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What is eczema (atopic dermatitis)?
This is the most common inflammatory skin condition.
It is a rash that can be dry, scaly, scabbed, and itchy.
It is not contagious.
It is estimated to affect about 10% to 12% of children in the U.S.
It can occur at any age.
About 85% of kids who develop it have it by one year of age.
About 95% of kids who develop it have it by 5 years of age.
Some kids will outgrow it.
It may worsen with age or get better with age.
It may last for short periods or long periods.
It may go away and come back.
What causes eczema (atopic dermatitis)?
In most kids, this happens when the skin doesn’t make enough of a protein that allows the skin cells to stay strong.
Since the skin barrier is not as strong, it is easier for it to be irritated by things in the environment and infections.
This also makes is easier for the skin to be irritated if your child is physically or emotionally stressed.
This also makes it harder for the skin to hold in enough moisture.
If your child has a family history they maybe more likely to have eczema.
If your child has allergies (including foods) or asthma they may develop eczema as well.
This is because their immune system is bothered by environmental factors more than other kids.
Of special note, foods themselves do not cause eczema.
What are the symptoms of eczema (atopic dermatitis)?
Your child may have a rash in one spot or in many spots.
Babies usually start with the rash on their head or face and the rash can expand to other body parts.
In young school-aged children the rash usually starts on the elbow creases, back of knees, around the neck or eyes and can expand to other body parts.
The rash may look raised or flat.
The skin may be dry, cracked, or look wet.
It may or may not bother your child, it depends on how itchy it feels to them.
The skin may look calm for periods of time, but also may “flare” where the skin is bright red, scaly, scabby, and may look wet.
How is eczema (atopic dermatitis) diagnosed?
Your child’s healthcare provider will examine your child.
Your child’s healthcare provider will ask you questions about the rash, skin products, new foods and what your child’s skin has been exposed to.
The appearance of your child’s skin and the questions asked, help your child’s primary care provider with the diagnosis.
Labs or further testing are not usually needed.
How is eczema (atopic dermatitis) prevented?
The best method of protection is skin hydration.
Keep your child’s skin moist by applying lotions, creams, or petroleum jelly at least two to three times daily.
If 6 months or older, encourage them to drink water as this helps keep the skin stay hydrated as well.
Encourage your child to eat a variety of fruits and vegetables (lots of different colors).
Fruits and vegetables have a variety of vitamins and minerals that help keep the skin healthy.
Avoid scented products.
Using soaps and detergents for sensitive skin may be helpful.
Using antibacterial soaps may be helpful.
Avoid scented dryer sheets.
Switching to a dryer ball can be helpful.
It is best to avoid fabric softeners, since the products in them can cause your child’s clothing to irritate their skin.
Luke warm water is better than hot water for baths and showers.
Showers are better than baths, as baths take more moisture from the skin.
After the bath/shower, gently pat your child down, leaving the skin damp and then apply a moisturizer.
Leaving their skin damp while applying moisturizer allows the skin to better hydrate.
Avoid what makes your child’s skin worse which may include:
Pollens, so it is best to keep your child from rolling in the grass.
Dry air, as it dries out your child’s skin.
Using of a humidifier in their room or a busy place in the house, may help.
Be sure to clean the humidifier as recommended on the directions.
Foods your child is allergic to.
Foods don’t cause eczema, but eating those foods can make your child’s skin worse.
Wools, rough and scratchy fabrics may irritate the skin.
Cotton is the most friendly fabric for skin.
Chlorinated pools, so be sure to have your child shower off as soon as they leave the pool.
If animals like dogs or cats worsen your child’s eczema it is best to avoid them.
Hypoallergenic pets are not truly allergen free, so they may still irritate your child’s skin.
A person with a skin infection, especially herpes, often referred to as “fever blisters”.
It is easier for your child to get skin infections, so it is best to keep your child from touching them.
Some children are prescribed a medication to use for prevention of eczema flares.
Be sure to follow the prescription directions.
How is eczema (atopic dermatitis) treated?
Keep your child’s skin hydrated.
Using creams, oils, and ointment is better than lotions, since the thicker the moisturizers the better it helps the skin.
Encourage your child to drink lots of water (if 6 months or older).
Encourage a healthy diet, free of any foods that you know your child is allergic to.
Offer a colorful variety of fruits and veggies to help your child get a balance of vitamins and nutrients.
Over-the-counter medications like diphenhydramine cream, calamine lotion, and hydrocortisone may help.
Hydrocortisone is a topical steroid so it can make your child’s skin more sensitive to the sun, so be sure to apply sunscreen.
Your child’s primary healthcare provider may prescribe:
A topical steroid that may be an ointment, oil, or cream.
A medication called a topical calcineurin blocker that may be an ointment or cream.
If your child’s eczema looks infected, your child may be prescribed an antibiotic (this may be a topical, oral, or both).
Be sure to follow the prescription directions.
Your child’s primary care provider may recommend:
An oral antihistamine like cetirizine or loratadine, if there is concern for environmental allergies.
An oral antihistamine like diphenhydramine if your child struggles with sleep due to itchiness.
If your child’s eczema is hard to control, they may refer your child to a dermatologist or allergist.
Bleach baths or wet wraps if your child’s eczema is severe or they feel it might help.
Bleach bath information.
For wet wraps follow these instructions:
1) Moisten a cotton dressing in warm water until damp.
2) Wrap the cotton dressing around the atopic dermatitis area.
3) Place a dry dressing over the wet dressing.
4) Carefully place pajamas (or clothing) over the dressings.
5) Hours later, or in the morning, remove the dressings and apply moisturizer to the skin.
When to contact your healthcare team:
You think your child has eczema (atopic dermatitis).
You are concerned about your child’s skin.
You are following your child’s treatment plan and your child’s skin is not improving or getting worse.
You have other questions or concerns.
You would like to have your child seen.
📚 References
Article written by TT DO. Reviewed by: TT, DO, JW MD, Patient Education Committee.
This content was adapted from DermNet, healthychildren.org, UpToDate, National Eczema Association, Medscape
Images from https://dermnetnz.org/topics/atopic-dermatitis,https://eczema.org/information-and-advice/information-for-parents-and-children/babies-and-eczema/