DRY SKIN / ECZEMA / ATOPIC DERMATITIS

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What causes this illness How its spread
Normal course of the illness Treatment
Similar illnesses When to seek help
atopicderm1.jpg (29301 bytes) This is a classic bad case seen on the face.
atopicderm2.jpg (28017 bytes) This case is a little bit more severe, but shows how extensive it can be.
kerpilaris1.jpg (42703 bytes) This is Keratosis Pilaris. Notice the individual bumps. They are usually skin color with little white heads, but they can be red as shown here. You can read about it below. The treatment of this requires topical steroids(Cortaid) or keratolytic agents (Epilyte of Lacticare).

This looks as it sounds, like dry skin and is not peeling skin ( please see that section if you baby is less than 3 weeks old ). The skin will be light pinkish to red in color, slightly raised or rough feeling, may be flaking with very small flakes, may itch, usually will be on the cheeks, chest, outer upper arms and legs and occasionally on the knuckles, elbows and knees.

The dry skin is often caused by repeated wet dry cycles, using water that's so warm it melts off the bodies protective oils, baby soaps or lotions ( yes that's right ), sometimes harsh laundry detergents and is definitely inherited. Dry skin is NOT an allergic disorder (check out the latest dermatology texts), although many people with dry skin have allergies and vise versa, and is not affected by diet.

Dry skin is not infectious or contagious and therefore cannot be spread.

Dry skin is worse in the winter when the air is dry, when the air is dried out further by heating and when we like to cleanse in hot water. Dry skin will come and go depending on the above factors. About half of those whom still have dry skin will develop normal skin in each of the following times of life: childhood, adolescence, young adulthood or possibly middle age. Occasionally a raised clear or skin color bump the size of a pin head will develop in the dry skin areas called KERATOSIS PILARIS (picture). This is prevented by the above, but will only resolve with the use of the steroids or keratolytic agents.

The treatment for dry skin involves removing the causes noted above. First, stop using all baby skin products. Second, the best skin cleansers to use are Cetaphil, Dove, Tone and Neutrogena. Wash your baby with luke warm to warm water, NOT HOT. Third, apply a good moisturizer within 3 minutes of getting out of the tub ( this seals in moisture rather than just covering up dry skin ). Good moisturizers are Eucerin, Lubriderm, Keri, Moisturel and Curel. Before going on to steroids, some dermatologists will use Aveeno cream ( not the lotion ). Forth, we resort to topical steroids for hot spot use, such as very red or raised areas that don’t respond to the above. Use over-the-counter hydrocortisone ( Cortaid 5 or 10 ) applied sparingly to small areas of skin only twice a day and no more than a week at a time. If an itch is present, hydrocortizone will also greatly help and you may also use oral over-the-counter Benedryl (diphenhydramine). Lastly, for the Keratosis Pilaris you might try Lacticare or Epilyte.These are actually weak lactic acid. The lactic acid acts as a moisturizer and dissolves away the thickened dry skin (keratolytic action). Lactic acid sometimes stings a little when first used.

Psoriasis - usually this looks "angrier" or brighter red and has a characteristic silvery scale.

Neonatal Acne - this looks like it sound like tiny acne and may be present below 4 to 6 months of age, but is usually only on the face or upper trunk.

Heat Rash (Milia Rubrum) - this looks like bright to dark red pin pricks that are slightly raised, but do not have a wide base of redness underneath. Heat bumps also tend to occur singly, while dry skin comes in patches.

Erythema Toxicum - this is only present in the first few weeks of life and is large sheets of bright red skin with occasional pin head sized pustules that contain yellow fluid. This is similr to neonatal acne, but has a wide base of redness and may be found below the chest where neonatal acne should not be

Cradle Cap - This is dry skin on the scalp.

Should this treatment not work, you should let your physician know at the next well child visit or make an appointment if it is getting very severe. If you are not sure if the lesions look infected or not, then call your doctor during office hours to see what to do (call anytime if your child looks very ill). We may try low potency steroids or stronger moisturizers before going on to the dermatologist.

Copyright 2006 Joe Matusic, MD. This document may be freely copied and distributed, providing there is no charge for duplication or the material and this copyright notice remains affixed.

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