Protocol for Diagnosis, Management, and Follow-up Care of Disorders

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Protocol for Diagnosis, Management, and Follow-up Care of atopic dermatitis

The growth and development process of pediatrics from infancy to adolescence is subject to many common body system disorders. It is important to understand the disorders in advance and enact strategies to deal with them when they arise. An advanced practice nurse caring for such patients require having a clear understanding of the pathophysiology and epidemiology of the disorders that helps to recognize the symptoms and selection of appropriate assessment and treatment options (Burns, Dunn, Brady, Starr & Blosser, 2013). The Essay provides a discussion of a protocol for the diagnosis, management, and follow-up care for a pediatric body disorder labeled as atopic dermatitis.

Pathophysiology and epidemiology of the disorder

Atopic dermatitis (eczema) is a common skin disease in children. They get the disease during their first year of life, and they develop dry and scaly patches on the skin. The Patches can also appear on the forehead, scalp, and the face. Atopic dermatitis is itchy, and infants tend to rub their skin to relieve the itch and can be intense to deny the child the comfort of sleep. The disease is long lasting and in some instances accompanied by asthma (Silverberg & Simpson, 2013). There is no specified cure for atopic dermatitis but treatments, and self-care measures help to relieve the itching effect and prevent new outbreaks.

Atopic dermatitis has an association with increased serum level of immunoglobulin E and a family history of atopy that describes a group of disorders like asthma and allergic rhinitis. The sensitization to environmental and food allergies has a clear association with atopic dermatitis phenotype but is not a causative factor that contributes to the severity of the disease.

A significant proportion of the U.S population has symptoms related to eczema. The statistics average at 31.6 million with eczema and nearly 17.8 million having moderate to severe atopic dermatitis. The prevalence of the disease in childhood in the United States is 10.7 % and goes as high as 18.1 % in the individual states. One child in every three children with atopic dermatitis has moderate to severe disease. Recent studies revealed that the prevalence of eczema in adults goes as high as 10.2 %, and it suggests that many children with the condition are affected to adulthood (Silverberg & Hanifin, 2013). The incomplete understanding of the disease results in the high prevalence and lack of good treatments.

Protocol for the diagnosis, management, and follow-up care

The signs and symptoms of atopic dermatitis vary significantly from one person to another. They include itching especially at night, and red to brownish-gray patches on the feet, hands, ankles, wrists, neck, upper chest, eyelids, elbows, and knees. Also common are the small raised lumps that leak fluid when scratched, cracked and dry skin, as well as sensitive and swollen skin due to scratching (Ring, Alomar, et. al., 2012)

No lab test is required to identify atopic dermatitis. The doctor makes a diagnosis by examining the skin and reviewing the medical history. Also important is to use the patch testing or other tests to identify other skin diseases and conditions that occur with eczema (Eichenfield, Tom,, 2014).

The disease is persistent and requires various treatments until its control. The response to treatment does not entirely end the disease since the signs and symptoms may reappear. The medications for the condition include creams to control itching and inflammation, creams to repair the skin, drugs to fight infection, and oral anti-itch drugs. The doctor prescribes a corticosteroid cream to control itching. Calcineurin inhibitors like tacrolimus and pimecrolimus affect the immune system, hence suitable when other drugs fail. The oral anti-itching drugs taken include antihistamines and diphenhydramine.  The applicable therapies include wet dressing, stress management, and behavioral modification (Ring, Alomar, et. al., 2012).

The patient ought to undergo for a follow up if the treatment options do not improve the rashes. The child may need a prescription medication to control the rashes, and the doctor may recommend using an oral antihistamine to lessen the itching and cause drowsiness. The measure helps the child to sleep at night. The management of the disease involves the use of skin rehydrates like petroleum jelly and use of steroids. Another method is to use a bleach bath that decreases bacteria on the skin and related infections (Eichenfield, Tom, 2014).

Impact of culture on the care of patients with the disorder   

Some cultural practices like the application of Vaseline to the infants in the African-American population may require additional education due to its perceived impact on the management of atopic dermatitis. It is not the ideal product for repair of the skin for a baby with eczema. The barrier effect is a big component of the disease and parents ought to apply a ceramide moisturizer on the baby before applying Vaseline on top. The application of the ceramide moisturizers is necessary to address the skin barrier repair regardless of the ethnicity and race of the child. Thus, the culture of particular population segment may have a significant effect on the effectiveness of the commonly used medications and therapies for the care of the children with atopic dermatitis.

It is evident that atopic dermatitis is a common disease that affects children in their growth stage, and thus requires appropriate methods to address it. Nurse practitioners have an obligation to understand the methods of diagnosis, management, and follow-up care of patients with the disease for effective management.



Burns, C. E., Dunn, A. M., Brady, M. A., Starr, N. B., & Blosser, C. G. (2013) Pediatric primary             care (5th ed.). Philadelphia, PA: Elsevier.

Eichenfield, L. F., Tom, W. L., Berger, T. G., Krol, A., Paller, A. S., Schwarzenberger, K., … &   Cordoro, K. M. (2014). Guidelines of care for the management of atopic dermatitis:            Section 2. Management and treatment of atopic dermatitis with topical therapies: Journal        of the American Academy of Dermatology, 71(1), 116-132.

Ring, J., Alomar, A., Bieber, T., Deleuran, M., Fink‐Wagner, A., Gelmetti, C., … & Schäfer, T.     (2012). Guidelines for treatment of atopic eczema (atopic dermatitis) part I. Journal of             the European Academy of Dermatology and Venereology, 26(8), 1045-1060.

Silverberg JI, Hanifin JM. (2013) Adult eczema prevalence and associations with asthma and       other health and demographic factors: A US population-based study. J Allergy Clin Immunol. 2013 Oct 3. doi: PII: S0091-6749(13)01366-3. 10.1016/j.jaci.2013.08.031.

Silverberg JI, Simpson EL. (2013) Association between severe eczema in children and multiple     comorbid conditions and increased healthcare utilization. Pediatr Allergy Immunol;   24(5):476-86.

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