Eczema

  1. General information
    1. Atopic dermatitis, often the first sign of an allergic predisposition in a child; many later develop respiratory allergies
    2. Usually manifests during infancy
  2. Medical management
    1. Drug therapy
      1. Topical steroids
      2. Antihistamines
      3. Coal tar preparations
      4. Cautious administration of immunizations
      5. Medicated or colloid baths
    2. Diet therapy: elimination diet to detect offending foods
  3. Assessment findings
    1. Erythema, weeping vesicles that rupture and crust over
    2. Usually evident on cheeks, scalp, behind ears, and on flexor surfaces of extremities (rarely on diaper area)
    3. Severe pruritus; scratching causes thickening and darkening of skin
    4. Dry skin, sometimes urticaria
  4. Nursing interventions
    1. Avoid heat and prevent sweating; keep skin dry (moisture aggravates condition).
    2. Monitor elimination diet to detect food cause.
      1. Remove all solid foods from diet (formula only).
      2. If symptoms disappear after 3 days, start 1 new food group every 3 days to see if symptoms reappear.
      3. The food that is suspected of causing the rash is withdrawn again to make sure symptoms go away in 3 days and is then introduced a second time (challenge test).
    3. Check materials in contact with child's skin (sheets, lotions, soaps).
    4. Avoid frequent baths.
      1. Add Alpha Keri to bath.
      2. Provide lubricant immediately after bath.
      3. Pat dry gently with soft towel (do not rub) and pat in lubricant.
      4. Avoid the use of soap (dries skin).
    5. Administer topical steroids as ordered (penetrate better if applied within 3 minutes after bath).
    6. Use cotton instead of wool clothing.
    7. Keep child's nails short to prevent scratching and secondary infection; use gloves or elbow restraints if needed.
    8. Apply wet saline or Burrow's solution compresses.

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