Eczema is very common skin problem. Children with eczema develop red, dry, itchy patches on the skin that result from inflammation. Itching may be severe and constant. With frequent scratching, the skin may develop blisters, oozing, crusting, or sores from infection. Sometimes, if the child scratches for many weeks to months, the skin may start to become very rough, leathery, and darker in color.
The most common form of eczema is called atopic dermatitis. Children with atopic dermatitis have a form of “sensitive skin.” Their skin is more easily irritated by sweat, heat, rough clothing, and some detergents, soaps and cleansers. They also may develop true allergies to foods, pets or other animals, dust mites, tree pollens, and grasses, which may require evaluation by an allergist for skin testing. Children with atopic dermatitis may also have asthma, allergic rhinitis and allergic conjunctivitis. It is important to recognize that although many children with atopic dermatitis have food or environmental allergies, identifying and avoiding allergens does not ‘cure’ the eczema, as there are other intrinsic factors related to the function of the immune system that play a role in the development of atopic dermatitis. Some children with atopic dermatitis may develop allergies to chemicals in their moisturizers, other skincare products, clothing, or medications. Evaluation may require special skin testing called patch testing.
Atopic dermatitis affects about 15-20% of children. In infants, atopic dermatitis commonly affects the face, scalp, arms and legs. In older children, atopic dermatitis may involve only the insides of the elbows and backs of the knees. Some children with severe atopic dermatitis may have involvement of their entire body. There is no cure for atopic dermatitis, although it can usually be controlled with good skin care and attention to triggers in the environment. Most children improve by the time they become adolescents.
For some children, limiting bathing to 1-3 times per week is helpful, as more frequent bathing can “dry out” the skin and make itching worse. For children with environmental triggers such as pollens and animal dander, more frequent bathing, especially after contact with known triggers, may be helpful. Your dermatology provider will help you to decide which approach is best for your child.
Use a gentle, non-soap cleanser
Limit time in shower or bathtub (5-10 minutes or less)
Do not use a washcloth, hot water or bubble bath
Pat skin dry with towel. Do not rub
Apply topical medications or moisturizers as instructed, immediately after bathing while the skin is still damp
Your dermatology provider may prescribe topical corticosteroids or other creams or ointments to treat your child’s eczema. Apply a thin film of medicine to affected areas up to two times per day as needed to keep the eczema under control. You may not need to use the medicine every day.
ALWAYS apply the topical medication before any moisturizer. Try to wait at least 30 minutes before applying any moisturizer.
If your child’s eczema flares, you may need to temporarily use a stronger topical corticosteroid. Use these corticosteroids twice a day or as instructed otherwise by your provider on areas that have flared in place of your everyday corticosteroids . Call the office if there is no improvement after 7 days.
DO NOT overuse or abuse the topical steroids. Doing so can harm your child’s skin, resulting in permanent thinning, stretch marks and discoloration.
Even when your child is not showing signs of active eczema, you should continue to use the moisturizer at least twice a day to help prevent flare-ups. Apply a moisturizer 30 minutes after you apply any topical medications. This allows time for the medicine to be absorbed into the skin. The moisturizer will then seal in the medicine. In general, ointments or creams are preferred over lotions. Do not use a moisturizer that comes in a pump-bottle, as these are usually lotions. Some children find ointments such as Vaseline and Aquaphor too greasy to use in the summertime, as they find it makes them uncomfortable when they sweat. These are some good moisturizers, although your doctor may recommend something else or you may find a different product that your child likes to use:
Cetaphil cream (including Restoraderm)
Antihistamines are a type of allergy medicine. They can also be used to decrease itching. They are most helpful when given before bedtime (antihistamines can make your child sleepy). Antihistamines include hydroxyzine (Atarax®) and diphenhydramine (Benadryl®). Follow the dosage instructions on the package.
Some children with environmental allergies and allergic rhinitis/sinusitis (itchy watery eyes and stuffy nose) may also need to take a daily, non-sedating antihistamine such as cetirizine (Zyrtec®), loratidine (Claritin®), or fexofenidine (Allegra®)in the morning to control their allergy symptoms.
Children with severe atopic dermatitis that is not improving with attention to good skin care, avoidance of known triggers or allergies, and topical medications may require additional treatment with an oral immunosuppressive medication or phototherapy (light therapy). Oral corticosteroids such as prednisone are NOT recommended for the treatment of atopic dermatitis as they often result in a flare of the eczema after they are stopped. They also have many potential side effects such as high blood pressure, weight gain, and poor growth.
Avoid foods or environmental triggers such as dog or cat dander, dustmites, and tree pollens that may make your child’s eczema worse. Even if your child is not around these triggers often, they can still make the eczema worse. Here are some helpful hints:
Keep skin covered with cotton clothing (long sleeves and pants)
Keep your home at a comfortable indoor temperature (sweating can lead to itching)
Avoid harsh, itchy materials such as wool and non-breathable fabrics such as polyester
Avoid fuzzy toys, stuffed animals and pets
When humidity is low, a vaporizer or humidifier may be helpful
Minimize exposure to extreme heat and sweating
Skin infections are common in children with eczema. If your child has a skin infection, your dermatology provider may temporarily change his/her skin care routine. He may also prescribe either a topical or oral antibiotic.
Topical antibiotics such as mupirocin (Bactroban, Centany) ointment should be applied twice daily to any open or crusted areas on the skin for several days until these areas heal. Continue to apply the topical medications and moisturizers to these areas.
Your dermatology provider may also recommend that you do one of the following:
Tar soaks with Cutar® (add 4-6 capfuls per bath) daily as needed to control itching
Bleach baths (add ¼ cup of Clorox® or other laundry bleach in the bathtub 1-2 times per week)
Follow-up visits are very important. The dermatology provider will examine your child’s skin and may change the medicines being used. It is important to follow the treatment instructions and keep all follow-up appointments.