Skip to main content

Nursing Guide to Atopic Dermatitis: Nursing Diagnosis, Interventions, & Care Plans

Updated On 6 Minute Read

Atopic Dermatitis Etiology and Epidemiology

Atopic dermatitis is a chronic skin disorder characterized by inflamed, itchy skin (Kim, 2021). It usually develops in early infancy and childhood. There may be periods of complete remission, especially in adolescence, and there may be a reoccurrence in young adulthood. In some individuals it doesn’t begin until the individual is an adult. It is characterized by dry, itchy skin with rashes that come and go. Oozing and crusting of the rashes can occur if the individual scratches the affected area. This can then lead to lichenification, which is a thickening and hardening of the skin. The pruritus can be so severe that the individual has difficulty sleeping and it interferes with a person’s quality of life. (Medline Plus, 2020)

Atopic Dermatitis Causes and Risk Factors (Kim, 2021):

  • Genetics
  • Infection: S. aureus
  • Environment
  • Smoking

The atopic triad includes atopic dermatitis, allergic rhino conjunctivitis, and asthma. All of these conditions can begin at the same time or arrive in succession. This succession is known as the “atopic march.” Individuals that have the atopic triad have a defective barrier of the skin as well as weakened upper and lower respiratory tract, which leads to this condition. If one parent is atopic, there is more than a 50% chance that their children will also develop atopic symptoms. (Kolb & Ferrer-Bruker, 2021)

85% of the cases of atopic dermatitis occur within the 1st year of the life, and 95% will appear before 5 years old (Kim, 2021). In developed countries, atopic dermatitis is found in approximately 10 to 30% of children and 2 to 10% of adults (Kolb & Ferrer-Bruker, 2021).

Atopic Dermatitis ICD-10 Code:

  • L20.9 - Atopic dermatitis, unspecified

Atopic Dermatitis Diagnosis

The history should focus on the following (Kolb & Ferrer-Bruker, 2021):

  • Onset and distribution of lesions
  • The severity of pruritus
  • Any history of the atopic triad
  • Contact allergens
  • The presence of triggers including allergens 

Physical exam should assess for the following:

  • Pruritus
  • Dry skin
  • Erythema
  • Scaling
  • Vesicles
  • Papules

Management

Four treatment modalities include (Mayo Clinic, 2020):

  • Anti-inflammatory therapy
    • Corticosteroid creams to help alleviate pruritus. Long term use can cause thinning of the skin. Apply after moisturizer.
    • Calcineurin inhibitors creams such as tacrolimus (Protopic®) and pimecrolimus (Elidel®). May affect the immune system. These creams are for individuals over the age of 2 years. The person should avoid the sun and apply after moisturizer.
    • Short-term antibiotic cream to treat infection. May require oral antibiotics.
    • Oral corticosteroid medication such as prednisone (Deltasone®) for more severe cases. Short term use is recommended.
    • In 2017, dupilumab (Dupixent®) was approved for atopic dermatitis. It is a monoclonal antibodies injectable medication approved for individuals over 6 years old. It is indicated for moderate to severe atopic dermatitis.
  • Daily skin care
    • Moisturize twice per day.
    • Use anti itch cream such as hydrocortisone (Cortef®).
    • Oral over the counter allergy antihistamine medications such as cetirizine (Zyrtec®) or Loratadine (Alavert®, Claritin®) can be helpful in controlling symptoms. If taking medication at bedtime, diphenhydramine (Benadryl®) may help decrease itchiness and promote drowsiness.
    • Avoid scratching. Press on the skin if itchy. Try covering the area if unable to resist scratching. Trim children’s nails and try using gloves at night.
    • Sprinkle a warm bath with baking soda or colloidal oatmeal. Soak for 10 to 15 minutes and pat dry. Use lotion while skin still damp.
    • Use mild soap. Always rinse off completely.
    • Use a humidifier to help decrease dryness of skin.
    • Wear comfortable, cool clothing to prevent irritation.
  • Avoidance of triggers
    • Avoiding or reducing allergens such as dust mites and animal dander can help decrease symptoms.
    • Cleaning products can irritate skin. Wear gloves when cleaning.
    • Prevent and treat dry skin with consistent moisturizing.
    • Avoid fabrics which irritate skin. May need to cut out clothing tags.
    • Fragrances can be irritating and can be found in many products including shampoo, body lotion, and scented candles. Avoid scented products when possible.
    • Heat and sweat can irritate skin. Wear breathable clothing. If exercising, use cool compresses.
    • Metals can cause skin irritation. Check jewelry for metals such as chromium, cobalt chloride, copper, gold, and nickel.
    • Avoid tobacco smoke.
    • Stress can aggravate skin conditions.
  • Complementary options and therapies
    • Counseling may help deal with stress of the skin condition.
    • Biofeedback, meditation, and behavior modifications may help individuals avoid scratching.
    • Wet dressings are used for severe cases. It is an intensive, effective treatment that uses topical corticosteroids and wet bandages on the affected area. It may be done in a hospital setting for individuals with many widespread lesions as it requires expert nursing care. There are times it may be done at home with instructions and physician/provider approval.
    • Light therapy is usually used for individuals who do not respond to topical treatments or they rapidly flare post-treatment. Phototherapy, which involves exposing the skin to controlled amounts of natural sunlight, can be an effective therapy. The other types are artificial ultraviolet A (UVA) and narrow band ultraviolet B (UVB) with or without medications

Atopic Dermatitis Nursing Care Plan

Nursing Considerations

Use the nursing process to develop a plan of care for individuals. The nursing assessment (with common findings listed), diagnoses, interventions, expected outcomes, and education for atopic dermatitis are listed below.

Assessment

Complete skin assessment should be performed. Skin assessment includes noting color, texture, temperature, and moisture of skin. Check lesions and document any presence of redness, edema, excoriations, cracking, and thickening of skin. Assessment of coping mechanisms for dealing with the chronic nature of atopic dermatitis and the resulting change in appearance should be done. The individual and family should be assessed for any gaps in knowledge. (Belleza, 2021)

Nursing Diagnosis/Risk For (Belleza, 2021)

  • Alteration in skin integrity
  • Disturbed body image
  • Risk for infection
  • Potential for knowledge deficit

Interventions (Belleza, 2021)

  • Instruct on proper skin care.
  • Instruct on proper use of topical corticosteroid creams.
  • Provide education on phototherapy treatments if applicable.
  • Provide education on wet dressings if applicable.
  • Encourage verbalizations of concerns and refer to counselor if needed.
  • Review steps to prevent infection.

Expected Outcomes (Belleza, 2021)

  • Optimal skin integrity will be maintained.
  • Individual verbalizes understanding of teaching provided.
  • Individual verbalizes concerns.
  • Individual will use positive coping mechanisms.
  • Infection will be prevented.

Individual/Caregiver Education (Belleza, 2021)

  • Reinforce importance of daily skin care.
  • Review infection prevention.
  • Review use of topical medications.
  • Encourage individual to avoid potential triggers.
  • Encourage individual to use complementary therapies if needed.

Read More About Our Clinical Guides

View Our Clinical Guides

Dermatology Nursing Jobs

Nurse.com has thousands of open jobs for you to sort through. Create your free profile to receive personalized recommendations, save and favorite the jobs you’re interested in, and apply later.

View Jobs

Additional Information

Content Release Date 

4/1/2022

Content Expiration

12/31/2028

Course Contributor

The content for this course was revised by Elizabeth Vaccaro, BSN RN, MSCN. Elizabeth Vaccaro earned her Bachelor of Science in nursing from Kean University. She is certified as a Multiple Sclerosis Nurse Educator. Elizabeth has worked in a variety of healthcare settings from the hospital to the pharmaceutical industry which has allowed her to have a great appreciation for all the challenges that span the healthcare field. She has practiced in the hospice setting for nine years in a variety of roles from Case Manager, Educator, and Director of both inpatient and home care hospice.

References

FAQs

Elizabeth Vaccaro, BSN RN, MSCN

Elizabeth Vaccaro earned her Bachelor of Science in nursing from Kean University. She is certified as a Multiple Sclerosis Nurse Educator. Elizabeth has worked in a variety of healthcare settings from the hospital to the pharmaceutical industry which has allowed her to have a great appreciation for all the challenges that span the healthcare field. She has practiced in the hospice setting for nine years in a variety of roles from Case Manager, Educator, and Director of both inpatient and home care hospice.