Definition

• Eczema is a chronic dry skin disease with recurrent flare-ups of severe itching
• The rash is red and itchy

Health Information

Symptoms

• The main symptom is itching. If it doesn’t itch, it’s not eczema.
• With flare-ups (itching attacks), the rash becomes red or even raw and weepy.
• Onset: Average onset at 3 months old. Range: 1-6 months old. Usually begins by 2 years old.
• Location: Classic eczema starts on the cheeks at 1 to 6 months of age. It can spread to the rest of the face. In infants, the outer surfaces of the arms and legs also become involved.
• In older children, eczema is found in the joint creases. The elbows, wrists, and knees are the most common places.
• The rash is usually the same on both sides of the body.

Cause

• A type of dry, sensitive skin that’s inherited.
• Flare-ups are from skin contact with soap, shampoo, pollen or other irritating substances.
• About 30% of babies with severe eczema also have food allergies. The most common is cow’s milk.
• Over 10% of children have eczema. It’s the most common skin condition of the first 10 years.

Prevention - Avoid Triggers of Eczema Flare-Ups

• Soaps. Never use bubble bath. It can cause a major flare-up.
• Pollens. Keep your child from lying on the grass during grass pollen season.
• Animals. Avoid any animals that make the rash worse.
• Foods. If certain foods cause severe itching (flares), avoid them.
• Wool. Avoid wool fibers and clothes made of other scratchy, rough materials.
• Dry Air. Use a humidifier if the air in your home is dry.
• Caution: Keep your child away from anyone with fever blisters (cold sores). The herpes virus can cause a serious skin infection in children with eczema.
• Don’t worry about which detergent you use to wash clothing.

Care Advice

1. Overview:
   • Eczema is a chronic skin disease. So, you need to learn how to control it.
   • Itching attacks (flare-ups) are to be expected.
   • The goal is to treat all flare-ups quickly and vigorously. (Reason: To prevent skin damage)
   • Here is some care advice that should help.
2. Treatment Based on Severity of Eczema:
   • Mild Eczema: Just need moisturizer cream and to avoid flare-up triggers
   • Moderate Eczema: Also needs steroid cream and bedtime allergy medicine
   • Severe Eczema: Also may need oral antibiotics (usually for 2 weeks). Several new perscription medicines can bring most severe eczema under control. Discuss with your doctor.
3. Steroid Cream or Ointment (Rescue Medicine):
   • Itchy skin is the main symptom of eczema.
   • Steroid creams or ointments are essential for controlling red, itchy skin.
   • Apply steroid creams only to itchy or red spots (not to the normal skin).
   • Most children have 2 types of steroid creams. (1) A mild steroid cream to treat any pink spots or mild itching. This is often 1% hydrocortisone cream. No prescription is needed. (2) Another stronger cream to treat any spots with severe itching. This is a prescription steroid cream such as Synalar. Never apply this stronger cream to the face.
   • Apply these creams as directed or 2 times per day.
   • After the rash quiets down, apply it once per day. After 1 week just use moisturizing cream.
4. Moisturizing Creams or Ointment (Controller Medicine):
   • All children with eczema have dry sensitive skin.
   • The skin needs a moisturizing cream applied once or twice daily. Examples: Cetaphil cream.
   • Apply the creams after a 5 or 10-minute bath. To trap moisture in the skin, apply the cream while skin is still damp. Do this within 3 minutes of leaving the bath or shower.
   • The steroid cream should be applied to any itchy spots first. Then use the moisturizing cream as the top layer.
   • While most parents prefer creams, moisturizing ointments are sometimes needed in the winter. Examples are Vaseline and Aquaphor.
   • Caution: Never stop the moisturizing cream. Reason: The rash will come back.
5. Bathing - Avoid Soaps:
   • Give one bath a day for 10 minutes in lukewarm water. Reason: Water-soaked skin feels less itchy. Follow the bath with a moisturizing cream to all the skin.
   • Avoid all soaps. Reason: Eczema is very sensitive to soaps, especially bubble bath. There is no safe soap for young children with eczema. They can be cleaned using warm water.
6. Allergy Medicine:
   • Many children with eczema need an allergy medicine by mouth at bedtime. Reason: Scratching in bed can cause severe skin breakdown. It may also interfere with falling asleep.
   • Give the medicine your child’s doctor suggested.
   • If none was suggested and over 1 year old, give Benadryl. No prescription is needed.
7. Itching Attack - Shower to Remove Irritants:
   • Playing in the grass, being around animals, or swimming can cause increased itching.
   • For itching from these causes, give your child a quick shampoo and shower.
8. Itching Attack - Treatment:
   • At the first sign of any itching, use the steroid cream. Put it on the areas that itch. If unsure, apply 1% hydrocortisone cream. No prescription is needed.
   • Keep your child’s fingernails cut short and smooth.
   • Ask older children to try not to itch, but never punish for itching.
   • For constant itching in young children, cover the hands with socks or gloves. Use for a day or until the itching is brought under control. Provide extra cuddling during this time.
9. Expected Course:
   • Eczema is a chronic condition. After puberty, about half get over their eczema.
   • Many children who have severe eczema as babies develop asthma and nasal allergies.

Call Your Doctor If

• Itching is not under control after 2 days of steroid cream
• Rash looks infected (spreading redness, yellow scabs or pus)
• You think your child needs to be seen
• Your child becomes worse

Author: Barton Schmitt MD, FAAP

Copyright 2000-2020 Schmitt Pediatric Guidelines LLC

Disclaimer: This health information is for educational purposes only. You the reader assume full responsibility for how you choose to use it. The information contained in this handout should not be used as a substitute for the medical care and advice of your pediatrician. Listing of any resources does not imply an endorsement.

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