Dr Robert Sidbury: How to Treat Facial Atopic Dermatitis in Infants

This session's talk is the first time anyone has ever delved deep into looking at atopic dermatitis in infancy, specifically of the face, says Robert Sidbury, MD, MPH, professor of pediatrics at Seattle Children's Hospital.

Transcript

Can you describe the highlights of your presentation on treating infant atopic dermatitis?

I specifically talked about treating the face in infancy, which is, as I mentioned in the talk, the first time anyone has ever carved out that particular topic in a session. That's kudos to Dr Silverberg for realizing that that—as I called it in this session— is the "original sin of atopic dermatitis," as most patients with atopic dermatitis develop it in childhood.

Most patients who develop atopic dermatitis in childhood, it starts, as an infant, on the face. And so, it's really important because not only is that sort of the "original sin," as I called it, it's also a place where pediatricians and parents, and oftentimes dermatologists, are reluctant to treat because it's a baby, it's around the eyes, it's close to the mouth, they might ingest something you put on their face. So, there are a lot of reasons why it's an important area to try to learn more about.

What is the most effective approach to managing and treating atopic dermatitis in infants?

It starts with nothing pharmaceutical at all, because a lot of times infants have irritant contact dermatitis; you biopsy it, it's identical to atopic dermatitis. It is eczema in a sense; it's rash, it itches, it's red, it's inflamed, it can get infected. All of these things are true, but sometimes it's primarily due just to the frequent wetting and drying that is part and parcel of being an infant, where a good percentage of the food goes on the face and not in the mouth. And then there's cleaning with potentially harsh wipes and things of that nature, which can make that area quite a challenge.

One of the first things that I always want to make sure parents realize is that, and therefore, try to mitigate it by simple things like putting barriers around the mouth before they feed. A petrolatum base, something relatively thick, around the mouth and the chin and the chest where the bib gets saturated. Wet, dry, wet, dry, the enemy of eczema. Put that barrier around the mouth before the meal, they feed, they get messy, after the meal you clean them up, put another barrier, they're good to go!

It's not a medicine, parents are very comfortable with it. They just need to realize that that's part of the problem, that sort of wet, dry, wet, dry, that sometimes something so simple can mitigate.