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TissueIntegrity

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TissueIntegrity:AtopicDermatitisinChildren
By:MyraCabus

TissueIntegrity

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Atopicdermatitis,morecommonlyknownasatopiceczema,isachronicinflammatory
dryskincondition.Eczemamanifestsasdry,scaly,red,itchyareasontheskin.Thisskin
conditioncommonlyaffectschildreninareasallovertheworld.Treatmentforeczemaconsists
ofavoidingtriggers(certaintriggerscauseanallergicreactionthatmanifestsaseczema),
emollientstosuppressitching,andtopicalcorticosteroids.Psychosocialdistressfromthe
physicalmanifestationsofeczemaissuppressedwhentheeczemaisphysicallyhealedproperly
withtreatment.(Robinson,2011)
Eczemamaybecomeinflamed,infected,and/orexacerbatedifnottreatedpromptlywith
appropriatemedication.Skinbreakdownisarepercussionofunattendedeczema,whichis
prominentinchildrenworldwide.Themaingoalismanagingeczemaanditscomplicationsasto
avoidfurtherskinbreakdownandinfectionsthatmaycausemoreseriousproblems.
Bacterialandviralskininfectionscanhindercorticosteroidsand/oremollientsfrom
treatingatopicdermatitis.BacterialikeStaphylococcusaureusand/orStreptococcuspyogenes
cancauseweeping,crustingandpustulesinworseningeczema.Laterininfection,feverand
malaisecanoccurinchildrenwhichleadstohospitalizationandsystemicantibioticstotreatthe
infection.(Robinson,2011)
Atopicsyndromeoccurswhenthethreediseases:eczema,allergicrhinitis,andasthma
aremanifestedinachildoradult,thoughmostcommonlyseeninchildren.Atopicdermatitis
affectschildrenphysicallyandpsychosocially.Manytimes,theeffectsofatopicdermatitisgoes
undertreatedduetopoorrecognitionoftheskinconditionbyparentsandthosewhosufferfrom
eczema,aswellaspoorunderstandingoftheskinconditionbyhealthcareproviders.(Robinson,
2011)

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Inchildrenyoungerthan18monthsofage,eczemaisseenmostcommonlyontheface
andvisualextensuraldermatitis,occurringinthecrevicesoftheskin(i.e.behindthekneeor
behindtheelbow).Inpeopleanyage,ahistoryofdryskininthepast12monthsalsomay
indicateeczema.Ahistoryofasthmaand/orallergicrhinitisordiagnosisofeczemainan
immediatefamilymembermaypredisposeanypersontoeczemaoratopicsyndrome.Schoolage
childrenmayencounterproblemswhenbeingtreatedwithemollientsforeczema,asitmay
conflictwithactivitiessuchasswimmingorphysicalexerciseinschool.Becauseeczemaisa
commonskinconditioninchildren,goalsaremadetotreatthesymptomsthatcause
psychosocialandphysicaldistressinchildren.Symptomsaretreated,astherearecurrentlyno
preventativeorcuringfactorineczema.Importantfactorsintreatingeczemainclude:parental
andchildeducationontherecognitionandmanagementofeczema;earlyrecognitionand
diagnosisoftheskincondition;andappropriatemedicationforeczema.(Robinson,2011)
Eczemahasperiodsofexacerbationsandremissions.Recognitionofallergictriggersthat
exacerbatetheskinconditionisimperativetomanagingeczemainchildren.Manytriggers
includesoaps,detergents,certainfoods(i.e.milkandmilkproducts),contactallergens,and
inhalantallergens.Therearemanysoapalternativesforchildrenwitheczema,aswellaslotions
specificforatopicdermatitis.Asmoreresearchisbeingdoneandmorediagnosesofeczemain
childrenarebecomingmoreprominent,manyhealthcareprovidersaremoreawareoftheskin
conditionanditscomplications.Thispromotesearlierrecognitionandtreatmentinchildrento
furtherdecreasetheincidencesofphysicalandpsychosocialdistress.Parentsareencouragedto
recognizeandreportanysuspiciousskinconditionsinchildrenasearlyaspossibletoavoid
exacerbatingeczema.Manymedicationshelptoimproveatopicdermatitisandatopicsyndrome,

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suchasantihistamines,calcineurininhibitors,andbandagesanddressings.Themostcommon
medicationsforchildrenwithatopicdermatitisareemollientsandcorticosteroids.Emollients,
alsoknownasmoisturizers,areusedintheearlystagesofeczematopreventexcessivedryingof
theskin.Manycompanieshavecreatedlotionandcreamproductsforchildrenwithatopic
dermatitis.Parentsshouldbetaughtthatbathsandwaterfurtherdrytheskinandshouldnotbe
usedexcessivelytotreateczema.Someemollientoilscontainantisepticswhentheskinhas
becomeinfected.Ingeneral,thedryerthechildsskin,thegreasiertheemollientshouldbe.
Emollientsshouldbeappliedinthedirectionofhairgrowthtoavoidfolliculitis.Thefrequency
ofapplicationshouldalsobeadjustedtothedegreeoftheeczema.Itisimperativethatparents
andchildrenrecognizeandlearnpropermanagementofatopicdermatitistodramaticallyreduce
theriskofsystemicinfectionfromeczema.(Robinson,2011)
Manytimes,parentsarewaryofthelongtermuseoftopicalcorticosteroidsinchildren.
Theuncertaintyoflongtermeffectsofcorticosteroidssuchashydrocortisonedelaysimmediate
treatmentinimprovingeczemasymptoms;However,itisresearchedthatlongtermuseof
corticosteroidsinchildrendoesnotposeanysignificantsideeffects.AresearchinthePractice
Nursejournalshowsthatthosechildrentreatedwithtopicalcorticosteroidshadmuch
improvement,andevensymptomfreeperiodsofeczemauponexamination,whereasthosewho
didnotusetopicalcorticosteroidshadlittleimprovement.Skinthinningwasnotfoundinthose
childrenwhowereplacedoncorticosteroidtherapy,whichisacommonconcernforparents
worldwide.(PracticeNurse,2011)
Atopicdermatitisisaconditionthatismorecommonlytreatedtodaythanbeforein
children.Parentalrecognitionandeducationoftheskincondition,avoidanceoftriggers,and

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propermedicationtreatmentisapriorityforparentswithchildrenwhohaveatopicdermatitis.
Thisleadstoadecreasedincidenceofskinandsystemicinfectionsduetoeczema.

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Resources

Robinson,J.(2011).Assessmentandmanagementofatopiceczemainchildren.Nursing
Standard,26(1),4856.
Topicalcorticosteroidssafetouseforchildhoodeczema.(2011).PracticeNurse,41(8),6.