Care of the Pedicatric Patient with Atopic Dermatitis and Secondary Bacterial and Viral Infections

1. Statement of Clinical Problem: Care of a Caucasian infant, and two African American school aged males with an atopic dermatitis flares. Infant presented atopic dermatitis and secondary impetiginization, second child presented with eczema coxsackieum and the third with eczema herpeticum. The pruritis caused the patients to excoriate their skin, eroded vessicles and bullae created from the viral conditions required wound care as well.

   1. A skin culture determined the etiology of the infection.

   2. Antibiotics and antivirals are prescribed.

   3. Pruritis was managed with deep dermal hydration through soaks and wraps.

   4. Transepidermal water loss was managed with topical ceramide creams and bland ointments.

   5. The flare was treated with topical steroids appropriate to the level of the flare.

   6. Wound care with petrolatum gauze, and medical grade honey was used on excoriations and erosions.

2. Education was provided to the family to manage atopic dermatitis. Etiology of atopic dermatitis i.e. filaggrin deficiency, ceramide deficiency was discussed.

3. Description of past management: Oral steroids have been used in the past to manage atopic dermatitis flares but are no longer used to manage flares. They are contraindicated for patients with eczema herpeticum.   

4. Current Clinical Approach: Antibiotics, antivirals and topical treatments with steroids, moisturizers and wound care were effective.
5. Patient Outcomes: Relief from pruritis was immediate with the application of wet wraps. Increased patient comfort and ability to sleep was seen in one day. Decreased erythema and granulation of open areas was noted in three days. Parents reported the patient’s looked better and sleep better. Parents articulated how to do treatments at home.
6. Conclusions: collaboration with hospitalist, and dermatology prepared CWOCN APRN can diagnose and treat patients with atopic dermatitis who require dermatological and wound care treatments.