sauce, spicy foods, and know food to which the patient is allergic.
  1. Sunscreens: Use #15 or higher.
  1. Wintertime: Keep moist!!!
  1. Summertime:Avoid excessive heat and sweating, moisturize immediately after swimming.

Soaking Wrap

The soaking wrap may be used in place of the soaking bath. Some children prefer the wrap because they can lie in bed, watch TV and even fall asleep. Children who have open areas of skin may find that the wrap is more comfortable than the soaking bath. The wet wraps retain moisture and body heat, resulting in increased comfort.

  1. Protect bedding with plastic padding.
  1. Fill a basin with tepid water (85F). To decrease stinging, add table salt or Domeboro powder to the water.
  1. Soak cotton cloths in the water. (Cotton diapers or towels work well)
  1. Have the child sit up in bed and place a wet, wrung out cloth over the back and shoulders, then have the child lie down. For each arm and leg, take a separated wet cloth and wrap it around each extremity, covering fingers and toes. Continue to cover the whole body with wet cloths. A separate cloth can be used to drape around the forehead and cheeks.
  1. Cover the cloths with plastic padding. It is important to cover the wet wraps with something plastic to prevent drying.
  1. Cover the child with a blanket
  1. Let the child stay in the wrap for at least 30 minutes. If the child falls asleep, the wrap may stay in place until the child awakens.
  1. After the wrap is completed, remove the wet wraps and immediately apply the occlusive substance (Aquaphor, Vaseline, Vanicream, or Acid Mantle) to the entire body. Apply very heavily.
  1. Next, apply the Triamcinolone ointment to the red area of the child’s skin. Never use this ointment on the face or the genitals. Wear non-latex gloves during application. Apply sparingly to affected areas.
  1. Next apply the Hydrocortisone ointment to the red areas of the face only. Wear non-latex gloves during application. Apply sparingly to affected areas.

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CAAC/dmc 08/10 Instructions for the Management of Atopic Dermatitis