While discussing the management for Atopic dermatitis, I would advise prevention first. It is very important to moisturize the child during a flare using a good moisturizer. A good moisturizer would be a paraben and fragrance free syndet possibly which is free of soap. Number 2, we should minimize the bathing and the washing. Number 3, it is important during these days when the child is suffering from a flare to keep his ambient environment a little humid. So you can use a humidifier or somewhere where the child cannot approach or tamper with. You can opt a hot vessel with steaming water. That would sort of humidify his immediate environment. Immunosuppresants play a major role in the treatment of Atopic dermatitis. It is a chronic inflammatory disorder. So generally the itching doesn’t get resolved by over the counter anti allergic syrups. They would need something that will pacify the immune cells that are attacking the skin during a flare. So the first line of treatment apart from the moisturizer would be an emmolient. An emollient also tries to preserve the moisture and prevent the transepidermal water loss the first line of management would be topical steroids which should be used for a minimum period of time. We should not abuse it or use it for a period of 2 – 3 weeks and it should always be done under the supervision of a dermatologist. Number 2 is topical calicineurin inhibitors. They form an interesting non-steroidal option because atopic children are predisposed to repeated flares. They would need a non-steroidal option for maintenance.so I would recommend these calicineurin inhibitors. Like tacrolimus and pimecrolimus depending on the age of the baby to maintain the results. Of course id the child is not responding to topical steroids, then we have to go for oral options for a shorter period of time like oral steroid are given for a very brief period of time. Parents are very scared when we mention the term steroids. An atopic child generally does not need immunosuppressants especially during the acute phase to calm it down.it should not be used for beyond 3 weeks, it should not be used indiscriminately, it should not be used for more than once a day. Please consult your dermatologist before opting for even topical steroids. Coming to oral steroids, one would prefer to give a short course of steroids in cases refractory to topical treatment. Other immunosuppressants like cyclosporine have been tried to varying success. There is another option called as phototherapy for recalcitrin cases and in cases where we cannot give an oral immunosuppressant. Most of the time people have fear of going steroids to their child.so in such cases, they have the option of giving narrow valve phototherapy to an older child would also be an option to reckon with.
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