January Week 1: Eczema

Article: Management of Atopic Dermatitis in the Pediatric Population

CASE 1: You are at CYAS clinic seeing a 2-month-old baby boy for a well child check. His mother brings to your attention that the patient’s older sister has mild eczema. His Mother asks you for guidance for prevention of eczema in this baby, especially regarding breastfeeding and introducing solid foods.

– What advice would you give her regarding benefits of breastfeeding versus formula?
– Should she delay initiating solid foods to prevent development of eczema?
– What would you advise regarding bath time and use of soaps?
– What are common triggers for atopic dermatitis?

CASE 2: You are now seeing a 6-year-old female for a sick visit, who has an dry, erythematous rash on his arms, especially at inside of elbows, trunk, and back of knees. You notice scaling and excoriation. Mother reports that emollients used to control the dry skin, but it has worsened during last few months.

– What would be your initial treatment for this patient? What side effects do you anticipate might occur?
– What second-line agents would you consider if symptoms do not improve?
– If the patient later had signs of secondary infection, what therapies would you recommend?
– When would you recommend an antihistamine for pruritis?
– When would you refer the child to a specialist?