Infection prevention: avoid rubber, toys: risk of GRAM – folliculitis
Baths
in saline 9g Nacl in 1lt (raise to 30-36g NaCl)
in KMnO4 1/10000: not on the head (effective, increases pH very slightly (paradoxical) but reduces St Aureus)
Moisturization of the skin
“stay less in water”
“drink more water”
Applying the adequate quantity of cream/ointment
2mg/cm2 are needed
for the whole body this corresponds to 36g/day in an adult
easy practical rule=the fingertip unit: 0.5g=2 adult palms=2% of the total body surface area (TBSA). Ointments are not very different, The main reason for differences are the tube opening sizes. This rule is calculated for an opening of 5mm in diameter.
Passive protection against scratching
bandaging
stockings on upper limbs
special socks (Japan) prevent friction and intertrigo
Which textile to choose ?
favour silk (Ricci, BJD)…
… and silver (Gauger).
What is the Best emollient for AD ? It varies:
for a given patient (geography…)
for a given phase of dermatitis (acute, chronic, infected)
for a given area
Allergy prevention
some washing machines can reduce allergens even without detergent
Devices killing House Dust Mites (“HDM killer”) : no proof it can reduce the signs and symptoms of AD.
Some vacuum cleaners are Atopy friendly
Common practical problems
perioral dermatitis in AD patients: “cover with zinc oxide” (not steroids !)
Cod liver oil? Vitamin D regulates tight junctions, gap junctions… (keratinocyte integrity therefore barrier function of the epidermis). Oral administration do DA patients would be effective.
Source of information: Gelmetti C. Tips for Management of atopic eczema. 19th Congress of the European Academy of Dermatology and Venereology (EADV) – Gothenburg (Göteborg), Sweden (Sverige)
