Tips for Preventing Further Skin Irritation with Adult AD

Preventing Further Skin Irritation

Personal care products and fabrics can be a major source of potential irritation for people living with atopic dermatitis.

Most atopic skin is more sensitive to “normal” products and fabrics so educating patients on what products to use and to avoid can go a long way towards improving symptoms.

Personal care products are a major source of potential irritation. Many patients with AD may also have a degree of contact allergy or sensitivity to ingredients commonly found in topical products. Avoiding personal care products such as soaps, lotions, body oils, and perfumes that advertise fragrance or botanical ingredients can help. Patients may be interested in these because they are advertised as being “natural.”

Instead, patients should carefully select just a few very bland, fragrance free products for regular use. Emollients should be free of fragrance or other added ingredients. Petrolatum is one of the cleanest and most hydrating emollients, though it can be greasy to apply. Similar guidelines should be given for soaps and patients should avoid spraying perfumes directly on their skin.

Key Ideas: avoid products with any type of fragrance or botanical additives, avoid using a large variety of different products: stick to a minimal regimen of one bland moisturizer and one bland soap

Fabrics can also be irritating to AD patients. Avoiding more scratchy fabrics such as wool can help as can avoiding synthetic fabrics like polyester.

Patients can also have a sensitivity to some chemicals used in wrinkle-free fabrics and should be educated to watch for this. All new clothing should be washed in fragrance free detergent before wearing. Light loose cotton clothing is ideal. All laundry products should be fragrance free, as there are many options for “free and clear” laundry detergents.

All dryer products should be avoided such as fabric softeners and dryer sheets as these can contain many potential irritants. Dryer balls can be used to cut down on static.

Key ideas: use laundry detergent that is free of fragrance and dyes, replace dryer products with dryer balls

Patients with hand and foot dermatitis can have particular difficulty with their skin disease. These body parts get “used and abused” more often than most other skin and therefore can be more difficult to control.

For those with hand dermatitis, providers should assess how frequently patients are washing their hands and encourage them to avoid over-washing. Avoiding cleaning and washing dishes by hand is another tip that can improve hand skin. Hand sanitizers tend to be less drying than traditional soap and water, though the alcohol-based solutions can sting if patients have open fissures.

Patients with foot involvement should try to wear cotton socks with shoes to help absorb moisture and avoid wearing tight fitting shoes or heavy boots for extended periods of time. When at home, patients should be encouraged to remove shoes and allow the skin to get air.

Picking of the skin on the hands and feet should be avoided as this can perpetuate skin irritation and inflammation.
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Key ideas: minimize hand and foot contact with water, utilize hand sanitizers over soap and water when appropriate, avoid picking skin on hands and feet

Showering and bathing is another area where providers can provide simple tips to AD patients. We have already discussed using bland soaps. Prolonged water exposure can lead to increased dryness and irritation of the skin. Showers and baths should be kept short, no longer than 15 minutes. Very hot water use should also be avoided, as extreme water temperature can increase skin dryness. Bathing should try to be limited to no more than once a day, as over washing can also dry the skin.

Dilute bleach baths can be utilized to prevent secondary bacterial infection where ¼ cup laundry bleach is added to a bathtub of water and patients soak for 10 minutes.

Key ideas: minimize length of bathing and keep to no more than once a day, try to use warm water instead of very hot, and consider use of weekly bleach bath to prevent skin infections

Lindsay Chaney Strowd, MD, is assistant professor, dermatology at Wake Forest School of Medicine in Winston-Salem, NC.