Atopic
Dermatitis: In Depth
Background
Quite simply, atopic dermatitis is the result of a faulty skin barrier. The skin barrier does not
function as normal, and thus, the skin loses vital moisture and also becomes
easily penetrated by allergens, toxins, and irritants. For a more complete
understanding of the skin barrier, I suggest that you read the handout I wrote
called “Skin Barrier Education,” and the booklet I wrote, “The ABC’s of Dry and
Sensitive Skin.” A person cannot begin to understand atopic dermatitis unless
he or she first understands the human skin barrier. Now, interestingly,
Vaseline ointment can work as a temporary skin barrier for atopic prone people.
Just apply Vaseline ointment two or three times a day and the patient will
improve. Stop the Vaseline, and the patient will get worse. Strip the skin oils
with Dial, Zest, Ivory soap, or bath gels, and the patient will get worse. So,
in a very simple nutshell, Vaseline combined with very gentle cleansers, will
help prevent atopic dermatitis flares.
What Is It?
Atopic dermatitis is a chronic inflammatory disease
of the skin that is often associated with other allergic disorders affecting
the respiratory system,such as asthma or hay fever.
Possible complications include: 1. Secondary bacterial infection in the
affected area.2. Increased susceptibility to adverse drug
reactions. 3. Decreased resistance to fungal and viral infections. 4.
Permanent scarring from scratching. The final outcome is unpredictable.
Flare-ups and remissions may occur throughout life. Signs and symptoms of
atopic dermatitis include: 1. Itching rash in areas where heat and moisture are
retained, such as skin creases of elbows, knees, neck, face, hands, feet,
groin, genitals, and around the anus. 2. Dry, thickened skin in affected areas
(lichenification) 3. Uncontrolled scratching (frequently
unconscious) 4. Chronic fatigue from loss of sleep due
to severe itching. The causes are unknown, but the disease is probably
inherited and probably related to immune system abnormalities.
Risk increases with: 1. hay fever or asthma. 2. Food
allergy. 3. Family history of atopic dermatitis or other allergic disorders. 4.
Stress. The rash and itching increase during stressful
periods. 5. Use of immunosuppressive drugs. Atopic dermatitis, also
known as atopic or allergic eczema, this chronic, relapsing, itchy skin
condition is usually inherited and is characterized by episodic acute
flare-ups. In 70%, it is generally associated with a family history of one or more of a triad of allergic diseases:
asthma, hay fever, or atopic dermatitis, and usually begins in infancy or
childhood. Any of several factors may be involved in the etiology (underlying
cause) of the disease in a particular patient. One of the most important of
these factors is dryness of the skin,
which appears to be due to a higher tendency towards water loss from the skin
of people with atopic dermatitis. This dry condition tends to be exacerbated
during periods of low humidity. For this reason, it is very important that you
follow the guidelines explained in my educational booklet on dry and sensitive
skin: The ABC’s of Dry and Sensitive
Skin.
Proper moisturization can help prevent the often
uncomfortable skin symptoms of atopic dermatitis. Sufferers of atopic
dermatitis always have very dry, brittle skin. The external layer of the skin
(called stratum corneum) acts as a barrier, protecting what lies underneath.
When the stratum corneum cracks because of dryness, irritants can reach the
sensitive layers below and cause a flare-up of atopic dermatitis. To prevent
dry skin, the best and safest treatment is the use of moisturizers.
Moisturizers provide a layer of oil on the surface of the skin, trapping water
beneath and thus making the skin more flexible and less likely to crack.
Normally, your skin moisture is protected by a thin film of oil lightly
covering the surface of skin cells. Soap can wash this protective oil film
away, and your skin can lose moisture. Dry air further causes the skin to lose
moisture, and your dried skin can scale, flake, and crack. The tiny cracks in
the skin are also called “fissures” and occur within the lines of the skin. As
tiny dry fissures deepen within the skin lines,
inflammation and sometimes infection develops, leading to a medical condition called:
asteatotic or xerotic eczema, the medical names to describe severely dry skin.
The words “eczema” or “dermatitis” are the same and refer to inflamed skin. In
addition to dryness, Allergies to certain foods may also play a role in some
patients; this factor, however, has probably been over-rated. Wool, as well as
lanolin (wool fat), appears to be irritating to the skin of patients with
atopic dermatitis. Finally, emotional stress and nervousness can aggravate
almost any pre-existing skin condition, such as itching, and can be a principle
factor in perpetuating the continuous "scratch-itch" cycle.” Other
precipitating factors include extreme allergies to house dust mites, animal
dander, plants, molds, fabrics, rugs, and other allergens. Sensitive atopic
skin can become itchy when exposed to allergic type substances such as
perfumes, dyes, conditioners, powders, anti-perspirants, hair sprays, grasses,
plants, fragranced products,
shampoos, unrinsed laundry detergents, fabric softener sheets, dog or cat hairs,
carpets, chemicals, Aloe Vera, PABA, detergents, acrylic nails, polishes,
nickel, elastic, latex, etc. Hair conditioners can induce itch!
How Does It
Begin?
Approximately 65% of patients with atopic dermatitis
develop the disease during the first year of life, and 90% will do so before
age 5. There is, however, seldom any evidence of disease present at birth. On
occasion, however, a follicular (hair follicle-like) eczema and/or erythema
(redness) may be noted within the first few weeks of life, which begins on the
exposed areas. By the time the infant is 2 to 3 months old, coordinated rubbing
and scratching begin, and a more typical picture of eczema manifests itself,
especially if the baby is not well moisturized. Atopic lesions in the infant
are usually distributed on the face, scalp, and extensor surfaces of the
extremities, or can be generalized throughout the body. The rash is often
weeping and vesicular (blistery), with oozing, crusting, and excoriations.
How Does It
Progress?
As atopic dermatitis progresses, extensive hair loss may occur in cases of severe scalp
involvement. The scalp hair will return once the dermatitis remits, except in
those rare areas where scarring has occurred. In older children and adults, the
primary distribution of atopic lesions generally includes the neck, antecubital
and popliteal fossae (flexor areas), wrists, and ankles. The dorsal surfaces of
the hands and feet, as well as the ears, may also be affected; the rash may
also be generalized, but this is unusual except in acute exacerbations
(flares). Frequently, the infantile form of atopic dermatitis may become milder
and perhaps remit completely by age 4 or 5. These patients, however, are often
subject to flare-ups by puberty and the late teens, which can go on to become
chronic eczema, and can be associated in about thirty percent of cases with
allergic asthma or hay fever. The skin manifestations of chronic atopic
dermatitis are characterized primarily by marked skin dryness (xerosis), thickening
(lichenification), pruritus (itch) excoriation (scratch marks), and even
scarring. The skin may develop a silvery sheen due to dryness, and may be
subject to superinfection by bacterial agents, such as Staphylococcus aureus,
by fungal organisms, or by viruses, the most common of which is herpes simplex.
Superinfection is of particular concern during acute, weeping flare-ups.
Dermatitis may also occur periorbitally (around the
eyes), and can range from mild dryness and scaling to severe lichenification of
the eyelids. The so-called "allergic shiners" seen in atopic persons
are manifestations of this condition. Other eye findings in chronic dermatitis
include a type of conjunctivitis which results in roughening of the inner
lining of the eyelids and can lead to corneal abrasion ("vernal
conjunctivitis"); keratoconus, a condition in which the cornea becomes
cone-shaped and may require transplantation; and cataracts, either as a result
of the atopic dermatitis itself, or as a side effect of systemic steroids or of
topical steroids used around the eyes as part of treatment.
How Is It
Treated?
If your child or you have atopic dermatitis, your
daily moisturizing routine is far more important than any medication Dr. Jacobs
can prescribe in the office. This is because your skin reacts to the
environment at a level much higher than the average person. Your skin is not
"bad" skin. In fact your skin is very special and requires special
treatment. Your skin produces less oil and therefore loses its protective layer
faster. Your skin will dry much faster than normal. The following are methods
of dealing with this problem. The mainstay of therapy in atopic dermatitis and
chronic eczema, as well as in acute flare-ups is the maintenance of good skin hydration. This can be best accomplished
in chronic dermatitis by bathing no more frequently than once per day (in order
to preserve the natural oils of the skin) and through the use of special
moisturizing “non”-soaps with minimal defatting
activity. Cream moisturizers should be used liberally, at least three or four times daily,
particularly after bathing. Exactly how are you supposed to moisturize? The most important part of moisturization therapy is to first restore moisture to the skin. It’s like filling a dry
lake bed. Skin lubrication will restor
e your skin’s moisture. How
is this done? Just add water! Water alone will briefly moisturize your skin,
but the new moisture is soon lost to the air by routine evaporation. How to
prevent evaporation? Creams and ointments provide a protective film or coating
of oil that prevents skin water from evaporating. This protective oil coating
prevents dryness. Any type of oil can prevent water loss. Bath oils can be an
effective way to prevent loss of moisture. You can rub bath oil onto your skin
after a shower or bath. You can add it directly to your bath water: CAUTION:
Slippery tub! When applying bath oil directly to your skin, first, soak in your
tub and wipe your skin with a moist towel.
Second, pour a small amount of bath oil into your hands. Liberally spread it
around. Three large tablespoons of bath oil is enough for the entire body of an
average adult male. If you prefer to use bath oil in the tub, after you have soaked for 10 minutes,
add a tablespoonful of oil to the bath water and soak for 10 to 20 minutes
more. Do not use soap, as you will be cleansed by soaking in the oil-water
combination. After soaking, pat yourself dry with a damp towel. Enough bath oil
will remain on your skin to prevent moisture loss. You can ask your pharmacist
to show you OTC bath oils or mineral oil. The most important point to remember: Any skin lubricant is best applied after
your skin has been wettened in the bath or shower, so as to trap and hold
moisture in. Think of yourself as a bone dry sponge that has been soaked or
dipped in water. The sponge is then dipped in oil to tightly seal the moisture
in.
Treating Dry
Skin Rash
When dry skin has developed into an itchy rash, a
cortisone cream or ointment usually brings quick relief. The cortisone may be
applied liberally to the rash and
deeply massaged in, usually at bedtime, or after bathing, and one or two other
times during the day. As your rash improves, the cortisone is decreased.
Remember, dry skin requires topical therapy. Many patients would like to treat their dry skin with either a pill, an injection, or diet. Some patients have
asked if fat intake improves dry skin. Excessive fat consumption can cause poor
health. Please remember, when treating dry skin, there is no safe substitute
for conscientious topical moisturization. If you want an oral cure, water is the best oral substance to
help with dry skin. Pills aren’t available. Topical care is best. First, soak
the water inside. Second, prevent evaporation with a film of oil. How about soap? Soap is bad for dry or
atopic sensitive skin. Dial, Zest, Lever, Safegaurd, Ivory, gels, and Irish
Spring are among the worst. Soap removes skin oils needed to hold in moisture.
If oils are removed, the skin develops cracks, fissures, and dry inflammation.
Soap should not be used on dry or sensitive skin. Most of us use far too much
soap. Actually, plain water is often just enough to cleanse the skin. If you
can't live without soap, it's OK to use Dove soap for your face, feet, armpits,
and groin. What about bathing? Patients may bathe or
shower once daily using the following guidelines:
ABC Bathing
Guidelines
Persons with atopic dermatitis involved skin may
bathe or shower twice daily: 1. Use no soap on dry or sensitive skin areas. You
may use mild Gentle Face and Body Cleanser, instead of soap. 2. After bathing, thoroughly lubricate
your skin using vaseline or a Replenishing Cream
available OTC. 3. After your bath, you should not towel dry. Wipe off the water
with your hands, then, apply a thick film of Cream to your entire body. This
film will seal in your new moisture. 4. For shampoo,
use OTC fragrance free Gentle Shampoo. Mild lubricants, or anti- pruritic
creams, or mild hydrocortisone creams may be used all over the body to soothe
the inflammation. Oral antihistamines may be used to reduce itching.
What about
topical cortisone?
Topical cortisones should be used only when needed
in the long time management of dermatitis, and should be tapered both in
frequency of application and in strength. Only low potency corticosteroids,
such as the various strengths and preparations of hydrocortisone, Acclovate,
and Des Owen, should be used for longer than 10 days on the thin-skinned areas
such as the face, neck, axillae, and groin, because of the increased risk of
side effects of skin atrophy (thinning), depigmentation (loss of pigment),
acne-like eruptions (particularly in the periorbital (around the eyes) and
perioral areas, striae formation (stretch marks, especially in the groin), and,
rarely, systemic corticosteroid effects. The use of more potent fluorinated or
esterified topical steroids such as Psorcon, Temovate, Diprolene, Ultravate,
Lidex, and Triamcinolone should be reserved primarily for limited application
to exacerbated skin regions on other parts of the body. Systemic
corticosteroids like prednisone or injectable Kenalog, should generally be avoided in all but the most acute and severe cases, and
then they should be used only for very short-term, tapered courses. The need
for topical corticosteroids may be reduced through the concurrent use of proper
moisturization and avoidance of allergens like house dust, plants, cats, dogs,
perfumes, and others. The treatment of acute flares of atopic dermatitis
differs from that of chronic (long-term) dermatitis primarily in the way that
the problem of hydration of the skin is approached. Dryness may be corrected in
acute dermatitis by the addition of water to the skin followed by the
application of a hydrophobic occlusive substance (Heavy Creams) or of occlusive
wraps to retain the absorbed water. Although it is preferable to treat acute
flares at home, in certain cases, hospitalization may be necessary,
particularly when superinfection of weeping skin lesions is present. How to treat severe flares? Affected skin
areas may be bathed for 15 to 20 minutes in tepid (never hot) water two to
three times daily, followed by gentle patting with a soft towel after the
patient leaves the bath, and immediate application of an appropriate heavy moisturizing cream or topical medication.
Bath oils may be added to the water if done after the skin is thoroughly
hydrated, and soothing substances such as Aveeno or sodium bicarbonate may also
be added. Severely affected areas may be treated with wet wraps after bathing,
to affect occlusion and thus maximize water absorption. If the face requires
wrapping, this may be accomplished with two layers of wet gauze followed by two
layers of dry gauze and held in place with Spandex netting. Such baths and
compresses are frequently effective in removing crusts and reducing exudation.
It is always important to apply heavy cream to seal in the moisture after the
skin has been exposed to the water. For severely weeping lesions, Burow's
solution (Domeboro available OTC), may be used with compresses, but should be
limited to 2 to 3 days, as the Burow's solution is extremely drying and could
lead to severe skin cracking and worsening of the itch. Topical corticosteroids
are also used in conjunction with occlusive dressings in the treatment of acute
dermatitis, again bearing all of the guidelines in mind which govern their use
in long-term chronic management. Ointments tend to be more useful than lotions
or creams in acute dermatitis, as they are more occlusive and thus provide
better medication delivery to the skin. Ointments are less drying than lotions.
Systemic corticosteroids, as noted before, are rarely if ever used in the
treatment of acute dermatitis, but may be helpful. What about itch? The often severe pruritus (itch) which
accompanies acute atopic dermatitis flares may be at least partially relieved
through the use of antihistamines, like Atarax or Benadryl, around the clock if necessary, or, if
those are not effective, tricyclic antidepressants such as amitriptyline
(Elavil) may help. In addition, wet wraps are often quite effective therapy for
nocturnal (nighttime) pruritus (itch). Topical lidocaine and topical Benadryl
are not advised, as they can cause allergies after repeated use. What can be done about infections? People
with atopic dermatitis are prone to skin infections, especially staph, yeast,
and herpes. In general, infections are hard to prevent. However, many including
staph, yeast, and herpes can and should be treated promptly to avoid
aggravating the atopic dermatitis. Therefore, if you or your child has atopic
dermatitis, learn to recognize the early signs of skin infection, and when you
notice them, see Dr. Jacobs for treatment. Signs to watch for include increased
redness, pus-filled bumps (pustules), and cold sores or fever blisters. Sometimes viral "colds" or "flu" cause
flare-ups of atopic dermatitis. With extra skin care for a few days
while the virus runs its course, severe worsening can be avoided. In cases of
secondary skin infection (most frequently of severely affected, weeping skin
lesions), appropriate cultures may be obtained and appropriate antibiotic
coverage may be started. Although the bacterium Staphylococcus aureus is the
most common causative organism, fungal and viral superinfections may also occur
and should be appropriately treated if present. Topical Mupirocin (Bactroban)
or gentimicin ointment may be used for very localized
Staphyllococcal infections, but for infection of larger areas, systemic (oral)
antibiotics are indicated. What about
climate, heat, and humidity? Extreme cold or hot temperatures or sudden
changes in the temperature are poorly tolerated by people with atopic
dermatitis. In atopic dermatitis, high humidity causes increased sweating and
may result in prickly heat-type symptoms, both of which may aggravate atopic
dermatitis. Low humidity, such as when homes are heated during the winter,
dries the skin. Unfortunately, humidifiers do not help much; the best
protection against "winter itch" is regular application of a good
moisturizer. While you can do little about the climate (and moving to a new
climate is usually not recommended), you can try to keep the environment
comfortable. For instance, keep your thermostat set low enough to prevent
excessive room temperature, and avoid using too many bed-clothes that cause
sweating during sleep. What about
exercise? When a flare-up of atopic dermatitis is hard to control, it is
wise to avoid strenuous exercise for a while. If you are sweating and starting
to itch, slow down. Layers of clothing can be removed as needed to avoid
overheating.
What about food
allergies?
As many as 1 or 2 of every 10
children with atopic dermatitis suffer from some form of food allergy. Since an allergic reaction
to food (either by skin contact during food preparation or by eating the food)
can trigger a flare-up of atopic dermatitis, it is important to identify the
foods to which a person may be allergic. Diagnosis of food allergies is
extremely difficult. The easiest form of test is a blood test that Dr. Jacobs
can order. There is also a skin test, where the skin is scratched with a small
amount of the suspected allergen. If no inflammation results (a negative test),
there is a good chance that the food will not affect that person. If the
scratched area becomes inflamed the test is considered positive, but
unfortunately, a positive result is difficult to interpret. First, a positive
skin test is right only about 20 percent of the time. Thus, positive skin tests
are only a clue to a possible allergy and should not be accepted as the last
word. Second, because the skin of people with atopic dermatitis is so sensitive
to irritation, simply scratching the skin can cause inflammation, making the
likelihood of a false positive skin test even higher. Another type of test for
food allergy is a blood test. As with skin tests, these have a very high rate
of false positives. They are also expensive. For these reasons, they are not
always recommended for allergy testing in people with atopic dermatitis. The
only way to verify a positive skin test is to undergo a food challenge where
the suspected food is eaten in a controlled setting. This proof can be
complicated (and sometimes dangerous) and should be carried out only under the
supervision of a physician. Warning: It is important to remember that simple
elimination of all suspected foods may result in serious malnutrition. In
children, unnecessarily removing nutritious foods from the diet can stunt
growth. Consult the pediatrician about your child's diet.
Other Helpful
Hints
Wear loose-fitting, cotton clothing: avoid wool and
synthetics. Do not allow an atopic person to be vaccinated against smallpox. It
can cause a life-threatening reaction. Try to reduce stress in your life if
possible. Remove as many irritants from your life as possible. Do not adopt a
cat or dog. Have a fish collection. Limit flowering plants both inside and
outside of the home. When pollen counts are high, stay inside and change your
air filter. If you do not have a good air filter on your heating and cooling
unit, get one installed. Drapes, rugs, and other cloth furniture or decorative
items will trap dust. Keep you environment as dust free as possible. Get rid of
rugs and drapes as they collect dust. Stuffed toys do the same. Consider
wrapping the mattresses in plastic to alleviate dust mites. Also, it is a good
idea to wash all bedding frequently in hot water to remove dust mites. If you
need pest control, always leave the house when chemicals are used. Better, put
the wet chemicals outside and the dry chemicals behind baseboards, etc. Avoid
fragrance products. Keep the Bounce, Downy, and fabric softener away. Keep the
cosmetic products limited to Almay, especially in hair spray. Use unscented
Tide in the laundry and double rinse. Wear natural fabrics. Always wash your
new clothing before wearing. Avoid wool next to the skin. Rayon is not a
natural fiber. It is a wood pulp derivative. It is not cool as cotton. What about food allergies? Food
allergies may play a role in any atopic dermatitis. It is best to avoid foods
which seem to cause increased itching. Some people can tolerate allergic foods
in small quantities but break out when the amount of food eaten is increased.
Test by eating only one suspected offending food at the time. If you have
atopic dermatitis you are at higher risk of having an infection spread on your
skin. If you think you are having an infection or fever blisters, call Dr.
Jacobs. You may also be at risk for allergic reactions to drugs or foreign
sera. Drugs should be prescribed with care. Dr. Jacobs will be happy to discuss
this with you on an individual basis since the drug you need may be important
and well worth the risk of allergy. Patients with atopic skin often improve
with age, however, most will always retain an
increased sensitivity to the environment. Knowing how to protect your skin is
important. What about other allergies? Occasionally people with atopic dermatitis notice a worsening of their
condition when exposed to certain things such as pets or dusty rooms. It is
possible that an allergy to dust mites (tiny organisms present in household
dust) may worsen atopic dermatitis in some people. As with foods, positive
scratch and blood tests are not very reliable for diagnosing an allergy to
these airborne substances. Research is being done on a type of patch test in
which the suspected allergen is placed on the surface of the skin under a
protective bandage. For now, however, the best approach is still the
trial-and-error challenge method where the person first avoids the allergen and
then is exposed to it while the skin condition is carefully observed. Treatment
with allergy shots does not seem helpful for people suffering from atopic
dermatitis. Sometimes the atopic dermatitis actually worsens during allergy
shot therapy, even as the allergy symptoms are improving. What is the difference between irritants and allergens? Irritants
are substances that are rapidly unpleasant or offensive, causing burning,
itching, or redness. They include solvents, industrial chemicals, detergents,
some soaps and fragrances, fumes and tobacco smoke,
paints, bleach, woolens, acidic foods, astringents and other alcohol-containing
skin-care products. If an irritant is potent or concentrated enough, it can
irritate anyone's skin, whether they have atopic dermatitis or not, on the
first exposure. In contrast, allergens are more subtle trigger factors. A
person is never allergic to something the first time they use it. It takes many
repeated exposures before the body can develop an allergy to a substance.
Often, a person will say, “Dr. Jacobs, I can’t understand how I can be allergic
to my perfume, I have been using it for 10 years.” Dr. Jacobs explains that the
person has used the perfume for 10 years, and has finally acquired an allergy
due to repeated exposure. An allergen does not irritate, but rather triggers a
flare-up of atopic dermatitis only in a small number of people who have become
allergic to the substance from prior exposures over time. Allergens are usually
animal or vegetable proteins from foods, pollens, or pets. Everybody with
atopic dermatitis must avoid the irritants. Those with known allergies should
likewise avoid the allergen. Proving that someone is allergic can be difficult.
What about
emotional stress?
Many older children and adults with atopic
dermatitis realize that stressful occurrences in their lives cause their atopic
dermatitis to flare up. Anger, frustration, and embarrassment all may cause
flushing and itching. The resultant scratching can cascade into a perpetuating
dermatitis. People with atopic dermatitis can learn how to avoid
stress-triggered flare-ups. Two key concepts are involved: 1. Coping with psychologically stressful events. 2. Controlling
scratching behavior. Some suggestions that might help are: Establish regular
structure for the behavior involved in skin care. Many people with atopic
dermatitis have found it helpful to establish a schedule with a regular daily
routine. In this routine, they include skin care along with all other
activities of daily living such as brushing and flossing teeth or washing the
dinner dishes. Yet, it is important to maintain a flexible attitude so that
when the dermatitis flare and extra skin care is needed, it can be worked into
the routine. It is important to recognize stressful situations and events.
Before you can learn how to cope with the stress in your life, you must first
notice when and how often stressful situations arise. These include day-to-day
hassles as well as major events such as a job change, money problems, legal
difficulties, family illness, etc. Ask yourself, "How do I react to
stress?” “How does my body feel when I am stressed?" It is important to
learn stress management techniques. Certain approaches to reducing stress can
be done on your own, such as setting priorities and organizing your time. Some
activities that may reduce stress and that need little or no professional
guidance are regular aerobic exercise, hobbies, and meditation. A brief
consultation with a psychologist can help you deal with stress. Keep a record
in a diary of calendar of time and situations when scratching is worst, and
then try to limit your exposure to such situations. Many people with atopic
dermatitis scratch the most during idle times. Engaging in a structured
activity with other people or keeping busy with activities that involve the use
of your hands may help prevent scratching.
How to control
dust mites?
The dust mite may be an important cause of eczema
and asthma. The dust mite can only be seen with a microscope but it is
nevertheless a common and significant cause of sensitivity. It may make the
nose run or cause sneezing and wheezing. In some patients it also contributes
to exacerbations of atopic dermatitis. A dust mite The dust mite hides
in the dust that can be found in even the cleanest bedroom - deep in carpets
and curtains and in the seams of mattresses, where even the most house-proud
individual can't find it. Bedding The dust mite is choosy and prefers
wool and cotton to artificial fibers. So you can deter it by using only
synthetic bedding materials, and by washing all sheets every week. A duvet - continental quilt - reduces
laundry, but feather, down or flock fillings must be avoided in these and in
pillows. The dust mite's favorite haunt
is bedding, particularly mattresses. Measures to reduce the
numbers of house dust mite. Special mite resistant covers for pillow,
mattress and duvets can be purchased. Sunlight destroys the dust mite. In the summer, put your blankets and
mattresses out in the sun and make the most of the sunshine to dry out your
sheets and pillowcases. Put soft toys in the freezer for a few hours. Use a vacuum cleaner Daily use of a vacuum
cleaner will help to reduce the amount of dust containing the mite. Vacuum all
carpets, especially in the bedrooms and under the beds. If you can, choose
vinyl flooring rather than carpet as it tends to hoard less dust. Vacuum
upholstery and curtains, and don't forget the mattress and blankets. Wash
curtains regularly. There is less dust when curtains are made of lightweight materials.
They also need to be vacuumed often, and wash them regularly too (perhaps
six-weekly). Be tidy Put clothes away in wardrobes, and that includes the dressing
gowns! Use a da p duster to do the cleaning as it is much better at collecting
dust than a dry one. Dehumidifiers can inhibit house dust mites, as they prefer
a moist environment.
What To Expect
In discussing the management of both acute and
chronic atopic dermatitis, it is important to bear in mind that atopic
dermatitis, is a disease for which there is no real cure. Atopic dermatitis can
only be controlled. Atopic dermatitis, does, however, usually improve on its
own, spontaneously as the patient reaches early adulthood. The extent of this
improvement tends to depend upon how severely affected the patient was during
childhood. Studies have shown persistence of severe atopic disease into adult
life ranging anywhere from 10% to 70%. Many people who do show improvement in
their eczematous disease do, however, go on to develop asthma and/or allergic
rhinitis (hayfever). Additionally, the three conditions asthma, hay fever, or
atopic dermatitis may also coexist indefinitely. If you have any other
questions, please ask Dr. Jacobs at your next visit.
|