Fujisawa Healthcare, Inc.

UnderMy

SkinA Kid’sGuide to Atopic Dermatitis

By Karen Crowe

Illustrated by Norm Bendell

This book belongs to:

Your Signature Here

Your Photo Here

Written and developed by Karen Crowe.Text copyright © 2000 by Fujisawa Healthcare, Inc. Illustrations copyright © 2000 by Norm Bendell. Published in 2000 by Fujisawa Healthcare, Inc.Three Parkway North CenterDeerfield, IL 60015-2548phone: 1.800.727.7003e-mail: medical_information@fujisawa.com

Art Direction & Design by Elaine Leonard. Leonard + McKernin Studio, Inc.,Riverside, Illinois.

Published simultaneously in Canada by Fujisawa Canada, Inc., Toronto.

All rights reserved. No part of this book may be reproduced or transmitted in any form or by any means, electronic or mechanical,including photocopying, recording, or by any information storage and retrieval system, without permission in writing from FujisawaHealthcare, Inc.

Printed in the United States of America.

Thank you to all the atopic dermatitis patients, family members, andtechnical advisers who shared their experiences and expertise to makethis book a great resource to those who need it.

UnderMy

SkinA Kid’sGuide to Atopic Dermatitis

By Karen Crowe

Illustrated by Norm Bendell

Fujisawa Healthcare, Inc.

The Physical Side6 What Is Atopic Dermatitis?

8 Why Do I Have AD?

10 What Causes Skin to Itch?

Common Triggers12 That Darned Dry Skin

14 Those Irritating Irritants

16 Ahh... Ahh... Allergens!

18 Don’t Sweat It!

20 Stressing Out?

22 All about Infections

24 Scratching Struggles

The Emotional Side28 A Flood of Feelings

30 Have a Healthy Attitude

32 Tips for Talking

34 Your Treatment Team

36 Create a Flare Calendar

The Healing Side38 Flare Care

40 Therapy and Side Effects

42 Looking Ahead

44 My Skin Profile

47 My Daily Routine

Table of Contents

Dear Reader,You know better than anyone: atopic dermatitis canreally get under your skin! Rough, red patches and fingernail scratches may make you want to hide. Treat-ments can take lots of time and be messy. And yourskin may itch so much at times you can hardly standit! All this can make you feel frustrated and alone.

But did you know that millions of people aroundthe world have atopic dermatitis? In fact, about one out of five kids are affected by it at some time! YouÕll meet a number of them throughout this book. TheyÕve share dtheir experiences and advice for dealing with atopic dermatitis, hoping to make coping with it easier for you.

Unfortunately, thereÕs no cure for this skin disease;itÕs a continuing problem unless youÕre lucky enough tooutgrow it. But good skin care can help you keep youritch and rash under control. This book will explainwhatÕs going on under your skin that causes it to flare .YouÕll learn ways to prevent itching and how to treatrashes when they occur. YouÕll also find pages to fillout that will help you manage your skin better.

We hope this book will answer your questions andhelp bring your skin relief. Ignoring atopic dermatitiswonÕt make it go away. Taking control of your treatmentreally helps. So read on to find out what you can do tostart improving your skinÕs condition today!

“I can’t go out in the middle of the afternoon when it’s hottestbecause sweat

makes me itch. I get very upsetbecause that’s when all myfriends are out playing.”

Age 9, Florida

“At sleepovers I don’t want to put skin cream on. I don’t like to go to

school with ointment showingaround my mouth, but if I don’t,it gets so dry it sometimes bleedsor looks all chapped.”

Age 11, Connecticut

“I can’t go swimmingin pools because of my eczema. Itmakes me sad—

I just sit on the side and watch.”

Age 7, Florida

“Some years, I’ve worn pants all the time—even during the summer—

because my skin looked so bad.”

Age 11, Georgia

“I itch all the time. It makes me crazy!I scratch all night long. I even scratch

in my sleep. I wake up everynight!”

Age 5, Florida

“I have to get upextra early to take abath and moisturizebefore I go to school.

Kids tease me because of myeczema. It bothers me because Idon’t want to be different.“

Age 9, Michigan

“The worst thingabout having eczema is when there are parties at school.

I can’t eat food I really like—like cupcakes and ice cream—or my skin will be itchy and hurt.”

Age 8, New Jersey

“I don’t want peopleto see the spots onmy knees and elbows. It’s embar-

rassing. I wish I could just forgetabout my skin and not have totake care of it all the time!“

Age 8, Florida

Here are some of

the problems

that kids with

atopic dermatitis

are dealing with.

ThereÕs no denying you have atopic dermatitis Ñ

you can see it with your eyes and feel that awful itch!

This section is all about whatÕs happening inside your

body to cause the things you see and feel.

The Physical Side6

AD BasicsAtopic dermatitis (ay-TOP-icder-ma-TY-tus), also knownas eczema (ECK-ze-muh) orÒAD,Ó is a disease that causesskin to be very dry andextremely itchy. The urge toscratch may be so uncontrol-lable that people scratch theirskin until it bleeds. Once theskin is broken open, it maybecome infected.

AD rashes come and go.They may get worse or bet-ter during certain seasons, oreven during the course of aday. At night, the itchingmay be so bad that it keepspeople from sleeping. Mostkids with AD have had itsince they were infants, butthe skin condition can alsodevelop when kids are older.

Kids’ ConcernsThese kids have lots ofquestions about their skin.

“Sweat and moldare two things that make me flare, but lots of times I can’t

figure out why it’s happening.”

“One of the most difficult thingsabout having AD ismaking decisions

about what’s OK for my skin.”

Age 13, Connecticut

“My skin flares any time of the day, often without any reason—it’s a mystery. That’s

partly why it’s so frustrating.”

Age 13, California

What IsAtopicDermatitis?

Under My Skin 7

The Looks of ItAtopic dermatitis may look different onevery person. It often occurs in the bend of the elbows and behind the knees, but itÕsalso found on the hands, feet, arms, legs,trunk of the body, scalp, face, and/orbehind the ears Ñ it can even cover theentire body in severe cases.

People with AD often have patches ofskin that are scaly and inflamed (red andswollen). Your skin may be thickened(raised and tough) and discolored (red tobrownish-gray) due to long-term scratchingor rubbing. It may also be cracked or flaky,have scabs, or have lost its color altogether.If areas of skin become infected, they mayhave little fluid-filled bumps that ooze orbecome covered with yellow crust.

The Way It Feels Maybe even more upsetting to you than theway AD looks is the way it feels: unbearableitching, painful blisters, raw, peeling skin.The skin at your joints may even be stiff anddifficult to bend. Dealing with these discom-forts can make a person very cranky. ItÕs OKto hate having ADÑ most kids do! But donÕtlet your anger keep you down. (Pages 27-36will give you tips for dealing with the sad-ness or frustration you may be feeling.)

The Physical Side8

Why Do I Have AD?Your atopic dermatitis is probably caused by a combination of things.Doctors are still studying this skin disease to find out more about it.These pages explain what is known about your awful itching.

The Reason for Your Rashes The exact cause of eczema is not known, but doctors think itÕs a type of allergy thatÕspassed down through families. If one of yourparents has had AD, thereÕs a 60% chanceyouÕll have it, too. If both your parents havehad eczema, thereÕs an 80% chance youÕll beitching along with them. In addition, if oneof your parents has had asthma or hay fever,your chances of having AD also increase.

What causes your AD to flare up, or getworse? Just as with other kinds of allergies,there may be things about your environment(your surroundings at home, school, or anyother place you spend time) that can makeyour itching and rash worse. Also, yourlifestyle (the way you do certain things) cancause flare-ups. The things that make yourAD flare are called triggers. (Pages 11-25explain triggers in more detail.)

9Under My Skin

The Truth of the MatterOne thing is certain: itÕs no oneÕs fault thatyou have eczema. Nothing you or your parents did or didnÕt do caused you to getAD. YouÕre not unclean or overly emotional,and itÕs not the result of poor nutrition, assome people who donÕt know any bettermight guess. And eczema is not contagiousÑyou canÕt ÒgiveÓ it to anyone else.

The Itch That RashesAD is often called the Òitch that rashes.ÓThatÕs because your skin usually starts to itchbefore a rash appears. ItÕs not until after youscratch your skin that the rash develops. The more you scratch, the worse the rashbecomes. To find out whatÕs happening inyour body that makes you want to scratch,turn the page.

10 The Physical Side

When people are exposed to triggers — things that their skin orbodies are sensitive to—certain cells in their skin release naturalchemicals in defense. These chemi-cals act as a kind of barrier toprotect the skin from whatever is“invading” the body.

Unfortunately, these chemicalsalso cause itching, redness, andswelling. The chemicals go awayafter a short time in people withoutAD. But in people who have AD,the cells don’t switch off as theyshould—instead, the cells keepproducing chemicals, so the itchingcontinues.

The problem gets worse whenyou scratch or rub the itchy area.Scratching further aggravatesyour skin and causes the cells torelease more chemicals, whichmake you itch and scratch evenmore. This is called the itch-scratchcycle. It’s a frustrating cycle that’stough to stop!

WhatCauses Skin toItch?Understanding why your skin itches can give you more control overyour disease Ñ and help you keep your AD from getting worse!

Scratch!

Scratch!

Scratch!

Cells

Chem

icals

Triggers

Dry, Flaky SkinRed, Swollen, Itchy Skin

In this chapter, youÕll learn all about triggersÑthe things that cause your skin to flare. The key to controlling your AD is to avoid

the things your skin is sensitive to. So turn the page to get the facts about triggersÑ and learn how to ditch your itch!

11

12 Common Triggers

That Darned Dry Skin

Why Dry Is DreadfulThe skinÕs main job is toprotect the body by keepingthings on the outside Ñlikedirt, germs, and chemicalsÑfrom harming things on theinside. In order for skin towork right, though, it needsto be flexible, which meansit has to stay moist.

But people with AD havea defect in their skin thatkeeps it from staying moist.When their top layer of skingets dry, it becomes brittleand it may crack. Then thingsoutside the body can getinside, irritating skin layersbelow and triggering a rash.

Moisture Mania! The best way to prevent skinfrom drying is to apply mois-turizers often. To keep yourskin healthy, use rich creamsor ointments that your doctorrecommends, not lotions,which contain a lot of wateror alcohol and can actuallydry the skin. Apply moisturiz-ers throughout the day, when-ever your skin feels dry, aswell as right after bathing.

Better Bathing Baths and/or showers areusually very helpful in treat-ing AD. They add moistureto the skin and rid rash areasof germs and other thingsthat can be irritating. Thekey is to moisturize immedi-ately after getting out of thewater. If you donÕt, your skinwill become drier, makingyour eczema worse.

As soon as you finishbathing, gently pat your skinwith a towel, leaving the skina little damp. Then smoothon a thick coating of moistur-izer to seal in water thatÕs lefton your skin. Here are someother bathing rules to followto keep skin moist.

Most AD flares happen when people bathe or moisturize incorrectly. Read on to learn how you can avoid common mistakes.

■ Use warm or cool water for bathing, not hot. Hot waterevaporates quickly off skin, causing it to dry out.

■ Avoid bubble baths, bath oils,and scented bath salts, which can aggravate AD.

■ Keep baths and showers short —5 to 10 minutes is enough. Anylonger and your body’s natural oils begin to get washed away.

■ Don’t rub your skin with a wash-cloth—it will irritate your skin.

■ Use a mild shampoo, and washyour hair in a sink or shower in-stead of in the tub. That way, thelather won’t linger on your skin.

■ Don’t use soap unless dirtwon’t come off with plain water.(Soap removes the natural oils onyour skin that help it stay moist.)Instead, use a mild moisturizingskin cleanser, and don’t lather all over—just wash the placeswhere it’s needed, then rinse well.

■ Your doctor may suggest soakingwith medicated oatmeal bath powder. This can help soothe itching.

Turn to page 44 and jot down any questions you have foryour doctor, as well as notes aboutbathing or moisturizing that youwant to remember.

14 Common Triggers

Those Irritating IrritantsWhat Are Irritants?Irritants are things that come in contact withyour skin and cause it to itch, burn, dry out, orturn red. These reactions usually happen veryquickly after the irritant contacts your skin.

Common Irritants ■ wool and other rough fabrics ■ laundry detergents and drier sheets ■ anything with fragrance, including

perfumes, colognes, deodorants, and lotions ■ some cosmetics and skin care products ■ tobacco smoke ■ paint ■ chlorine■ cleaning products ■ acidic foods

15Under My Skin

What You Can Do■ DonÕt wear wool Ñ the sharp fibers irritateskin. Watch for other places you might comeinto contact with wool besides your ownclothing: donÕt use a wool blanket on yourbed, donÕt snuggle up to anyone wearing awool sweater, and donÕt lie down on a woolcarpet to watch TV.

■ Avoid clothes made from other itchy or stifffabrics such as polyester, nylon, or acrylic.Instead, wear soft, loose-fitting cotton clothes. ■ Remove clothing tags that rub against theskin. Also avoid clothes with rough seams or trim.

■ Wash new clothes before wearing to softenand to remove any chemicals on the fabric. ■ Use a dye-free and perfume-free clothesdetergent, and rinse laundry twice to removeany soap left behind. ■ If your feet are flaring, give them a bre ak Ñwear shoes no more than necessary. Try tobuy shoes made of leather or some othermaterial that breathes Ñ not nylon or plastic.

“My feet get itchy when they’re hot and sweaty. I wear sandals whenever I can to keep my feet cool.”

Age 6, Florida

■ Avoid eating or preparing acidic foods(such as tomatoes or citrus fruits) if theyseem to trigger a rash.■ Wear rubber gloves any time you usecleaning products. (Latex-free gloves with a lining are best.)■ Avoid breathing paint fumes and smoke.

Turn

to p

age

45

to r

ecor

d yo

ur n

otes

abo

ut ir

ritan

ts.

Ahh...Ahh...Allergens!Allergy AlertAvoiding allergens takeseffortÑjust ask these kids.

“When I play in the grass, my skin flares. I had to wait a few years until my AD

was under control before I couldstart playing soccer.”

Age 9, Michigan

“We got rid of our dogs because I’mallergic to them. I can’t go to friends’

houses if they have pets.”

Age 8, Florida

“I changed schools because my ecze-ma was bad atmy other school.

There was dust in the carpets and mold in the air conditioner.”

Age 7, Florida

What Are Allergens?Sometimes kids with ADnotice that their skin getsworse when theyÕre exposedto allergens Ñthings theyÕreallergic to, which their bodiestry to fight. Everyone withAD should stay away from

the irritants listed on pages14 and 15, but you only needto avoid allergens if youÕreallergic. Avoiding allergenswill help your skin itch lessand soothe your runny noseand watery eyes, too.

Common Allergens ■ pet dander■ pollen ■ dust mites ■ mold■ certain foods

Under My Skin 17

What You Can Do■ If youÕre allergic to a pet, the best solution is to have a neighbor or nearby relative adoptyour furry friend. But if you canÕt bear to partwith a pet, vacuum your house often andkeep your pet off your bed and other furnitureyou use Ñ or outside.

■ If youÕre allergic to pollen, stay inside asmuch as you can during allergy season. Keepwindows closed Ñ use a fan or air conditionerto keep cool instead. When you do go out-side, avoid playing on the grass, and bathebefore going to bed to rinse off any pollenthat is clinging to your skin or hair.

■ If youÕre allergic to dust mites, buy specialcovers for your mattress and pillow. Removecarpets and curtains from your bedroom ifpossibleÑ if not, clean them often. Also washyour bed sheets and comforter frequently inhot water. Stuffed animals are dust-catchers,too, so if you canÕt give them up, give them a hot bath now and then. ■ Mold grows in damp, dark places. If youÕreallergic to it, avoid basements, and keep theshades up in your bedroom to prevent it fromgrowing, especially if you use a humidifier.■ DonÕt eat foods that seem to trigger flare-upsor make your rash worse. The foods kids aremost commonly allergic to include: milk, eggs,nuts, wheat, soy, and seafood. (To make sureyour diet stays balanced, check with yourdoctor before eliminating any foods.)

“I can’t eat anything made with milk. But we found special vanilla soy ice-cream sandwiches at a store, and they’re great!”

Age 6, IowaTu

rn to

pag

e 45

to w

rite

dow

n de

tails

abo

ut a

ny a

llerg

ies

you

have

.

Don’t Sweat It!

18

The Trouble with TemperaturesKids with AD have very sensitive skin.Sometimes flare-ups occur when the tem-perature changes suddenly Ñ such as whenyou step indoors to warm up after playingout in the snow, or when you leave a coolair-conditioned store on a hot summer day.

Hot and cold weather may trigger yourAD in other ways, too. During cold wintermonths, the heat indoors can make your skineven drier and itchier than normal. (The hot,dry air causes moisture everywhere to evapo-rate, including moisture in your skin.) Onhumid summer days, increased sweat can irritate your skin and cause your AD to flare .

“Since sweat makes me itch, I try to wear light-colored clothing to keep from getting hot.”

Age 12, Illinois

Solutions for All SeasonsHere are some suggestions to help youkeep comfy year round: ■ Try to stay indoors during very hot orvery cold weather whenever possible. ■ If sweat irritates your skin, avoid vigorousexercise, especially when your skin is flaring.If you are active, wear cotton clothing (it Òbreathes,Ó so youÕll perspire less and sweatwill evaporate easily). Also, bathe as soon asyou can afterwards to wash off sweat.■ Ask your doctor to recommend a goodsunscreen. Some gels are drying.

Common Triggers

19

■ Wear layers of clothing during all seasonsso you can remove items when you feel too warm. ■ Lower the temperature in your bedroom at night, and wear lighter pajamas to bed toprevent sweating while sleeping.■ Keep your skin warm in winter by cover-ing it when you go outside.

■ During winter months, use a cool-misthumidifier to help keep the air in your bed-room moist. (If youÕre allergic to mold or dustmites, be careful Ñ they both like humidity.Clean your humidifier daily to prevent moldfrom growing, and follow the suggestions onpage 17 to guard against dust mites.)■ The best way to prevent Òwinter itchÓ is tomoisturize regularly. You can also use lip balmto help keep lips from becoming chapped.

Turn

to p

age

45 a

nd li

st id

eas

for

keep

ing

skin

hea

lthy

in a

ll ki

nds

of w

eath

er.

20

Stressing Out?Emotions That TriggerMany kids with AD notice that stressfultimes or events make their eczema worse.Stress includes feelings of frustration, worry,embarrassment, anger, and even extremetiredness. These emotional states can allcause your skin to ÒflushÓ or blush. Whenthis happens, extra blood surges throughyour skin, especially in your face, causing itto redden. For kids with AD, this increasedactivity in the skin may cause itching.

Spot the ProblemsSome things that may make you emotionalinclude fights with family members, a friendmoving away, or a big game coming up.School struggles such as test-taking, beingcalled on in class, or homework overloadmay also make you feel stressed. And ADitselfÑ and your treatment routine Ñ can bea cause of frustration, too.

Sometimes you can learn to recognize andavoid the situations that bother you. Whenstressful things canÕt be avoided, though, try tocope with your feelings in other ways. Discusswhat upsets you with a parent, friend, or yourdoctor. They may be able to suggest ways tohelp lower your stress. The tips on the rightand the calendar on page 36 can also helpyou deal with stress.

Sports are a great way to reducestress. Just don’t let close calls orother tense moments take the funout of your games!

Under My Skin 21

Stress-BustersTry these calming tips to prevent getting tense:

■ Organize your time. Planahead so you donÕt feelrushed getting ready in themorning, studying for tests, or completing school projects.

■ Take breaks during studysessions. Walk around,breathe deeply, get a drink of water, or stretch to relaxyour muscles and energizeyour mind.

■ Exercise regularly Ñ if sweatisnÕt a problem for you. Ahalf-hour of activity thre etimes a week will help yourbody flush out unhealthychemicals that build up inyour blood due to stress.

■ Take time to enjoy yourhobbies. They raise yourspirits and reduce your stress. ■ Celebrate small successesyou achieve each day, suchas going scratchless or get-ting a good grade. (Pages27-36 give more ideas forkeeping a positive outlook.)

De-stressing TipsHere are some soothingsuggestions from kids.

“I scratch when I’m very nervous—likewhen school was just starting or

when I go on amusement parkrides. To relax, I take a breathand slowly count to ten. I keepdoing this until I feel better.”

Age 6, Florida

“We go on morningand night walks. It takes my mind offmy itching, makes

me feel stronger, and helps mecalm down and get sleepy.”

Age 7, Massachusetts

“My skin gets itchy when I’m nervous. Playing with my Gameboy

helps me relax and keeps mefrom scratching.”

Age 6, Florida

Turn

to p

age

46 to

rec

ord

note

s ab

out s

tres

s.

Common Triggers22

Why Do They Happen?Kids with AD get skin infections more easilythan kids with normal skin. HereÕs one reasonwhy. Bacteria are on everyoneÕs skin andunder fingernails. Healthy skin provides a bar-rier that keeps the bacteria out so they canÕtharm the body. But kids with AD sometimesscratch open their skin, giving bacteria a wayto get into the body and cause an infection.

Infections in other parts of the body can also trigger your skin to flare. A cold,flu, fever blister, or athleteÕs foot fungus putsstress on your body. Your skin may flarefrom this stress.

Why Should I Worry?When your skin is infected it takes longerto heal. Infections also cause more itchingas they heal. Unfortunately, even if youpractice good skin care, infections are toughto preventÑmost kids with AD get themevery once in a while.

What Can I Do?The good news is if you start to treat a skininfection early on, and take good care ofyour skin during the times you have a cold,flu, or other illness, you may be able to prevent flare-ups from getting worse.

All about Infections

BacteriaBreak in skin

Infected skin

Signs of InfectionTo keep your skin as healthyas possible, learn to recognizethese signs of infection:■ Skin feels warm and morered or tender than usual.■ Skin may have bumps thatooze a yellowish fluid.■ Some infections can havean unpleasant odor.

23Under My Skin

What Should I Watch For?If you notice any of the symptoms listed onthe poster below, tell a parent. You should see your doctor immediately. He or she maygive you an antibiotic ointment or pill to helpyou fight the infection. Be sure to follow yourdoctorÕs instructions for applying or taking any medication. Even if youÕre starting to feelbetter, itÕs important to continue to use yourmedicine to be sure that the infection is cured.

“Whenever I’m sick, my skin is very bad. Once my ankle became very infected from scratching and I got a blood infection.I had to go to the hospital and keep it

wrapped up and stay inside.“

Age 5, Florida

List things you wantto remember about infections,and your doctor’s instructionsfor medications, on page 46.

24

Daytime ScratchingMany kids scratch the most when theyÕrebored, or when their hands arenÕt busy doingother things. Often, people with AD donÕteven realize theyÕre scratching! If this is truefor you, try to keep busy by doing activitieswith other people, especially things thatinvolve your hands. You can also protect yourskin by wearing clothes that cover. Remember,the less you scratch, the less youÕll itch!

“I play the piano when I itch. It helps me forget about my itchiness—and keeps my fingers busy!”

Age 8, New Jersey

“ I scratch when I watch TV— I do it without thinking. Sometimes I put on pants soI can’t scratch open my skin.”

Age 11, Illinois

Scratching StrugglesSometimes even after you do all you can to avoid the things that makeyou itch, you still end up scratching. Is there anything else you can do?

Give your hands somethingfun to do, such as playingcards or creating crafts.

25

ItÕs hard to feel perky in themorning when youÕve beenup scratching all night. If youritching is keeping you fromsleeping, try these suggestionsto help soothe your skin:■ Cover the itchy area with a cold, wet washcloth for awhile, then apply moisturiz-er. (For extra cool relief, trykeeping your skin cream inthe refrigerator. )

■ Your doctor may prescribean antihistamine, which willease your itching and maymake you sleepy.■ Cut your fingernails sotheyÕre as short as possible.Since even short nails canbreak open your skin, filethem smooth so that if youscratch while you sleep, youÕlldo less damage. Lightweightcotton gloves (found in manydrugstores) can keep yournails covered and skin safe.

Scratch-StoppersSleep tight with these tips.

“When I was little, my mom would tell me a story about somewhere far away

to relax me and help me forgetabout being itchy. If I’m having a bad night, I’ll still go to mymom and ask for a story to takeme away.”

Age 12, Illinois

“To keep from scratching open my skin while I sleep,I wear long socks

and pajamas with long sleevesand pants. Because of all thatclothing, my mom makes it cool-er in my room at night.”

Age 6, Florida

“Sometimes I take an ice pack to bed.If I wake up in the middle of the night

feeling itchy, I put the ice pack on my skin.”

Age 9, Michigan

Nighttime Advice

Turn

to p

age

46 to

writ

e th

ough

ts y

ou h

ave

abou

tscr

atch

ing.

26

“Don’t let other people convince you to be embarrassed about your skin. I’ve always

felt eczema was a part of me, and I think people see it doesn’t botherme, so it doesn’t bother them.”

Age 12, Illinois

Remember: youÕre

not alone! Here are

some more thoughts

Ñand solutionsÑ

from kids with AD.

“I used to get embar-rassed when I had to wear shorts for basketball. But my

coach is a doctor, so he knowsabout eczema. He told my team-mates that’s what I have, andthat it’s no big deal. I’ve beenmore relaxed since then.”

Age 11, Illinois

“I can’t go to parties at carpeted houses because I’m allergic to dust mites. Some-

times friends have their partyoutdoors or roll up their rugsand put them away, so I cancome over and not itch.”

Age 7, Massachusetts

“Windbreaker pantskeep me from itchingin wintertime. They’rereal loose and don’t

rub on my legs. “

Age 7, Florida

“When I get school pictures taken, I putfoundation makeuparound my mouth to

cover up the flares.“

Age 9, Illinois

* Check with your doctor before trying any type of makeup.

“I have eczema onmy fingers. Two ofmy nails even felloff, so sometimes I

hide my hands. To make themlook more presentable, I paint

my nails and wear bracelets.”

Age 13, Illinois

* Check with your doctor beforeusing nail polish.

“Sometimes when I have trouble with my homework, I start to scratch my

arms. I usually take a break andput a cool washcloth on myneck. It actually helps my armsstop itching!”

Age 8, California

“I wear plain shorts but bright-colored shirts with interest-ing details. That

way, people will look up and not notice my legs as much.”

Age 12, California

Understanding your feelings and taking care of them is just as important as understanding and taking care of your skin

problems. This section offers suggestions to sootheyour emotions when they flare .

28 The Emotional Side

A Flood of Feelings

IÕm confused aboutwhatÕs happeningwith my skin.

I worry that myAD will get worse.I feel embarrassed

when my skin flaresÑI just want to hide.

I get angryÑ itÕs not fair that I have tospend so much time taking care of my skin.

IÕm afraid no one willwant to be my friend.

I envy other kids whohave perfect skin.

I feel alone, likenobody understandswhat IÕm goingthrough.

I donÕt want to talkabout it. ThereÕsnothing wrongwith my skin!

I feel guilty becauseI scratch even thoughI know I shouldnÕt.

Having AD can bring out a wide range of feelings in you. Thereactions described on these pages are all normal. In fact, you mayhave felt several of these emotions at the same time.

29

Feeling FlawedAD not only affects the outside of yourbody Ñit can also affect what goes on insideyour mind. ItÕs natural to feel upset some-times. AD can be a frustrating disease Ñafterall, you canÕt always control what it does toyour skin. But you can try to keep it fromcontrolling your emotions, too.

How can you gain power over youreczema? Talking about your embarrassment,anger, or worry can help. Sharing your feel-ings with a family member, doctor, or goodfriend lets you vent some of the emotionsthat upset you. And together you may beable to come up with some solutions forwhatÕs bothering you! (Pages 32-35 offersome tips for talking about AD.)

If your itching has gone on so long thatyou are overwhelmed by feelings of anger,hopelessness, or depression, tell a parent orsome other adult you trust so you can getthe help you need.

Accepting RealityIt may seem tough to accept the fact thatyour skin is not normal. Some kids witheczema wonÕt admit they need to take specialcare of their skin. ItÕs as by pretending theydonÕt have AD, they can make it go away.This is also a natural reaction. But if you feelthis way and donÕt eventually change thebehaviors that harm your skin, thereÕs a goodchance your condition will just get worse.Think you could use a little help improvingyour attitude? Turn the page!

30 The Emotional Side

Have a Healthy AttitudeYou may be stuck with skin problems right now, but you donÕt haveto be stuck with a bad attitude, too. Having a healthy outlook is thefirst step towards having healthier skin!

Don’t Be So Hard on Yourself!If you feel like the whole world is staring at your flares, itÕs time to do a reality check.Most people are more focused on the flawsthey see in themselves than the flares you seeon your skin. Instead of hiding from people,tell them about your AD. (Pages 32-33 canhelp you find the words to use.) Other peo-ple will probably accept the fact that yourskin isnÕt perfectÑand you should, too!

“My mom says that everyone has some-thing that they’re embarrassed by or afraid of, so just be yourself. Sometimes my friends ask about my skin. When we

talk, they remember that someone in their family has rashes, too.”

Age 9, Michigan

Don’t Make AssumptionsSometimes kids with AD think others areavoiding them because of their disease. Beforeyou assume this is true, make sure you havenÕtwithdrawn from others out of embarrassmentor fear of what they might think. Other kidsmight mistake your nervousness as beingunfriendly. Kids might also be staying awaybecause they donÕt know what to say or howto act. They may need you to break the ice.

“Try to be friendly. Before you know it, you’ll start playing with others and they won’t even notice your skin. They’ll just

like you.”

Age 9, Michigan

Remember: thereÕs much more to you thanyour AD. The qualities you have Ñsuch asyour friendliness, sense of humor, or talentsÑare what other people like and admire in you.Eczema is just a small part of who you are .

Take Risks Has your skin ever kept you from trying outfor something you might enjoy, like a schoolplay or a sports team? Sometimes kids witheczema unknowingly use their disease as anexcuse for not trying something. ItÕs easierto blame their AD than to face their fear oftrying something new.

If this is true for you, hereÕs a tip: go forit! It may not be easy, but refuse to let ADkeep you in hiding. As you interact with people, your self-esteem will increase, youÕllfocus less on your skin, and others will getthe chance to know the real you Ñand seethat you arenÕt held back by your skin. Anadded benefit: your skin might even improvesince you may scratch less because your new activity will keep you so busy!

32

What to SayYou may wonder what to say about yourflares to friends or others who are curious.Try explaining it straight out. ÒItÕs kind of likean allergic reaction. My skin gets red anditchy, but it goes away after a while.ÓExplaining AD lets others know they havenothing to be afraid of. And real friends willwant to help you through rough times. ItÕsnot surprising ÑyouÕd be supportive of them,too, wouldnÕt you?

Teasing Troubles Unfortunately, kids with AD are sometimesteased. What can you do if this happens?Some kids say that presenting a report abouteczema in class helps. Talking openly abouttheir disease shows they accept it and con-sider it an interesting and important subject.Once your classmates know the facts, theyÕllprobably adopt your positive attitude, too.

Tips for TalkingWish others could understand what youÕre going through? Have a hardtime putting into words how you feel? DonÕt know what to say whensomeone teases you? Here are some hints for handling the topic of AD.

The Emotional Side

Teacher TalkSometimes AD can interfere with school-work. A sleepless night of scratching mightmake it hard to pay attention in class thenext day. A flare-up thatÕs severe may evenkeep you home. If you miss a lot of school,you might have trouble keeping your gradesup. What can you do?

You and your parents should meet withyour teachers to discuss your AD. Teachersneed to know that you may have trouble sitting still when your itching is at its worst.There may also be days a teacher needs toexcuse you so that you can apply moisturiz-er or take medication.

Words of WisdomThese kids donÕt let theireczema get them down.Read their advice for how to handle AD hassles.

“I explain that eczema is a skin rash that doc-tors don’t know the cure for, but kids can’t

catch it from me. If you are teased,you should just say, ‘I am like thisand you’ll have to deal with it.’”

Age 11, Connecticut

“Once I heard a boy’smom tell my teachershe didn’t want herson to sit next to me

because my skin sometimes cracksand bleeds. So my mom got a let-ter from my doctor that explainseczema. She gave copies to all thekids to take home. Now, the boy I told you about is my best buddy.He even goes with me to theschool nurse when I’m itching andneed medicine. ”

Age 7, Connecticut

“My friends like mebecause of what’s onthe inside of me. Ifyour friends don’t like

you because of what you looklike, they’re not true friends.”

Age 11, Virginia

“Some kids at schoolare very caring andconcerned. They helpme when my eczema

hurts me too much to do things.”

Age 8, Florida

The Emotional Side34

Doc Discussions You and your doctor are working together to keep your eczema under control. Be openand honest when talking about your skin.The more information you can give to thedoctor, the better. If youÕve let your treatmentslide, tell the truth Ñyour doctor needs toknow all the facts to care for your skin thebest way he or she can.

ItÕs also important that you understandyour treatment plan and follow it carefully. If youÕre confused by or disappointed withsome part of your therapy, talk with yourdoctor. DonÕt be afraid to ask questions. Yourdoctor will be glad youÕre interested and wantto help you learn more about your skin.

“My doctor really understands how I feel.She treats me like a grownup andworks hard to make me feel better. Theoffice is even starting a support group

for kids with AD.”

Age 12, Illinois

Your Treatment TeamWhen youÕre up against AD, you need supportive teammates. Your doctor and family members are important players on your side. HereÕs a game plan for keeping communication open and effective.

If you have questions about your skin or treatment at home, write them down in your SkinProfile on pages 44-46 and bring them to your nextdoctor’s appointment.

Under My Skin 35

Family Matters!Your eczema may sometimes lead to familyarguments. If your itching is keeping you andother family members up at night, everyonemay be moody. Family support is very impor-tant for anyone who has eczema, so here area few things you can do to help everyonekeep their cool when tempers heat up: ■ If you feel your parents are hounding youabout your treatment, realize that theyÕre justtrying to keep you comfortable by prevent-ing your AD from flaring. Do your part totake care of your skin so your parents donÕtfeel they must constantly remind you.■ Like you, your parents may feel frustrated.ItÕs hard for them to watch someone they lovestruggle with eczema. Talk with your parentsabout your feelings. This will help all of youdeal with problems you may be having.

“It helps to talk to my mom because shehas AD, too. I got the gene from her.”

Age 11, Georgia

“My mom says it’s what’s on the inside that makes me the person I am, not my skin. My skin is just more red than other kids’, and there’s nothing

wrong with that.”

■ ItÕs natural for you to feel envious of sistersor brothers who donÕt have skin problems. A sibling might also get upset with you oryour parents if they spend extra time helpingyou take care of your skin. Try reading thisbookÑor parts of itÑwith your siblings.Doing something fun together can alsostrengthen your relationship.

Create a Flare CalendarYou can use a calendar like this to help youdiscover what may be causing your skin toflare. Each week, jot down new or unusualthings you do such as your first soccer prac-tice or trying new foods. Also record any situations that make you emotional, such asa fight with a friend or a big test. Whenever

you notice a flare, write that down, too (“F”).Can you connect your flares to any of theevents or situations you experienced? Talkwith a parent about how you can avoid orbetter handle situations in the future thatcause you to flare. Visit www.fujisawa.comto print calendars or use your own.

Sunday Monday Tuesday Wednesday Thursday Friday Saturday

(month)

54321 6

1110987 13

191817161514 20

262524232221 27

302928 31

12

37

It may often seem like you have no control over your AD.

When it comes to caring for your skin, however, youÕre in charge!

This section contains tips for moisturizing, information about

medicating, and a helpful skin profile for you to fill out.

38 The Healing Side

Flare CareTaking time every day to moisturize may seem like a drag Ñespecially during those periods when your skin is doing better. Here are some tips to make your skin treatment more tolerable.

Set Up a CenterTurn an area of your bathroom orbedroom into a skin-care center.Keep moisturizers and medicineshandy. Hang inspirational postersto keep you motivated. Photos ofyourself when you’re looking yourbest might inspire you to stick toyour treatment. Every time you doyour skin care, try to relax byfocusing on positive things.

“I think of skin care as a way of recharg-ing my energy. I get tired of itching and

sore from scratching. Putting onmoisturizer or medication helpsme get through the day morecomfortably.”

Age 13, Illinois

Stay in SupplyKeep moisturizers availableeverywhere you might need them.

“I keep lip balm andVaseline in my backpack, in my desk at school, in both of our

cars, and in our boat so I can putthem on whenever I need to. “

Age 9, Illinois

Make It AmusingPlay games while you moisturize, on your own or with your family.

■ Dab your cream or ointment onin a pattern, then connect the dots.You can also play tic-tac-toe usingyour moisturizer as markers.

■ Smooth your moisturizer on in a thick layer, then draw pictures onyour “easel.” Erase by gently rub-bing the moisturizer into your skin.

“I make polka-dots withmy moisturizer all over, then I rub it in. It looks funny when I look in the

mirror and it’s less boring that way.”

Age 12, California

“My mom makes sure she washes her hands before she puts moistur-izer on me.”

Have a Routine Make skin care part of your dailyroutine along with other activitiessuch as brushing your teeth. If youmoisturize at the same time everyday, you’ll be less likely to miss atreatment. And don’t be temptedto take days off when your ADimproves, or your itching and rashjust might start all over again!

“Stick to a routine. If you do the same thing day after day, it just becomes a part

of you.”

Age 12, Illinois

“ I wrote ‘skin treatment’on a piece of paper and taped it on my bedroom wall where

I see it every day. That helps meremember to do my treatment inthe morning and night, and duringthe day whenever my skin is feeling dry.”

Age 13, California

Take Extra CareRemember to be doubly devoted toyour skin at stressful times. Applymore moisturizer than usual, don’tmiss a treatment, and be sure tokeep any open scratches clean.

Turn

to p

age

47 to

com

e up

with

you

r ow

n da

ily r

outin

e sc

hedu

le.

39

40

MoisturizersCreams and ointments applied to the skin keep it from drying out, which

helps prevent flares and infections. Moisturizersalso keep your skin softer and more flexible so it doesnÕt break open as easily.

Moisturizing can be time-consuming and may leave you feeling greasy or

as if your skin canÕt breathe.

SteroidsAlthough steroid creams and oint-ments donÕt cure AD, they can calm

itchy, swollen, red skin. Your doctor will give you the mildest steroid possible to avoid side effects.

If not used properly, steroids can cause discoloration or skin thinning,

so listen very carefully when your doctortells you how to use them (how, when, andhow long to apply). Be sure to wash yourhands after applying steroids and othermedications.

Therapy and Side EffectsHere are some of the most common types of therapy. Your doctor mayprescribe a few, several, or all of the treatments listed on these pages,

depending on what he or she thinks will be best for you.

“If your skin hurts, don’t rub your moisturizer in—tap it on instead.”

Age 7, Connecticut

AntihistaminesThese are pills or liquid medicines that help stop itching

Some antihistamines may make you sleepy, which is helpful if your AD

is keeping you up at night but a problem ifyouÕre trying to pay attention in school.Antihistamines can also have the oppositeeffectÑ they may cause you to feel restlessor fidgety.

AntibioticsThese can be pills, liquid medicine, or creams and ointments that cut

down on the amount of bacteria on skin. If bacteria are reduced, flares may be, too.

If you use or take antibiotics too often, or for too long a time, the

bacteria will eventually become so strong the medicine wonÕt work anymore.

Light Therapy Special lights, sometimes combinedwith a medicine you swallow, can

help calm your skin. This treatment may beused to give people a break from steroids.

Light therapy is inconvenient. YouÕll probably have to make several visits

to the doctor and must stay out of the sunafterwards to avoid overexposure .

New Therapies There are many new medicines being developed. Some are applied to the

skin and relieve itching, redness, and swelling.Unlike steroids, you may be able to use someof these new drugs on your face as needed.

When first applied, some of these medicines may sting slightly, increase

itching, or make your skin sensitive to heat.After several applications, however, the dis-comfort usually fades.

“I’ve been trying lots of different medicines, hoping to find one that works. It took a long time, but we finally found one that helps my skin.”

Age 8, California

“If my skin itches, I flick it, blow on it, do whatever I have to do —I just don’t scratch it!”

Age 9, Michigan

42 The Healing Side

Looking Ahead

Will I Ever Be AD-Free?Doctors canÕt predict how long you maystruggle with AD. Most kids grow out of thisdisease by their early teen years. But a smallpercentage of people continue to have prob-lems with eczema as adults. While this mightnot seem like great news, it may help you toknow that remissionsÑperiods of time whenthe disease goes away Ñare common. Remis-sions can last for months or even years, andoften happen as the result of good skin care .

Life after ADIf you are lucky enough to grow out ofeczema, you may still have a few relatedhealth concerns: hay fever and asthma arevery common in people who have AD.These are allergic reactions just like atopicdermatitis is. More than half of all kids witheczema either already have hay fever or asthma or develop one or both in the future .

YouÕll also still have to take good care of your skin. People with AD in their pastwill usually experience one or more of thefollowing skin challenges in their future :■ dry skin thatÕs easily irritated ■ hand eczema■ skin infections.

YouÕve learned the techniques of goodskin care Ñ stick with them, and theyÕll helpyou reduce future skin problems!

YouÕve learned things you can do to help your skin now Ñread on to find out what the future may hold. Plus, learn how you can helpother kids the way the kids in this book helped you.

There’s a good chance you’ll growout of AD, but some kids continueto experience problems with thedisease into adulthood.

43

Share Your ExperienceRemember, millions of kids are dealing withatopic dermatitis. You met just a few in thisbook. If youÕd like to meet more Ñ or shareyour own tips, thoughts, or experiences Ñvisit www.fujisawa.com or write to theaddress below. WeÕll post as many commentsas we can on this web site so that other kidscan learn from your experience. Let us hearfrom you!

Fujisawa Healthcare, Inc.Medical Information Dept.

Three Parkway North CenterDeerfield, IL 60015-2548

44

Here is a place for you to write down ques-tions for your doctor and keep notes about allthe things that affect your skin —both goodand bad. You might want to take these pages

with you when you visit your doctor, to recordproduct names or the doctor’s instructions fortreatment. Your doctor may also find it help-ful to see the notes you keep on your skin.

Bathing

These are questions I have for my doctor about bathing:

These are my doctorÕs instructions for bathing (how long? how often? skin cleansers and

shampoos to try):

These are the bath products that work best for me:

Moisturizing

These are questions I have for my doctor about moisturizing:

These are my doctorÕs suggestions for moisturizing (products to try, instructions for applying):

These are the moisturizers that work best for me:

45

Irritants

These are questions I have for my doctor about irritants:

These are the things I try to avoid because they irritate my skin:

Allergens

These are questions I have for my doctor about allergens:

These are the things I am allergic to:

Here is how I deal with these allergens to keep them from aggravating my skin:

Weather

These are questions I have for my doctor about how weather affects my skin:

This kind of weather is the worst for my skin (hot/cold/dry/humid):

Here is what I do to help my skin during this season:

46

Stress

These are questions I have for my doctor about stress:

These are some situations or times when I feel upset or stressed:

Here are suggestions my family, friends, or doctor gave me to help me deal with my stress:

Medications

These are questions I have for my doctor about infections and/or my medications:

These are my doctorÕs instructions for treating my infection and/or for using medications:

Scratching

These are questions I have for my doctor about scratching:

These are the times I tend to scratch most often:

Here are my ideas to keep busy so I wonÕt scratch:

Time Skin Care Time Skin Care

47

Your skin will stay healthiest when you stick to a regular skin-care routine. Here’s a samplelist of activities you might do every day. Askyour doctor or parent to help you create your

own daily routine to follow. Write out yourschedule below, then keep it handy so you canfollow it each day. Your can print more dailyroutine pages at www.fujisawa.com.

“AD has made me think about how kids feel when they’re different—

like if they’re a different race,or whatever. I try to treateveryone in my school thesame. We’re all equals, andeveryone has feelings.”

Age 12, Illinois

“To keep myself from scratching I go rollerblading a lot. All that

practice helped me become a much better skater!”

Age 11, Virginia

“My sister and I both have AD. I help by reminding her not to scratch and by

listening to her when other kidsmake her feel bad. At least we’regoing through it together.”

Age 8, Florida

“Your eczema might improve as you get older. Mine has, and now I’m not as

embarrassed about it.”

Age 11, Connecticut

“ When I feel sad, my brothers remind me that everyone is dif-

ferent. And like I always say:eczema is a tough thing todeal with, but I’m waytougher than this disease!”

Age 8, Connecticut

“I always remember what my mom told me: that I shouldn’t compare myself to

other children. I also tell myselfthat I should be proud of who Iam—proud of myself and myaccomplishments.”

Age 13, California

“If I didn’t have eczema, I might have been one of those people who

judged others by their appear-ance. Eczema has probablymade me a better person.”

Age 13, Connecticut

“Whenever I get really upset and ask, ‘Why me?’ my mom points

out that there are other peo-ple sicker than me. I remem-ber that I’m lucky to be ableto run and play.”

Age 9, Florida

Think nothing good can

come out of AD? HereÕs

how it changed the way

these kids look at

themselvesÑand others!

48

To produce this book, we talked with kids who live inCalifornia, Connecticut, Florida, Illinois, Iowa, Massachusetts,

Michigan, New Jersey, and Virginia. Remember, though, atopicdermatitis doesnÕt care where you live Ñ it affects

people all over the world.

Fujisawa Healthcare, Inc.www.fujisawa.com