GOOD DAILY SKIN CARE IS A MUST!!  Skin becomes dry because normal skin oil glands may secrete an inadequate amount of surface oil to prevent excess evaporation of water from skin. Use of soaps and handling of paper, abrasive clothing or other skin chafing further removes oils and dries and damages the skin. The skins oil layer also keeps allergens (dusts, molds, animal danders) out of skin and away from allergic T cells and histamine cells (“MAST cells”) deeper in skin. It is important to practice the basic principles of good skin care daily, because atopic dermatitis is a chronic problem and you may always have dry, sensitive, easily irritated skin.  Sun, wind, low humidity, cold temperature, heredity, age, excessive washing without use of moisturizers, abrasive clothing and use of harsh, drying soaps can cause dry skin conditions.  

1. When taking  baths or showers avoid using soaps except in areas where they are needed.  Most days use some soap under arms or where needed, but try to wash with water alone on dry, irritated skin areas. 
2. When you do soap the skin use only a gentle soap such as Dove, Oiltum, Alpha Keri, Neutrogena, Purpose, Basis, or a non-soap cleansing agent such as Aveeno or Emulave, or a liquid cleansing wash such as Moisturel, Neutrogena, or Dove.  All soaps remove skin oils.
3. Gently pat away excess water and immediately apply moisturizer or the special skin medications prescribed for you onto your skin.  This will seal in the water and make the skin less dry and itchy.  Creamy baby oil or Petroleum Jelly, are good inexpensive occlusive preparations to seal in the water.
4. Apply a good moisturizer every night at bedtime and often twice daily. Again, creamy baby oil or Vaseline Petroleum Jelly are simple and cost effective.  Other products for daytime use include Aquaphor Ointment, Eucerin Cream, Moisturel Cream or Lotion, DML Cream or Lotion, Lubriderm Cream or Lotion, Neurtogena Emulsion, Eutra, Vaseline Dermatology Lotion, or LactiCare Lotion, throughout the day whenever the skin feels dry or itchy.
5. Low to medium potency topical cortisone ointment (such as triamcinalone, Elocon Cutivate, Hydrocortisone or others) can be used at bedtime and twice daily if needed for several weeks any time skin rash is flaring.  
6. Potent cortisone ointments (Diprolene AF, Temovate, etc.) should be used only for 1-2 weeks maximum and should not be used on face, skin folds or fragile skin areas (groin, eyelids etc.)  Newer anti-inflammatory ointments Elidel and Protopic, may also be helpful on skin areas flaring with eczema.

AVOID ALLERGENS THAT PROVOKE DERMATITIS

1. Care must be taken to avoid substances which may flare your disease.  Dust is the most important allergen causing atopic dermatitis, so dust avoidance (breathable polyurethane (“classic”) pillow & mattress covers) are absolutely essential for all patients.  Cat & dog danders, molds, pollen dusts, and some foods can also trigger Dermatitis.
2. Proper skin testing and/or challenges must be done in a controlled environment with physician supervision to determine which allergens provoke your dermatitis.

REDUCE SKIN IRRITATION.                                                           

1. Wash all new clothes with at least a double rinse before wearing to remove formaldehyde and other chemicals.
2. Residual laundry detergent in clothing may be irritating.  While changing to a milder detergent may help, more often adding a second rinse cycle to ensure removal of soap, is better.
3. Wear garments which allow air to pass freely to your skin.  Open weave, loose-fitting, cotton-blend clothing may be most suitable.  Do NOT wear wool, feathers, or other dusty, abrasive clothing.
4. Work and sleep in comfortable surroundings with a fairly constant temperature and humidity level.
5. Keep fingernails short to help prevent damage due to scratching.  Realize that scratching rubs dust and allergens into skin worsening eczema. 
6. Appropriate use of antihistamines is important to reduce itching through both histamine blocking and sedation effects.  Nighttime antihistamines help minimize itching and avoid scratching.
7. Use hypo-allergenic sunscreen on a regular basis and avoid sunburn.
8. Residual chlorine or bromine on the skin after swimming in a pool may be irritating.  Immediately after swimming, take a shower or bath, washing with a mild soap from head to toe, and then apply and appropriate moisturizer.

MINIMIZE STRESS.  Anxiety, anger, and frustration are commonly experienced by patients with atopic dermatitis and can provoke itching.

1. Prevent the disease!  Closely follow skin care & allergy control measures above.  It is important to understand the chronicity of this disease, the triggering factors, and the management measures which can help control it.
2. Have family members learn about the disease so they can be supportive.
3. Seek counseling if your environment is non-supportive.

CONSULT WITH YOUR PHYSICIAN AT THE FIRST SIGN OF ANY FLARING OF YOU SKIN. AN OCCASIONAL BRIEF PREDNISONE BURST MAY HELP QUICKLY RESTORE NORMAL HEALTHY SKIN. Remember it is much easier to keep skin normal once it has normal oil barrier function; so MOISTURIZE regularly and avoid chaffing skin.

REMEMBER, EACH PATIENT REQUIRES INDIVIDUALIZED THERAPY, AND WHAT WORKS FOR ANOTHER PERSON MAY NOT WORK FOR YOU.