March 29, 2020

by drplasticpicker

Today the politicians are again arguing about who is to blame for the skyrocketing COVID-19 cases. But in California, there is a glimmer of hope. We began mandatory quaratining relatively early, and in our community our local leaders have been working together across the aisle to help our homeless communities and provide rent relief to our population. Beaches are closed and our local friends the Police were driving calmly up and down the beach telling our relaxed San Diegans to disperse. I was born and raised in San Diego, and I have a great love for my homeworld (Star Trek reference). In this increasingly polarized world, there is still a sense of civic responsibility and engagement in my hometown. I am hoping this helps us #flattenthecurve. Looking at the prediction models, it looks like we will likely have enough ICU beds for our county. So I am still vigilant but hopeful. I wrote yestserday that the best way I can help, is by doing the job I am qualified to do – a general outpatient pediatrician who middle-manages a department and is responsible for a few actual outpatient clinics https://drplasticpicker.com/be-like-a-tree-during-the-covid-19-cytokine-storm/.

So in that vein, I will be an outpatient pediatrician and give general advice about eczema! This is such a common problem and I hope this gives you some relief since we are trying to keep these “minor” issues at home. But minor issues are important to deal with as well.

What is Eczema? Eczema is really an umbrella term that is used to describe several inflammatory dermatoses that are characterized by erythema and can include scale/crust. Those several inflammatory dermatoses include (1) Seborrheic dermatitis (2) Allergic contact dermatitis (3) Irritant contact dermatotos (4) Atopic dermatitis . So in clinic now I will try to be more precise and tell you if you have one of the 4 specific inflammatory dermatoses, or I will tell you that your child has an inflammatory dermatitis instead of eczema. Maybe that will confuse people more?

What is Atopic Dermatitis? Atopic dermatitis in more specific. It is an immune-mediated, CHRONIC, relapsing skin disorder. It is characterized by itching (pruritis). This is why we call it that “the itch that rashes.” It seems even itchier than it looks! And since it often looks really bad, that is saying a lot! Xerosis (dry skin). Inflammation. Lichenification (thickened skin).

What is the Atopic Triad/Atopic March? You will hear Dr. Plastic Picker refer to this in the office, either the Atopic Triad or the Atopic March. I promise you I’m not trying to just sound smart. I feel this wording and imagery is helpful. It gives me a framework to understand how your family’s medical history will influence your child’s clinical course, and to anticipate what may happen with your child over the next 18 years. The Atopic Triad is the common clustering in individuals of atopic dermatitis, asthma and allergic rhinitis. Having one does not mean you will 100% have the other, but the odds are higher. The Atopic March is when individuals will progress in their life to have the following condiitions eczema, food allergies, asthma and allergic rhinitis.

I can hear half of my parents saying, “Okay Dr. Plastic Picker! We know you went to Crimson University. Can you just tell us how to care for our child? I have baseball practice to get to.” So now I will just get into the general advice on skin care. This is meant as general advice for children with atopic dermatitis. For specific advice, please call your doctor. If I’m your doctor, message me through the patient portal and not this blog! This blog is for fun and entertainment purposes. My entertainment mostly! LOL.

What is Wrong With My Child’s Skin (Diagnosed with Atopic Dermatitis)???!!! The etiology of atopic dermatitis is that your child’s skin is abnormal. It is abnomral because skin is supposed to be a barrier, and your child’s skin has abnormal barrier function. It has less filaggrin, ceramides and other lipids than non-atopic dermatits children. Your child’s skin also loses water more easily (layman’s way of saying increased trans-epidermal water loss) and that is why the skin is always so dry. Your child’s skin also has increased allergen and irritant absorption, which is why it gets inflammed and itchy more easily than other non-atopic dermatitis children.

How Do I Care for His/Her Skin? Rather than telling you what topical atopic dermatitis creams you need, lets go back to basics. It is so much easier to just give a patient a prescription. But the most important thing is how you care for your child’s skin. Details matter quite a bit, that is why Dr. Plastic Picker is asking you more questions in clinic because I have to change your regimen. For your child’s skin, it should be gentle cleansing, aggressive moisturizing, and topical medications if needed. This is different than the advice I was taught 15 years ago in my dermatology rotations.

How Do I Bath His/Her Skin? Daily bathing is okay and is it especially important in hot weather, because sweat can be an irritant for eczematous skin. Bathing accomplishes the following functions. It removes bacteria, removes scale/crust, removes irritants and allergens, and provides moisture. Baths should be short (5-10 minutes) in warm NOT HOT water. Use a gentle cleanser. Pat the child dry (so that the child is still a bit damp) and then apply any prescribed medication, and then moisturize the skin! Remember what I say in clinic, Your child is like a muffin! We want to lock in the moisture and slather that moisutrizer ALL OVER! I don’t know where I came up with the muffin imagery and it doesn’t make sense, but Dr. Plastic Picker loves moist muffins.

What Kind of Cleanser Should I Use? Dr. Plastic Picker does not receive any money from anyone, other than my HMO salary and a few rental properties. So this is advice from several trusted dermatology lectures and actual dermatologist have told me. Any brand is fine. It seems different ones work for different people. I always advise the cheapest! (1) Dove for sensitive skin (your doctor prefers the bar because less plastic, but liquid would be okay). (2)Cerave liquid cleanser – own son uses this one. (3) Cetaphil gentle cleanser – our daughter uses this one (4) Oil of Olay for sensitive skin – my mother uses this one (5) Aveeno Advanced Care Wash – this one seems the most readily available at the Walmart across our clinic. Remember always buy things that are fragrance-free. FRAGRANCE-FREE and not unscented. Sometimes companies put fragrances in to make things unscented. Isn’t that crazy?

What kind of Moisturizer Should I Use? Again no speficic product endorsements. The most important is to use CREAMS and not lotions. Lotions dry the skin. CREAMS only please. CREAMS and OINTMENTS have more lipids (remember your kid’s skin is lipid-deficient) and fewer ingredients. It needs to be DYE-FREE and FRAGRANCE-FREE. I advise against anything with fragrances so all those bath and body works stuff, Honest brand, unproven organic “natural” stuff – stay away from those. This is for kids with true atopic dermatitis. If you don’t have eczema, I could care less. Do whatever you want. But for eczematous kids, this is super super important. Just pick from the long list below of things that work. Apply at least TWICE A DAY after you’ve put on any presccribed topical eczema medications. Seems different patients sometimes respond better to the different products. Choose from the list below. Remember Dr. Plastic Picker is a Costco/Target type doctor, not a Louis Vutton doctor. Which is better, because Louis Vutton is a waste of money! (1) Aquaphor ointment (2) Vaseline ointment (3) Vanicream (4) Cetaphil Cream – our son uses this (5) Cerave Cream – our daughter uses this (6) Aveeno Eczema Therapy Cream – my mother in law uses this (7) Eucerin Cream . I used to tell people vaseline or Crisco Vegetable Shorteninig (yes the food thing). That has been recommended by our previous pediatric dermatologist in our practice, but I’ve actually never had anyone use Crisco. Petroleum jelly or vaseline is good, but it lacks the ceramides in the other products.

Wet wraps? This is an intriguing and old fashion way to treat bad eczema. I’ve started this on some of my really bad atopic deramtitis patients, and it has worked. The great thing is that it requires no extra medicines, no extra plastics, and no extra money. It’s just kind of messy and takes time. But it’s worth a try! This is prescribed for flares and bad eczema. It enhances moisture skin penetration and decreases water loss. It also decreases scratching, and supported by various studies. To do a wet wrap (1) Bathe as usual (2) Pat Dry (3) Apply any topical eczema prescribed by your docotr (4) Apply Vaseline (5) Apply warm, damp clothing (6) Apply dry clothing. The kids essentially sleep in damp pajamas that super-moisturizers the skin overnight. Below is a link to a cool How-To video from National Jewish Health. https://www.youtube.com/watch?v=Wf9xt78wG6Y

So that is it! The eczema/atopic dermatitis post I’ve been meaning to write for a while. I hope this helps! But remember, please always check with your own pediatrician. And if I’m your pediatrician, I’ll see you in the office. Remember I only check Dr. Plastic Picker when I have free time. And I don’t want to get in trouble with my HMO. So unless you want me to get fired, send me a message on our patient portal and don’t come to my house! I’m probably at the office anyway.