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Expert Q&A

	By David L. Fay, M.D. Family Physician Associate Director, Waukesha Family Practice Residency Program

My 5-month-old has relatively severe eczema (already had a bout with impetigo). I regularly use Eucerin liberally all over his body. Double rinse his clothes (use Dreft detergent), only cotton clothes, sheets, blankets, etc. I use 2.5 percent hydrocortizone when it gets REALLY bad (splits in the skin). While on vacation (seven days) it COMPLETELY disappeared -- within 12 hours of returning home it returned. Could it be diet? Poor air quality in the house? Any suggestions?

What you are describing sounds most like atopic dermatitis, which is clinically difficult to distinguish from eczema, and many authorities believe is different aspects of the same disease. It is immune-mediated, but not necessarily allergic; this means the manifestations are caused by a reaction of the immune system, but to many various triggers. Things which can trigger a bout of dermatitis include: changes in temperature and humidity; excessive salivation (as in teething infants) and moisture of the skin; excessive washing; contact with allergens or other irritating substances; microorganisms; foods; and emotional stress. From your description of complete clearing while away from home and recurrence upon your return, it sounds like some environmental factor related to your home. This could be an animal, the weather where you live, or any item in or around the home. Your best bet is to analyze the differences between your home and your vacation destination to see if you can find the culprit. Keep in mind, however, it may be more than one item causing the problem.

You are doing the right things at home, but you may wish to consider the following: if you have a pet, you may need to consider removing it from the home; if you smoke, stop; consider a humidifier and air filter; use artificial plants instead of real ones; avoid aerosols; and use plastic mattress and pillow covers.

The good news is that most children will "outgrow" this by 18 months; the bad news is it usually returns after puberty.

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