atopic dermatitis, an intensely pruritic, often excoriated inflammation commonly found on the face and antecubital and popliteal areas of allergy-prone (atopic) individuals. In infancy and early childhood it is called infantile eczema. Also called atopic eczema. Compare contact dermatitis. See also atopic. ▪ OBSERVATIONS: There are no specific cutaneous signs of atopic dermatitis. The lesions seen are a result of scratching from intense itching. The constant and severe itching sets up an itch-scratch-rash-itch cycle that produces red, scaly papules, which coalesce into plaques that ooze and crust. Common sites include the hands, face, upper trunk, and flexural areas, such as bends in knees and elbows. Lesions tend to be symmetric on extremities. Diagnosis is made primarily through clinical evaluation and evidence of personal or family history. Immunofluorescence may show that elevated IgE levels and serum eosinophilia is present as cases worsen. ▪ INTERVENTIONS: Primary treatment for acute outbreaks includes emollient lotions to decrease dry skin; topical steroids or pimecrolimus cream (Elidel) or tacrolimus ointment to decrease inflammation; oral antihistamines or other antipruritics to control itching. Outbreak prevention is aimed at avoiding triggering factors, such as sudden temperature shifts, contact with irritants, foods that provoke exacerbations, stressful situations, allergens, or excessive hand washing. ▪ PATIENT CARE CONSIDERATIONS: Nursing care is aimed at helping the individual break the itch-scratch cycle and reduce outbreaks. This includes proper use of topical medications, and instruction in ways to prevent or reduce outbreaks. Adequate rest can reduce the threshold for itching. Modest exercise in a controlled temperature environment can increase circulation. A balanced diet that avoids food triggers can strengthen skin protective functions. Hygiene is aimed at cleanliness, avoidance of drying, and maintenance of acidic pH on skin. Nails should be kept clipped to decrease abrasion from scratching. Affected individuals need to know that this is a genetically determined chronic disease with cycles of exacerbation and remission.
