The problem is the barrier, not dirt
Picture healthy skin as a brick wall with good mortar: the cells are the bricks and the lipids are the mortar. In atopic dermatitis the mortar is missing. Water escapes — which is why the skin is dry and rough — and irritants, allergens and microbes get in easily, triggering inflammation.
This explains almost the whole of management at once. It explains why moisturiser is not a cosmetic but the foundation of treatment. It explains why harsh soap and very hot showers make things worse — they strip what little mortar is left. And it explains why hunting for “the guilty food” rarely resolves anything: food did not break the barrier.
The itch-scratch cycle
Itch is the central symptom and the engine of the disease. Scratching relieves it for seconds and damages the barrier a little more, which inflames, which itches more. In children it wrecks sleep — and with it, school performance and the peace of the whole household.
So the goal of treatment is not “skin that looks good”: it is to stop the itch, because without itch there is no scratching, and without scratching the barrier can repair. Short nails, cotton clothing, avoiding excess heat and sweat, and — most importantly — treating the inflammation adequately and early, rather than in dribs and drabs.
How it is treated
Decided and supervised in the dermatology consultation. No drug names or regimens are published here:
- Emollients, every day, forever. Even when the skin looks fine. This is the base everything else works on, and it is the thing most often abandoned.
- Short bath, lukewarm water, gentle unperfumed cleanser, and emollient onto still-damp skin.
- Topical anti-inflammatory therapy under prescription during flares, used at the correct potency and for the correct duration. “Steroid phobia” — using too little, for too short a time — is one of the commonest causes of failure.
- Control of personal triggers: heat, sweat, wool, perfumed soaps, stress, abrupt temperature changes.
- Moderate-to-severe disease: phototherapy or systemic therapy, under supervision.
- If there is yellow crusting, oozing or sudden worsening: there may be superimposed infection. It is assessed, not waited out.
What does not work (and is tried a lot)
Blind elimination diets. Removing foods without a proven allergy diagnosis rarely improves the skin and can cause nutritional deficiency in a child. If there is genuine suspicion of food allergy, it is investigated — see allergy unit — not guessed at.
Bathing less. A short bath with emollient afterwards is good. What is bad is very hot water, harsh soap, and getting out without moisturising.
Using steroid only when it becomes unbearable, and in insufficient amounts. It treats badly, takes longer, and ends up requiring more medication, not less.
The honest expectation
Atopic dermatitis is chronic and relapsing. With a good plan, most patients spend long stretches with calm, itch-free skin, and many children improve substantially as they grow. That is the goal, and it is achievable.
But it is not cured. The barrier is still what it is, and a dry winter, a stressful season, or abandoning emollients will reactivate it. Treatment continues even when the skin looks fine — that is, in fact, the part that yields the most and is abandoned the most.
Who treats it here
Diagnosis and treatment of atopic dermatitis belong to the clinic’s dermatology consultation — the same one with which Dr. Francisco Arellano Ocampo founded the house in 1971. Dr. Arístides Arellano is a plastic surgeon, not a dermatologist: his contribution here is surgical and reconstructive, and the disease itself is managed in the consultation. Book at dermatology consultation.
Dr. Arístides Arellano is a plastic surgeon holding a specialty licence: he practises under a Mexican medical licence (D.G.P. 1125959) and a specialty licence in Plastic & Reconstructive Surgery (0002008), both issued by the Directorate General of Professions (DGP), which reissued his certificate of professional standing in 2025. His career began before Mexico’s present-day specialty-board system existed: he belongs to the founding generation of plastic surgery in Puebla, the second generation of a surgical tradition started in 1971 by Dr. Francisco Arellano Ocampo. Trust is verified, not promised: both licences are public and anyone can look them up in the DGP’s National Registry of Professionals.
Risks and expectations
Every medical treatment —topicals, peels and energy-based devices included— carries risk and requires a prior assessment. In darker skin (Fitzpatrick IV–VI, the most common phototypes in Mexico) a poorly indicated procedure can darken the patch instead of lightening it. Results may vary according to each patient, their phototype and their individual triggers.
Trust is verified, not promised. All 210 scanned documents —degree, licences, diplomas, publications and certificates, from 1977 to 2025— are open in Dr. Arístides Arellano’s credential archive, alongside an explanation of the difference between a specialty licence and a board certification.
Control plan
- DiagnosisDermatology consultation. Extent, sleep impact and triggers assessed.
- Base, alwaysDaily emollient, even when the skin looks fine. The most abandoned step.
- FlareTopical anti-inflammatory under prescription, at sufficient potency and duration.
- Suspected infectionYellow crust, oozing or sudden worsening: assessed, not waited out.
- Moderate-to-severePhototherapy or systemic therapy, under supervision.
- ExpectationLong itch-free stretches. Not cure: control.
Frequently asked questions
Can atopic dermatitis be cured?
No. It is a chronic, relapsing disease: it is controlled very well, and many children improve substantially as they grow, but the skin barrier remains what it is. With a good plan you get long stretches without itch and with calm skin, which is the real goal. Abandoning emollients when the skin looks fine is the commonest cause of relapse.
Is it an allergy to a food?
Almost never. Atopic dermatitis is a skin-barrier defect on a reactive immune system, not an allergy to something you can remove from the pantry. Blind elimination diets rarely improve the skin and can cause nutritional deficiency in a child. If food allergy is genuinely suspected, it is investigated; it is not guessed at.
Why do you insist so much on moisturiser?
Because it is not a cosmetic: it is the foundation of treatment. Atopic skin loses water and lets irritants in because it lacks the lipid “mortar” between cells. Emollients replace it. Without that base, anti-inflammatories work less well and flares return sooner. It is used every day, even when the skin looks fine.
Are steroids on the skin harmful?
What is harmful is using them badly. The commonest error is not excess but deficiency: using too little, for too short a time, out of fear. That treats the flare poorly, prolongs it, and ends up requiring more medication, not less. Potency, amount and duration are prescribed in consultation and should be followed exactly.
How do I stop the itch?
By treating the inflammation adequately and early rather than in dribs and drabs, because itch is the engine of the disease: scratching breaks the barrier further, which inflames, which itches more. Short nails, cotton clothing, avoiding excess heat and sweat, short lukewarm baths and emollient on still-damp skin all help.
Every case is different. Discuss yours in a personal consultation.
Book a consultation on WhatsAppEvery figure published on this site is approximate and is not a quote. Any procedure or treatment first requires a private assessment consultation with Dr. Arístides Arellano —$800 MXN, charged separately— and it is at that consultation that the definitive cost of your case is determined.
Educational content; it does not replace a medical consultation. Results may vary from person to person.