Atopic dermatitis is an all too common problem in infants and toddlers. It is a problematic skin rash that tends to be chronic, relapsing, and prurutic (itchy). Eczema can be caused by many things, including genetics, allergies, and infections. It usually has established itself by age five and fortunately digresses by adolescence. Ingestant allergies overall seem to be the largest contributor. Staphalococcal infections also play a minor role.

It has often been termed the itch that erupts, meaning the pruritis precedes the rash. Skin allergy testing is paramount, and immunotherapy can be dramatically helpful. This is one area wheresublingual therapy really shines.

Skin hydration and topical therapies are also the mainstays of treatment. Bathing with tepid water and locking in moisture with emollients such as Aquaphor is very helpful. Vanicream has been very helpful in some patients. Patients are encouraged to prevent scratching by trimming nails and possibly wearing gloves or socks during sleep.

Topical steroids such as triamcinolone cream are paramount. The strength of the steroid must match the nature of the skin applied because atrophy and bleaching may occur.

Topical immunosupressants such as Protopic and Elidel can be helpful in children over two. Some safety issues have been raised.

Antibiotics for Staph colonization have proven helpful as well. Antipruritics (antihistamines) are extremely helpful. Sublingual immunotherapy is a safe and effective therapy.

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