A 9-year old boy with a history of chronic atopic dermatitis & recurrent skin infections had extensive eczematous dermatitis clinically, with a history of starting behind his knees at the age of 4 years, spreading to the popliteal and antecubital fossae, arms and abdomen.

He rendered a history of scratching the lesions, particularly at night, with disturbance in sleep. He used chronic moisturizing therapy and topical corticosteroids, but experienced seasonal flares of eczema during the winter months. At the age of 6 years, he also experienced bronchial asthma with a persistent cough. No history of any food allergy was reported. Family history rendered his father to be asthmatic and his younger sister to have allergic rhinitis and cow’s milk allergy. He was referred to an allergist for further evaluation and management.

Skin examination showed scattered scaly eczematous patches in the flexural areas of his upper and lower extremities. Impetigo “crust-like” lesions with serum oozing were present on the left elbow.

Laboratory testing of an environmental allergen panel was performed. His total serum IgE level was found to be markedly elevated at 4300 IU/ml with highly positive ImmunoCAP specific IgE levels to dust mite, mouse, and cockroach, along with multiple trees and grass pollens. Dust samples from his home demonstrated a very high level of the house dust mite.

His family was explained appropriate allergen avoidance and integrative pest management (IPM) strategies. 

Atopic dermatitis is a chronic inflammatory skin condition that generally begins during infancy and is the most common skin disease in children under the age of 11 years. Potential causes include irritants such as soap and detergents, food allergens, contact allergens, and skin infections.

The aim of topical therapy is to protect the skin from scratching and environmental factors and to suppress the inflammatory changes and infection if present. Emollients inhibit water loss and provide a protective coating; they are recommended in all patients with atopic dermatitis.

Wet wrap therapy refers to wet bandages applied over emollients and/or topical steroids. The use thereof is indicated in acute flares of atopic dermatitis in cases that are severe and refractory to conventional topical corticosteroid treatment. The main advantages of wet wrap therapy is that it rehydrates the damaged skin, reduces itching and erythema, cools the skin, and enhances the penetration of topical medication utilised. It also provides a physical barrier against scratching, which in turn prevents secondary infection.

Source: Ann Allergy Asthma Immunol. 2015;114(1):6-11. doi:10.1016/j.anai.2014.08.016