A boy with atopic dermatitis Name: Gregory Age: 8 years History: When Gregory was a tiny baby, his parents noticed that his skin sometimes looked red and irritated, especially on his cheeks, behind his elbows and at his hands and wrists. As Gregory grew older, his mother realised that his whole body would itch when he bathed with normal bubble bath, or when he wore clothes that contained wool, but that it did not itch when he used more gentle bubble bath or wore cotton clothes. However, even with this knowledge, she was unable to prevent periodic flare-ups of the rash on his hands, wrists, arms, legs and neck. Gregory's doctor diagnosed atopic dermatitis and prescribed emollients. Gregory's parents were also given a prescription for low potency topical steroids for use during a flare-up. But they had read newspaper reports about some of the side effects of topical steroid use and so did not fill the prescription. The last winter was very severe and Gregory's hands in particular became very dry, rough and chapped. His skin cracked and became very uncomfortable. The skin on the back of his hands looked white when it was pressed, and it was exceedingly itchy. When Gregory scratched his hands, they became even more sore and he could not hold a pencil to write or draw with. His itchy hands kept him awake at night, so that he was tired during the day, which also affected his school performance. As a result, during flare-ups, he was often naughty, irritable and easily bored. He is not alone in this; 54% of parents in the Dermatitis Family Impact Questionnaire Study reported a change in their child's behaviour during atopic dermatitis flares. Diagnosis: Gregory has atopic dermatitis Management: Gregory's mother took him back to the doctor. She explained the problems he was having at school. The doctor offered to prescribe stronger topical steroids, but Gregory's mother admitted that they had not given Gregory the steroids he had been prescribed previously. She said that a friend's child had got a "moon face" after using steroids. The doctor agreed that topical steroids were not suitable for long term use, especially in children, or on the face or neck. But she explained that she had no real alternative to offer them, except to continue to use the emollients she had originally prescribed. Since they were already doing this, Gregory's parents reluctantly decided to give topical steroids a try. The doctor compromised by only prescribing low potency topical steroids. But these were not sufficient for Gregory, and so within a few months he was back at the doctor's surgery, with his problems unresolved. At this stage, his parents refused more potent topical steroids, because the low potency topical steroids Gregory had used had reinforced in them the belief that topical steroids had too little benefit at too great a risk. The doctor can therefore only recommend that Gregory's parents make greater use of measures to avoid triggers of dermatitis, such as keeping the central heating turned down, and removing the carpets from his room to reduce his exposure to the house dust mite. Prognosis: Although only 50% of cases that develop after age 2 years are likely to resolve by adulthood, Gregory's prognosis is good because his dermatitis has never been over his entire body.