Clive Anderson - AT THE DERMATOLOGISTAnswering readers' letters
Preventing the atopic march
My two-year-old was diagnosed with Atopic dermatitis (AD) since she was four months old. My question is, 'how can we avoid or prevent the march to asthma taking place?' Are there special types of diet or use of a topical ointments that will reduce the incidences of recurrence or indeed halt the march?
P.O.
Response: I hope the second article 'Halting the atopic march' answered some of your questions. Please understand that the concept of atopic dermatitis, being the first manifestation of a disease process that leads to allergic rhinitis, asthma and food allergies, is at this point still only a theory. While there is considerable evidence to support this theory it is by no means conclusive.
Studies are currently under way to try to determine how treatment affects this 'march'. Perhaps the most important study of this kind involves the use of the non-steroidal immunomodulator Elidel. Regardless of the outcome of these studies atopic dermatitis is a disease that affects significantly the quality of life of the child and their family, and good control of the disease is important.
Remember that atopic dermatitis is a chronic recurrent disease for which there is no cure. Flare-ups are going to occur even with the best treatment. There are some children in whom diet plays an important role in the severity of their AD. This group of persons will benefit from a special diet in which the offending allergens are eliminated. The most common offenders are milk, eggs, nuts, seafood wheat and chocolates. An elimination diet, which excludes these products, is best undertaken with the supervision of your health care provider because of the importance of these products in the child's diet.
You are on the right track using a mild soap to bathe your child and applying a moisturiser within two to three minutes afterwards to trap moisture in the skin. Continue the use of the moisturiser often, especially on itchy patches of skin. As the child grows, she can be given a small bottle of moisturiser to carry around and be encouraged to rub it on rather than to scratch at itchy skin.
It is so important to break the itch/scratch cycle. Some bath additives like oatmeal do help to soothe itchy skin. Try to use a non-biological detergent and ensure that clothes are well rinsed to remove all traces of detergent from the fabric. Avoid rough, harsh fabrics in the child's clothing. The good news is that most often the severity of AD improves with age. Finally, if your child has frequent episodes of itchy skin, maintain a close relationship with
your dermatologist.
Dry scalp
I have had dry scalp from childhood days. I'm 33 years old and have tried all sorts of medication from my doctor.
Michelle
Response: Michelle, you report having a scaly scalp since childhood and a severe reaction including blistering of the scalp, and a rash to the back of the neck, shoulders, forehead and eyes after using a shampoo. It sounds as if you have had a contact dermatitis caused by the shampoo. This may be either an irritant or an allergic reaction. You do not say what treatment you are on or for how long, so it is difficult to comment on possible side effects. The therapeutic shampoos can, however, result in the hair becoming dry and brittle and causing the hair to break. You should be under the care of a dermatologist.
Bumpy face
I have bumps on my face which I'm having a hard
time controlling. I use
medicated soaps, and drink water very frequently.
A.M.
Response: Most often bumps on the face are due to acne. Unless the acne is very, very mild you will not be successful in controlling it with medicated soaps only. While drinking sufficient water is important for good health it will do little for bumps on the face. Most persons with acne bumps feel that frequent washing or scrubs are the answer wrong! Acne is not caused by bad hygiene and more scrubbing is not the answer.
Products that contain Benzoyl peroxide (an excellent anti-acne medicine) are available over-the-counter in soaps, cleansers or creams. These may be used as the basis of a regimen for acne control. These bumps, even the small ones, can leave scars on the face. This scarring may occur even when the bumps are not squeezed. The scars are often seen as 'open pores' and are not easily eradicated. Many different acne treatments exist because no
single one works with all types
of acne and for everyone.
Dr. Clive Anderson is a Dermtologist and Venereologist; email: yourhealth@gleanerjm.com.
