The FP recognized that the boy had a case of severe atopic dermatitis. There was considerable inflammation of the skin, but the erythema was less visible because of the boy’s darker skin color.
The father had the full atopic triad: asthma, allergic rhinitis, and atopic dermatitis. This explained the son’s inheritance of atopic dermatitis. The FP recommended aggressive treatment and the father was relieved, as it hurt him to see his son suffer.
The FP prescribed a tub (454 g) of 0.1% triamcinolone ointment to be used twice daily all over the involved skin, especially after bathing. The FP said that the child should be given a daily bath with mild soap. (There is no data to support the notion that bathing dries out the skin; bathing before the use of topical steroids actually helps the steroids absorb into the skin.)
Oral hydroxyzine was prescribed for use before bedtime, as this sedating antihistamine can improve sleep and diminish pruritus. Considering the severity of the condition, the FP decided to prescribe a short course of oral prednisolone for one week (1 mg/kg/d). There is some evidence that dilute bleach baths help atopic dermatitis, but the FP decided to discuss this at a future visit—after the flare had subsided. There was no evidence of a secondary infection, so antibiotics weren’t prescribed.
Photos and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Usatine R, Finklea L. Atopic dermatitis. In: Usatine R, Smith M, Mayeaux EJ, et al, eds. Color Atlas of Family Medicine. 2nd ed. New York, NY: McGraw-Hill; 2013:584-590.
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