For Patients: Identify Your Child’s Atopic Dermatitis Triggers

For children with atopic dermatitis, common irritants and allergens in the surrounding environment can cause the skin to become red and swollen, with an itchy rash. These irritants and allergens -- i.e., "triggers" -- can be found both indoors and outdoors, at home and at school.

Triggers that irritate the skin include, for example, fragrance-laden soaps, synthetic fabrics, and even perspiration. Since many children with atopic dermatitis also have allergies, including hay fever, asthma, and/or food allergies, allergens such as pollen, pet dander, dust mites, and mold -- as well as eggs, dairy and nuts -- can also trigger a flareup.

Your doctor will help you identify your child's triggers, and may recommend you keep a daily diary. This will make it easier to spot patterns, since it can take several hours for a flareup to develop.

Once the triggers have been identified, you'll need to find ways to avoid them. Again, your doctor will have suggestions, but be aware that you may need to make some lifestyle changes that affect the entire family -- such as, for example, having a pet.

The good news, though, is that when combined with good skin care, and the proper use of other treatments, effectively managing these triggers will help you regain a sense of control over the child's health and well-being.

Here's what experts recommend in terms of triggers and possible solutions:

Trigger: Animal Dander

If you have a pet with fur or feathers (birds produce a form of animal dander), you need to determine whether this is making the symptoms worse.

What you can do: Remove the pet from the family home for a few weeks and see if the symptoms improve. In most cases, though, the best solution is to find a new home for the pet; note that dander from a hamster or guinea pig can be a powerful allergic trigger.

Trigger: Pollen, Air Pollution

Pollen is an allergen in air pollution, along with many other substances, including industrial emissions. On days when the pollen count is high, and/or the Air Quality Index is rising (indicating high pollution/pollen counts), exposure should be minimized.

What you can do: Limit your child's outdoor time, and wait for 2 hours after cutting the grass before going outside. Close windows to reduce the amount of pollen or air pollution entering your home or car, and turn on the air conditioning.

Also: dry clothes in a dryer rather than outside on a clothesline where they may be exposed to airborne pollen.

Trigger: Wool or Synthetic Fabrics

Any fabric made from wool or synthetics can trigger a flareup.

What you can do: Make sure all your child's clothing and bedding is made from natural, breathable fabrics such as 100% cotton. Remove all tags. If the child's gym or sports uniform is made from polyester, make sure it is loose-fitting. For washing, use a mild, fragrance-free detergent, and be sure to wash anything before being worn for the first time.

Trigger: Dust Mites

Microscopic bugs known as dust mites can trigger a flareup of atopic dermatitis.

What you can do: Put dust mite covers on pillows and mattresses. Remove area rugs or carpeting from your child's bedroom, and from common areas such as the kitchen and family room.

Dust and vacuum your child's bedroom each week, and wash bedding in hot water.

Trigger: Scented Products

Fragrance-containing soaps, lotions, shampoos, detergents, fabric softeners, air-fresheners, scented candles, colognes, perfumes, essential oils, and the like are all big no-no's for the child with atopic dermatitis.

What you can do: Choose products formulated for sensitive skin that are labeled "fragrance-free." Also, be aware that "scent-free" products may contain a masking fragrance. Avoid wearing cologne, perfume, or fragrance of any kind and ask friends visiting your home to do the same.

Trigger: Sunburn

Too much sun, even in children with darker skin tones, can trigger a flareup.

What you can do: Avoid exposure to direct sunlight in any child younger than 6 months old. Stay in the shade or create your own using an umbrella or the hood of a stroller.

Dress your baby or toddler in a lightweight long-sleeved shirt and pants, a wide-brimmed hat, and sunglasses with UV protection. In children older than 6 months, use a mineral-based or "barrier" sunscreen that contains zinc oxide or titanium dioxide and offers broad-spectrum sun protection with an SPF of at least 30, and make sure the sunscreen is fragrance-free.

Trigger: Dry Skin

Dry skin can cause itching and scratching that leads to a flareup.

What you can do: Moisturize your child's skin often. Avoid antibacterial soap, which is extremely drying.

Use a humidifier to offset dry air caused by indoor heating. Make sure the child is not directly exposed to hot air from heating vents, radiators, or a fireplace.

Give your child a short bath each day with warm (never hot) water. Wash only the high-traffic areas: face and hands, armpits, feet, and the diaper or groin area. If there is inflammation, immediately after bathing is a good time to apply a thin layer of prescription cream or ointment to still-damp skin; unaffected skin can be treated with a rich moisturizing cream or ointment such as petroleum jelly, which will hold in more moisture than lotion can.

Trigger: Saliva and Food

Saliva and food that is left on the skin can trigger redness and swelling in infants and toddlers.

What you can do: Absorb using a soft cloth. Gently pat the skin; never rub. Apply a thin layer of petroleum jelly to protect vulnerable skin on the chin, around the mouth, and on the cheeks and hands.

Trigger: Perspiration

When your child gets overheated, perspiration and its salty residue can irritate the skin.

What you can do: Keep your home at a comfortable temperature, no higher than 75ºF, avoid putting too many covers over your child at night, and always dress your child in layers that can be removed as needed. Also, rinse off perspiration (or skin-irritating chlorine from a swimming pool) with a quick shower or bath, and moisturize while the skin is still damp.

Trigger: Cigarette Smoke

Second- and third-hand cigarette smoke can trigger a significant flareup, and smoking inside the home puts every family member's health at risk in any case. Second-hand smoke is inhaled, and third-hand smoke refers to coming in contact with smoke residue that clings to surfaces, including clothes, walls, carpeting, and curtains.

What you can do: Ban smoking inside your home, and commit to a 100% smoke-free living environment. Be aware that second-hand cigarette smoke is not eliminated by opening a window; sitting in a separate area; or using ventilation, air conditioning, or a fan. If you smoke, talk to your doctor about ways to quit that are effective and long-lasting.

Resources

Good information is available from the American Academy of Dermatology.

Read previous installments in this series:

For Your Patients: Atopic Dermatitis 101

For Your Patients: How Will My Doctor Diagnose Atopic Dermatitis?

For Your Patients: Skin Care to Control the Symptoms of Atopic Dermatitis in Children

"Medical Journeys" is a set of clinical resources reviewed by physicians, meant for the medical team as well as the patients they serve. Each episode of this 12-part journey through a disease state contains both a physician guide and a downloadable/printable patient resource. "Medical Journeys" chart a path each step of the way for physicians and patients and provide continual resources and support, as the caregiver team navigates the course of a disease.