The Local Treatment of Atopic Dermatitis

Filed under: 4 - Atopic Dermatitis

Although sometimes much good is done by immunologic treatment, and it is certainly worth while because it attempts to get at the cause of the disease, too often it does not actually accomplish much. When all is said and done, skillful local treatment is more valuable than anything else.

It is not necessary to have at your com­mand a large number of preparations. The proper use of a few is more im­portant, and after you have treated many of these patients you begin to see what really works and what does not. It is important to bear in mind that at any given time the eczema may be in different stages on different parts of the body, and one part may need an entirely different treatment from another part. In general, mild

preparations are used for acute eczema, strong preparations for chronic. My favorite lotions, ointments, and pastes are as follows:

I. For Acute Oozing Eczema.- If there is much oozing, a clear wa­tery lotion should be used-not a shake lotion or a salve.

Fig. 29.-An oozy face which has been treated with a shake lotion. This should not be done. Proper treatment is with Burow’s solution, camomile tea, or potassium perman­ganate. (From Brennemann’s Practice of Pediatrics.)

It is best used as a continuous wet dressing, or if this is not possible, it should be sopped on very frequently.

(1) Burow’s    solution    1    tablespoonful Water 1 glassful

(2) Potassium permanganate 1 to 10,000 Potassium permanganate gr. vi Water g iv

1 teaspoonful to 1 quart of water gives about a 1 to 10,000 dilution of permanganate

or

A 5-grain tablet to a gallon of water gives about a 1 to 12,000 dilution

(3)  Silver nitrate  solution,  0.25%.

This  is  used  for  small   areas  only.

(4)  Camomile tea. This is prepared by steeping 4 teaspoonfuls of camomile flowers in a quart of boiling water for 20 minutes. Then strain.

II. Shake Lotions.-

There are innumerable shake lotions. I use the three below more than any others.

(1) Burow’s solution 3 iv Zinc oxide

Talc aa 3 i

Glycerin 3 vi

Lime water 3 iv

This is somewhat astringent and sooth­ing. It is useful for slightly moist areas where two skin surfaces come together as in the front of the neck, axillae, and groins.

(2)  Calamine lotion (TJ.S.P.) (without carbolic)

(3)  Liquor  carbonis  detergens   (N.F.) Glycerin aa 3 iii Calamine   lotion    (U.S.P.)    ad   5 vi

These lotions are useful for rather mild, extensive, maculopapular erup­tions on the trunk. If tar is tolerated No. 3 is better than No. 2. This lotion is painted on with a small ordi­nary paintbrush. If it is too drying it can be alternated with one of the mild “creams” listed below.

III. Ointments and Pastes.-

(1)  Acid Mantle Creme* ‘

(2)  Neobaset t

(3)  Hydrophilic    ointment (U.S.P.)

(4) Petroleum jelly

(5) Toilet lanolin*

None of these has any great thera­peutic action. They are used where the skin is dry, scaly, and where a mild soothing and lubricating action

*Dome Chemical Co.

t Burroughs Wellcome & Co. JE. R. Squibb Co.

Fig.  30.-Papular  form  of  diffuse  atopic  dermatitis.     Local  treatment:     calamine  lotion  with added   liquor  carboms  detergens.     (From   Brennemann’s   Practice   of   Pediatrics.)

Fig.   31-Pruriginous  form   of  atopic   dermatitis.     Local   treatment:     calamine   lotion   with liquor carbonis detergens. Lotions are better than salves for this type.
(From Brennemann’s Practice  of Pediatrics)

is desired. Many children over the age of ten years with long-standing atopic dermatitis have very definite ideas about what they like to use, and what their skin will tolerate. Most of them find that some mild soothing application, such as one of those above, give them as much relief as anything. The first three are water-soluble, the last two are not. Lanolin should not be used if there is sensitivity to wool. There is a great difference in what skins with long-standing atopic derma­titis can tolerate. For some, a greasy preparation such as Lanolin or petro­leum jelly may be irritating; for oth­ers these work better than the water-soluble ointments.

(6)  Salicylic acid gr. xx Petroleum jelly % ii

This is sometimes useful after Swartz’s ointment has been used and there are many small adherent shrivelled scales left on the skin.

Fig. 32.-Note thickening of palm and many flne crisscross lines. This appearance is seen in atopic dermatitis which has lasted a long time. It will continue to last a long time. Such an appearance of the palms is of rather bad prognostic import. (From Brennemann’s Prac­tice of Pediatrics.)

The use of this ointment softens them, and they can then be detached by washing with pHisoderm. Some older children with atopic dermatitis have very “dead,” dry, thick, scaly skins all over which closely approach ichthyosis. Many have keratosis pilaris, which consists of many little horny plugs in the follicles, and is seen particularly on the outer surface of the upper arms and on the lower legs.

Still others have “keratosis palmaris et plantaris,” which is often hereditary, and which is shown by great keratotic thickening of the palms and soles. These three condi­tions cannot be entirely cured and they complicate the therapeutic prob­lem, for such skins “eczematize” very easily from any sort of chronic ex­ternal irritation, particularly in the winter. Ointment No. 6 is helpful; it should not be used over a large body surface at one time. In most textbooks of dermatology large doses of vitamin A are recommended for ichthyotic skins and for keratosis pilaris. I have never seen it do any good.

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