Eczema (Atopic Dermatitis) and Your Child

Eczema (atopic dermatitis) is a chronic skin problem that causes dry, red, itchy skin. Your child’s doctor can help you and your child relieve the symptoms and keep them under control.

Here is information from the American Academy of Pediatrics about eczema and how to help your child prevent flare-ups and manage the symptoms.

Who gets eczema?

Anyone can get eczema, but it is most common in babies, children, and young adults. Eczema often runs in families with a history of eczema or other allergic conditions, such as hay fever and asthma. It is not contagious.

•  About 65% of patients who develop eczema develop symptoms before age 1 year, and about 90% of these patients develop symptoms before age 5 years. Many babies outgrow eczema by age 4 years.
•  Some children outgrow eczema by the time they are young adults, although their skin remains dry and sensitive.
•  A few people may have eczema all their lives, but there are ways to relieve the symptoms.

What are the symptoms of eczema?

The symptoms of eczema are different with each child. Common symptoms include dry, red, itchy skin and rashes. These rashes can be oozing or very dry. Because eczema is a chronic skin problem, these symptoms can come and go. There are times when the symptoms are worse (called flare-ups or exacerbations) followed by times when the skin gets better or clears up completely (called remissions).

Eczema can appear anywhere on the body or in just a few areas.

•  In babies, a rash often appears on the face and scalp.
•  In younger children, a rash often appears in the folds of the elbows and knees.
•  In teens and young adults, a rash often appears on the hands and feet.

How can flare-ups be prevented?

One of the most helpful things you can do is to prevent flare-ups before they happen.

• Keep your child’s skin moisturized. Moisturizing should be a part of your child’s daily treatment plan.
  •  Use fragrance-free moisturizers. Cream or ointment is more moisturizing than lotion.
  •  After a bath, gently pat the skin with a towel and then apply moisturizer to the damp skin.
  •  Apply moisturizer at least once a day, or more often if needed.
  •  Moisturizer should be applied to the face and entire body.
• Avoid irritants. People who are sensitive to scratchy fabrics or chemicals in soaps and detergents should
  •  Wear soft fabrics, such as 100% cotton clothing.
  •  Use mild, fragrance-free body cleansers.
  •  Take short baths with room temperature water.
  •  Use mild laundry detergent with no dyes or perfumes.
  •  Skip using fabric softener in the dryer.
•  Remind your child not to scratch. Scratching can make the rash worse and lead to infection. Also, the more your child scratches, the itchier the area will be. Keep your child’s fingernails short and smooth, and try to distract your child from scratching.
•  Ask your child’s doctor if allergies could be associated with eczema. Sometimes allergies, such as ones to food, pets, pollens, or dust mites (in bedding), can trigger the rash or make it worse. If your child’s eczema is associated with an allergy, avoid the triggers, if possible.
•  Ask your child’s doctor about other things that can trigger a flare-up. These things include overheating or sweating and stress.

What types of medicines are used to treat symptoms?

Your child’s doctor may recommend medicines to help your child feel better and to keep the symptoms of eczema under control. The type of medicine recommended will depend on how severe the eczema is and where it appears on the body. The medicine can be given in 2 ways: applied to the skin ( topical ) or taken by mouth ( oral ). Topical medicines are available as oils, lotions, creams, or ointments; oral medicines are available in pill or liquid form.

Medicines that only a doctor (and some other health professionals) can order are called prescription medicines. They are usually more powerful than over-the-counter (OTC) medicines. Prescription medicines are intended to only be used by the person prescribed the medicine. Over-the-counter medicines are available without a doctor’s order. This does not mean that OTC medicines are harmless. Like prescription medicines, OTC medicines can be very dangerous to a child if not taken the right way.

Before you give your child any medicines, be sure you know how to give them. Talk with your child’s doctor if you have questions or concerns about giving your child medicines.

Over-the-counter Medicines

Topical steroids (hydrocortisone creams or ointments) may help relieve itchy skin and decrease inflammation. They work best for mild eczema.

Steroid-free topical itch relief medicines may give fast relief of dry, itchy skin with few side effects. Some of these medicines contain alcohol, which can cause a burning sensation.

Oral antihistamines (particularly the kind that make some people sleepy) may help relieve the itch.

Prescription Medicines

Topical steroids are used to reduce inflammation (redness and swelling) and to stop the itch. They are the oldest and most widely used medicines for eczema and are effective and safe when used as directed. Uncommon side effects, including thinning of the skin, stretch marks, or acne, may occur if they are not used as directed.

Topical immunomodulators (steroid-free medicines) are used to reduce inflammation and stop the itch. They are a newer class of medicines shown to work in 80% of studies done in children older than 2 years.

Oral antihistamines come in several prescription types and may help stop the itch in some children.

Oral antibiotics may be prescribed if there is a secondary bacterial skin infection.

Oral steroids are rarely recommended, especially for young children, because they pose many health risks. Also, after patients stop taking these medicines, they often have rebound flare-ups.

Resources

American Academy of Pediatrics

www.AAP.org and www.HealthyChildren.org

American Academy of Allergy, Asthma & Immunology

www.aaaai.org

American Academy of Dermatology

www.aad.org

American College of Allergy, Asthma & Immunology

www.acaai.org

National Eczema Association

www.nationaleczema.org

National Institute of Arthritis and Musculoskeletal and Skin Diseases

www.niams.nih.gov

Society for Pediatric Dermatology

www.pedsderm.net

Remember

Eczema is a chronic skin problem, so it can come and go. It requires ongoing management by you, your child, and your child’s doctor. If your child’s eczema is not improving, talk with your child’s doctor about your concerns.

Listing of resources does not imply an endorsement by the American Academy of Pediatrics (AAP). The AAP is not responsible for the content of external resources. Information was current at the time of publication. The information contained in this publication should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances. .