Emergency Department Care

mascap中有一些AD急性期照護的資訊,

不過除了居家照護我們比較能做到,

藥物的部份也只能配合醫生指示,
重要的仍是在家中能做好保養的部份了。
以下資訊供參考:

Emergency Department Care

• Many patients with AD present to the ED during acute exacerbation. Therapy is targeted toward alleviation of pruritus and prevention of scratching. ED physicians must also look for signs and symptoms of bacterial superinfection and treat accordingly.
• Skin care
• • In the acute setting patients should be instructed to bathe once-to-twice daily using mild soaps (eg, Dove). There is no preference over showers or baths, whichever makes the patient most comfortable.---急性期洗澡很辛苦,我的孩子都會大哭,
  • 因為傷口碰到水很痛......我曾經使用太陽曬過的水洗澡,溫度還好（有一點溫溫的）,
  • 但感謝主！約一週後傷口結痂,洗澡就不痛了。我比較偏向直接泡浴,不會以蓮蓬頭沖皮膚,我的孩子 較能接受。
    
  • The patient should dry quickly and immediately (within 3 min) lubricate the skin. Many creams and lotions are available, and the optimal one is the greasiest the patient can tolerate.
  • Creams (eg, Eucerin, Cetaphil) are preferred over lotions, as they have lower or no water content and will not evaporate off of the skin during the day. Parents may use petroleum jelly on infants, but most children and adults will not tolerate the texture.
• Topical steroids
• • Acute attacks should be treated by mid-high strength topical steroids for up to 2 weeks. Medium-to-high potency topical steroids should not be used on the face or neck area because of the potential adverse effects. These are preferred over low-mid strength medications, as they better control exacerbations. Patients should apply the ointment within 5 minutes of twice-daily bathing.
  • Inform the patient about adverse effects of topical steroids (eg, atrophy, hypopigmentation, striae, telangiectasia, thinning of the skin).
• Antihistamines: Physicians have been prescribing antihistamines for years to control the pruritus associated with acute AD. Little evidence exists that antihistamines help with the itching in an awake patient; however, the use of sedating antihistamines is supported to control scratching while the patient is asleep.
• Systemic steroids: The use of systemic steroids in the treatment of acute exacerbation of AD is controversial. Most authors reserve oral prednisone (at least 20 mg/d for 7 d) for the most severe cases, although it seems the disease quickly relapses once the medication is discontinued. Patients also tend to discontinue topical steroid creams and other treatment as they feel better, which contributes to the relapse after oral steroids are done.
• Topical calcineurin inhibitors: Topical calcineurin inhibitors (pimecrolimus 1% and tacrolimus 0.03%, 0.1%) are available for patients older than 2 years. These medications may be used all over skin surfaces (including face, neck, and hairline) because they do not have the side effects seen with topical steroids. Evidence supports the twice-daily use of these creams during acute exacerbation of AD, and some evidence exists to support use up to 4 years. The long-term side effects (including the possibility of increased risk for malignancy) have not fully been elucidated. For these reasons, the Food and Drug Administration (FDA) does not recommend long-term use yet. Side effects of tacrolimus include burning and stinging on broken skin.
• Oral immunosuppressive agents: Patients with refractory AD may benefit from oral immunosuppressive agents, such as cyclosporine A. This medication is effective in treating severe AD in the acute setting. It is not recommended for long-term use.