Atopic Dermatitis  (Eczema)

What is atopic dermatitis?

• Atopic dermatitis (eczema) is a chronic or recurrent inflammatory skin disease. "Atopic" means that there is typically a genetic tendency toward allergic disease. Atopic dermatitis usually begins in the first few years of life and is often the initial indication that a child may later develop asthma and/or allergic rhinitis (hay fever).
• In infants, eczema usually appears as tiny bumps on the cheeks. Older children and adults often experience rashes on the knees or elbows (often in the folds of the joints), on the backs of hands or on the scalp.

Symptoms of atopic dermatitis (eczema) include: 

• Patches of skin that are red or brownish
• Itchy skin, especially at night
• Dry cracked or scaly skin

How is atopic dermatitis treated?

• Eczema is sometimes described as an "itch which rashes." The rash is caused by scratching, so the more the patient scratches the more severe the rash will be. This is why it's important to avoid scratching.
• The most effective way to treat eczema is to use moisturizers and topical ointments that reduce the inflammation e.g. topical steroids or calcineurin inhibitors. The itch is not relieved by antihistamines although these are sometimes used at night to help people with eczema sleep.
• Antibiotics may be prescribed if a skin bacterial infection is suspected as a trigger for your eczema flare-up. Symptoms include crusting, oozing and pain.

Wet Wrap Instructions

Supplies

• Topical steroid ointment/cream as prescribed by your physician
• Moisturizer such as Vaseline, Cetaphil, Eucerin, Aquaphor, Vanicream, etc.
• Warm water in a sink or basin
• Tape
• The wraps themselves: This will include two layers, a wet layer, and a dry layer.
• Gauze wrap (e.g., Kerlex®) or cotton pajamas may be used. For arms and legs it is also possible to use adult socks for wraps: Cut a small hole in the toes of any adult-sized pair of 100% cotton socks to create a pair of tubular bandages that fit easily over an extremity. These can be moved up or down as needed and can be washed and reused.

To Apply

• Always wash your hands thoroughly with soap and water prior to performing skincare
• Apply the steroid ointment to the patient’s inflamed skin as directed by your physician.
• Apply moisturizer to the rest of the child’s skin.
• Take a layer of the wrap (e.g., gauze or one sock) and soak it in warm water.
• Wring out any excess water until this bottom “wet layer” is only very slightly damp.
• Wrap the affected area with the "wet layer" material. You may secure with one small piece of tape, only taping the wrap, not the skin.
• Immediately put the "dry layer" over the "wet layer." You may secure the end with a small piece of tape, only taping the wrap, not the skin. DO NOT cover with plastic, which may be a choking hazard.
• Make sure the wraps are not too tight that it affects the patient’s circulation.
• Make sure the child remains in a warm environment. This helps to promote a higher degree of humidity. It also ensures that the child does not get too cold as the evaporation process happens.
• Please refer to your Eczema action plan for specific recommendations on how often and how long to use wet wraps for your child.