Health Library

Eczema

Eczema is a very common skin problem. The most common form of eczema is called atopic dermatitis.

Atopic dermatitis often begins in infancy, affecting about 15 to 20% of children. It usually improves as the child grows older and may resolve by school age or puberty. Some children with atopic dermatitis may have more chronic disease.

Causes

Children with eczema have a form of “sensitive skin” that may be more easily irritated by sweating, heat, rough clothing and some detergents, soaps and cleansers. Children with atopic dermatitis may have allergies to foods, pets or other animals, dust mites, tree pollens and grasses, although it is not clear that these allergies actually “cause” the eczema in most children.

In most cases, identifying these allergies does not help the eczema. Rarely, some children with atopic dermatitis may develop allergies to chemicals in their moisturizers, other skincare products, clothing or topical medications.

Symptoms

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.

In infants, eczema commonly affects the face, scalp, arms and legs.

In older children, eczema may involve only the insides of the elbows and backs of the knees.

Some children with severe eczema may have involvement of their entire body. Eczema is very itchy.

Treatments

There is no cure for eczema, although it can usually be controlled with good skin care. Frequent follow-up with your doctor is important so they can see whether the prescribed medicines are working. Your doctor may need to adjust treatment during different seasons of the year, during flares, or as your child gets older.

Bathing

For some children, limiting bathing to one to three times a week is helpful. Bathing more often can “dry out” the skin and make itching worse. For children with environmental allergies such as pollens and animal dander, bathing more often, especially after contact with known allergens, may be helpful. Your doctor will help you decide which approach is best for your child.

• Use a gentle, non-soap cleanser such as Dove Sensitive Skin bar soap or Cetaphil cleanser.
• Limit time in bathtub or shower to 5 to 10 minutes or less.
• Warm water; hot water will further dry out the skin.
• Do not use a washcloth, hot water or bubble bath, or loofahs.
• Pat skin dry with towel. Do not rub.
• Apply topical medicines or moisturizers as instructed, right after bathing while the skin is still damp.

Topical (Skin) Medicines

Your doctor may prescribe topical steroids or other creams or ointments to treat your child’s eczema. Apply a small amount of medicine to affected areas up to two times a 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 moisturizer. Try to wait at least 30 minutes before applying moisturizer.

If your child’s eczema flares, you may need to use a stronger topical steroid for a short time. Use these steroids twice a day or as instructed by your doctor on areas that have flared in place of your everyday steroids. Call your doctor if the areas are not any better after seven days. As the eczema improves, you should be able to use the topical medication less often, ideally two to three times a week or less, to keep your child’s skin clear.

Do not overuse or abuse the topical steroids. Doing so can harm your child’s skin, such as stretch marks and spider veins.

Moisturizers

It is important to moisturize from the inside, so have your child drink plenty of water.

Apply a thick layer of moisturizer 30 minutes after you apply any topical medicines. 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 like Vaseline and Aquaphor too greasy to use in the summertime. It makes them uncomfortable when they sweat.

Here are some good moisturizers, but your doctor may suggest something else (You may also find a different product that your child likes to use):

• Vaseline or petrolatum jelly (in a tube or jar) ointments
• Aquaphor ointment
• A-Mantle cream
• Aveeno cream
• CeraVe cream
• Cetaphil cream (including Restoraderm)
• Eucerin cream
• Vanicream

There is also a list of “approved” products available on the National Eczema Foundation webpage.

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.

Antihistamines

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 (itchy, watery eyes and stuffy nose) may also need to take a daily, non-sedating antihistamine such as cetirizine (Zyrtec), loratadine (Claritin) or fexofenadine (Allegra) in the morning to control their allergy symptoms.

Environmental Triggers

Avoid foods or environmental triggers such as dog or cat dander, dust mites and tree pollens that may make your child’s eczema worse. Even if your child is not around triggers often, they can still make the eczema worse. Some helpful hints:

• Keep skin covered with cotton clothing (long sleeves and pants when possible).
• 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 cool mist humidifier may be helpful.
• Minimize exposure to extreme heat and sweating.

Skin Infections

Skin infections are common in children with eczema. This may show up as pustules, yellow crusting, oozing, tender areas or nodules, or red/warm plaques. If your child has a skin infection, your doctor may change the skin care routine for a short time. They may also prescribe either a topical or oral antibiotic.

Topical antibiotics such as mupirocin (Bactroban, Centany) ointment should be applied twice a day to any open or crusted areas on the skin for several days until these areas heal. Keep putting the topical corticosteroid medications and moisturizers on these areas.

Bleach Baths

Routine diluted bleach baths will cut down the bacteria on the child’s skin and decrease the risk of bacterial infections. 1-2 times a week is recommended. May do more often if in a severe flare. Bleach bath recipe:

• A quarter of a cup of unscented laundry bleach in a regular size bathtub filled half full
• One teaspoon per gallon of water in a baby tub

Wet wraps

Wet dressings can be placed on the child after applying topical steroid medication. This makes the medication more effective by helping it penetrate deeper into the skin. Tubifast is a type of tube dressing that comes in many sizes. It can be cut to fit areas of the body such as arms, legs, and torso. You may also use ace wrap, or wet cotton pajamas. After the nighttime dose of topical steroid application is ideal, as the child can then wear them to bed for increased duration of treatment. They can also be worn after application of moisturizing cream to more effectively lock moisture into the skin.

Follow-up Visits

Follow-up visits are very important. The doctor will examine your child’s skin and monitor for side effects of steroid medication use and infections. They may change the medications being used. It is important to follow the doctor’s instructions and keep follow-up appointments.

When to Call the Doctor

• If your child develops open, oozing areas of skin that are painful or associated with a fever
• If your child’s eczema worsens or does not improve with the use of prescribed medications

Referral to a Specialist

Most infants and children with mild to moderate eczema can be managed by their primary care provider as long as the treatment plan is followed and follow-up visits are made. Referral to an allergist or dermatologist is appropriate when:

• Food or other allergies are suspected
• Skin infections are frequent
• Your child is not responding to the treatment plan prescribed by the primary care provider after several follow-up visits and adjustments to the treatment plan have been made
• Eczema website