February Week 1: Eczema

Articles:

Effects of Early Nutritional Interventions on the Development of Atopic Disease in Infants and Children – Pediatrics, 2008

Atopic Dermatitis and Ichthyosis – Peds in Review, 2010

Cases/Questions:

Case 1:

You are seeing a first time mom with her 2 week old for a well child check. Mom is concerned about her baby developing eczema because so many of her friends have kids with it. There is no family history of atopy or food allergies.
Mom wants to know what is best – breast feeding or formula feeding – to help prevent eczema.
If Mom breastfeeds, should she avoid certain foods such as dairy, egg or peanuts?
Would delaying starting solid foods past 6 months of age help prevent the development of atopy in her baby?

Case 2:

You see a 12 month old for a rash on his trunk that is erythematous, rough, and has been itching him. On exam he clearly has eczema but luckily no secondary infection. Mom has been bathing him once a day in hot water using soap and not applying any lotion to him.
What would you counsel her to do about baths?
What would you counsel her to do about daily skin care? What lotions are best for every day use? For use with an eczema flare?
Would you recommend she take her child to an allergist?
Would oral benadryl help with the itching?
Would you recommend bleach baths? How do you give one?

Cases/Questions written by Dr. Jess Long