A 5-year-old boy presents with the severe rash shown in the photographs. The rash is pruritic, and it is especially intense in the flexural areas. The mother reports that the symptoms began in infancy (when it also involved the face) and that her 6-month-old child has similar symptoms. Which of the following is the most appropriate treatment of this condition?
- Coal-tar soaps and shampoo
- Topical antifungal cream
- Ultraviolet light therapy
- Moisturizers and topical steroids
- Topical antibiotics
Eczema is a chronic dermatitis that occurs in a population with a strong personal or family history of atopy. The skin presents initially as an erythematous, papulovesicular, weeping eruption, which progresses over time to a scaly, lichenified dermatitis. From about 3 months to about 2 years of age, the rash is prominent on the cheeks, wrists, scalp, postauricular areas, and arms and legs. In a young child 2 to 12 years of age, mainly the extensor surfaces of arms, legs, and neck are involved. Pruritus is a predominant feature, and scratching leads to excoriation, secondary infection, and lichenification of the skin. The rash has a chronic and relapsing course, and treatment is determined by the major clinical features. Cutaneous irritants (bathing in hot water, scrubbing vigorously with soap, wearing wool or synthetic clothing) should be avoided, and maximal skin hydration with emollients is essential. Topical moisturizers, steroids, and topical calcineurin inhibitors (tacrolimus and pimecrolimus) are the mainstays of therapy for atopic dermatitis. The use of antihistamines can provide additional relief from pruritus.