and ongoing, clearing and maintaining the resolution of the pruritic plaques that interfered with sleeping. Adding medical-grade skincare can supplement appropriate topical steroids to reduce visible atopic disease and improve symptoms.
Patient 6: This 2-year-old girl with Fitzpatrick phototype I presented with recurrent rashes and scratching in her sleep since infancy (Table 6). She appeared to have a lanolin allergy, which allergy testing did not confirm. She previously used topical mupirocin and nystatin with no improvement. She visited a dermatology provider and received hydrocortisone 2.5% cream, which did not help. She had difficulty sleeping because she was scratching her skin in her sleep. Upon a visit to our clinic, we changed her treatment to alclometasone 0.05% ointment for the face, mometasone 0.1% ointment for the body, and oral hydroxyzine 10 mg. CER-containing hydrating cleanser and CER-containing healing ointment were applied once or twice daily. The parents were also advised to switch detergent to a hypoallergenic product.
After eight weeks of treatment, the patient had a better sleep pattern with less waking up during the middle of the night. The regime had significantly cleared her skin of visible disease.
The main lessons learned: Lanolin-containing products may aggravate AD flares, and switching to lanolin-free skincare products can provide significant improvement with appropriate topical steroids.
DISCUSSION
AD is clinically diagnosed based on history, morphology, distribution of skin lesions, and associated clinical signs and symptoms.1-3,14,16 Other factors predicting severity include early-onset (<2 years of age), comorbid atopy, and family history of AD.14,16 The diagnosis should be reevaluated, particularly in patients not responding to appropriate treatment, to verify the accuracy of this diagnosis.14,16
Understanding the specific properties of newborn and infant skin and discussing and recommending skincare products and routines to parents may help promote a healthy skin barrier, delaying flares.16 Daily and ongoing skincare using a gentle cleanser and moisturization is the foundation of AD management, as evidence-based international guidelines recommend.4-6 Moisturizer application initiated in early infancy may delay or prevent AD flares, especially in high-risk populations, and when used continuously.14-16
Educating parents about the difference between healthy newborn skin and infants predisposed to AD who may have xerosis after birth is instrumental in promoting skin health.16 When seeing newborns and infants with healthy skin in their clinic, advisors may or may not discuss skincare, and it's rare for parents to bring it up on their own. Advisors recommend building the discussion into the first newborn visit to ensure it happens.
