Atopic dermatitis: Dermatologist guide

Atopic dermatitis
Atopic dermatitis

Atopic dermatitis: Dermatologist guide

“Doctor, my daughter has atopic dermatitis. As soon as I stop using steroid creams and anti-allergic, she gets rash. How can I stop her flares without medicines?”

This is the first request I get from parents who are struggling to stop flares of atopic dermatitis. After successfully treating hundreds of patients of Atopic dermatitis at our clinic, I am sharing the secret of stopping the flares in this article.

This article is long, but if you miss any details you might not get the benefits. I spend on the average 15-30 minutes with parents of atopic kid because atopic dermatitis has huge impact on the family.

What triggers Atopic dermatitis?

There are 4 important triggers in Atopic dermatitis

-dry skin


-exposure to irritants and allergens

-sudden withdrawal of steroids

How to stop atopic dermatitis?

We at our clinic address all the above triggers. Children who could not be controlled with oral steroids are now better with stringent skin care measures.

The approach to stop flares of atopic eczema is not easy. You have to be vigilant and working daily to keep skin calm daily. But the results are rewarding. So are your ready to calm atopic dermatitis of your child? Here is what you need to do!

Avoid dry skin 

You would agree that skin of your child gets dry and flaky easily. The skin barrier of dry skin is breached easily. Therefore, it is more likely to get irritated or flared. If you keep your child skin hydrated, skin barrier is kept intact and flares will reduce drastically. Now let us understand how to take care of atopic skin.

Step 1: Bath time

Bath with lukewarm water. Hot water can strip NMF (natural moisturising factor) from the skin. This is the reason hot water is used for cleaning a greasy utensil. Cold water is not harmful, but a lukewarm water is best. Give short baths. Half bucket or a quick shower is ideal.

Use a non-soap fragrance free body wash. Avoid regular soap bars because they can disturb the skin barrier. A right cleanser can preserve the natural lipid layer of skin. It doest not disturb the pH of skin. Here few brands that you may try:

Cetaphil Restoraderm

Fragrance-free option

Available in


-United States @

-United Kingdom @

-Canada @

Aveeno Baby Body Wash and Shampoo 

body wash for atopic dermatitis

Has mild fragrance

Available in


-United States @

-United Kingdom @

-Canada @

Step 2: Put coconut oil liberally

After bath, pat dry with soft towel and put liberal amount of coconut oil on slightly damp skin. If your child skin gets red, irritated or itchy with coconut oil, then use a hypo-allergenic moisturiser.

Step 3: Apply steroid cream on area of rash

Apply Steroid cream prescribed by dermatologist on the rash after 30 minutes. Do not use steroid cream without asking dermatologist because they have side effects like skin thinning, infection, stretch marks to name few. For full list of side effect, read this article, Betnovate.

If are in a United States,  You can buy hydrocortisone cream OTC. Make sure to buy brand that does not contact allergens. Aveeno Maximum Strength 1% Hydrocortisone Anti-Itch Cream is one such option. You can start it immediately. It is safe to use twice a day for 14 days. However, it is mildest steroid that might not be enough many time. Meanwhile book a consult with your GP or dermatologist.

Step 4: Apply moisturiser on rash 

While steroid can ease the inflammation, right moisturiser will aid in healing your skin. You literally have to put it every 2 hours in first week, every 4 hourly in second week, and every 6 hourly until the rash heals.

Reapply moisturiser if your child itches. This will soothe the inflammation and reduce itching sensation.A wrong moisturiser can be disaster in atopic skin. Here are few brand recommendations:

Cetaphil Restoraderm lotion

Available in


-United States @

-United Kingdom @

-Canada @

Cerave Moisturizing Cream

Available in


-United States @

-United Kingdom @

-Canada @

Aveeno Skin Relief Intense Moisture Repair Cream



-United States @

-United Kingdom @

-Canada @

Step 5: Moisturise full body at night

You should moisturise the skin of your child twice a day, even if it is normal. In the morning use coconut oil. At night use healing moisturiser. Put it liberally. You can choose from any brands given in above section. 

Step 6: Apply steroid cream on area of rash

Apply Steroid cream prescribed by dermatologist on the rash after 30 minutes.

Do not stop steroid abruptly

Do not stop steroids abruptly. Instead, apply twice a week for a month so that rash does not come back. If the rash comes back as soon as you stop steroid cream, the you should ask your dermatologist for non-steroidal cream like Tacrolimus.

Steroids work like magic. However, you if you stop them abruptly, eczema comes back. The idea is to reduce them gradually. Replace them with non-steroidal preparation to avoid side effects.

Avoid Itching

Atopic dermatitis is “itch that rashes”. Meaning that Itching triggers the rash. Moreover itching is compulsive. Itch is not at all under the control of your child. Therefore, no point scolding them. Don’t panic when ypur child itches badly.

First step is to make them feel at ease. Any strong emotion form your side can trigger the itch in your child. If see your child itching, Hug them and gently take there hands off the rash. Apply moituriser. If episode of itching is severe, the give anti-allergic if the last dose was given 8 hours earlier. 

Most parents avoid giving anti-allergics to eat. But that is going to make the condition of your child worse. Give them anti-allergic prescribed your dermatologist twice a day in beginning, and then at night until rash settles. Night time anti-allergic will give good sleep. Child wont scratch unknowingly at night. 

You can consult doctor for the best anti-allergic for your child. Mostly Allegra (above 6 years)  can be given during day time and Cetirizine (above 2 years) at night. Do ask the dose from your GP.    

Act before the rash starts

Every day while applying moisturiser, feel for areas on skin that feel drier, or gritty. Start hydrating these area every 2-4 hours until they heal. 

This is red signal. Most often the trigger can be traced for this flare. It s absolutely important to remove for triggers (mentioned in next section).

Otherwise atopic dermatitis tends to come back.

Avoid triggers

Atopic dermatitis can be triggered by food, cloth, sweat, winters, dryness, stress..the list is long. Watch this video for the complete list:

We at our clinic, strictly tell parent that nothing should touch their child skin except the products mentioned above and cotton.

Skin care products

Literally any skincare product can trigger atopic dermatitis. Once the skin is sensitive, then products that suited earlier might become trigger. Therefore, stick to the products prescribed by your dermatologist.

Do not try cosmetics, fragrances, herbs, home remedies, or normal moisturisers. They might trigger rash.


The only fabric that suits atopic skin is cotton. Avoid synthetic or woollens. If your child says that a particular attire is itchy or uncomfortable, then believe him/her. Avoid artificial jewellery or any nickel based buckles or bands. 


Avoid fluffy, furry and woollen stuff. Cover them with cotton. 


Avoid stuff toys, slime, chemical based toys, cosmetics, nickel etc.


Avoid if you see a definite relation.


Food can trigger Atopic dermatitis in small children. I have mentioned the list of food items in above video. 

Avoid cow’s milk, peanuts, seafood, wheat, soya or uncommon food items until 9 months of age. Do not introduce more than 1 food item in a week. Even for older children, introduce a new flavour of ice-cream, or new brand of biscuits one per week. Maintain a food diary. Write down the date of flare and see if you have introduced anything new in last few days. If you notice repetition of food items in your dairy. Avoid them.


Carpets catch dust, so does heavy curtains, furniture, statues, etc. Keep your home less stuffed. 

Play in park or on floor

Atopic dermatitis is backed by hygiene hypothesis. The cleanser child is kept more is the chance of allergy. Let your child crawl on floor or play in park, get dirty in rain water when they are not flaring up. One they have skin rash, these might make rash worst.


Moulds tend to inhabit rooms that are less airy and damp. So, make sure that you let enough light and sun shine into your home. 

Improve gut microbiome

Lot of studies now prove that probiotics can improve atopic dermatitis. Good bacteria in intestine prevent leaky gut. Therefore, curd or Yakut is good for atopic kids. Avoiding junk and unhealthy food can also help.

This is the reason, AD runs in family. If one parent is affected, then there are 50% chances that the child might develop AD, but this percentage increases to 80% if both the parents are affected.

Symptoms of Atopic dermatitis

Atopic Dermatitis can present with the following symptoms:

  • Dryness and roughness of skin
  • Itching is usually severe and occurs in episodes triggered by heat, low humidity, woollen and synthetic clothes, and sudden change in temperature.
  • Rashes on body fold like eyelids, neck, at the bend of arms, wrist, and back of the knees. In severe cases, the whole body may be involved. The rash can be red and oozy initially, but with time skin becomes brown and thick, if proper treatment is not given.

The good news is that most children show remission during adolescence, but they might have eczema on hands, eyes, ears, etc. during adulthood.

Thus, professions that involve contact with chemicals like hairdressers, artisans, cookery, chemical industries, etc. should be avoided.

Watch this video to know about symptoms in detail especially, understand the reason why your child cannot stop itching voluntarily:


Atopic dermatitis needs constant care from a dermatologist. Self-medication should be avoided because overuse of steroids can cause side effects.

Your dermatologist might prescribe:

  • Most of the mild cases settle with the application of topical steroids only.
  • Anti-bacterial and anti-viral, if there are signs of infection.
  • Anti-histaminic syrup to reduce itching and help to put your irritated child to sleep.
  • Oral steroids can be used.
  • Recurrent cases may be put on tacrolimus and pimecrolimus.
  • In rare cases, immunomodulators like cyclosporine may be needed.
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