Springdale Mason Pediatrics

Eczema (Atopic Dermatitis)

Definition

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

Call or Return 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

About This Topic

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.

After Care Advice

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.
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 prescription medicines can bring most severe eczema under control. Discuss with your doctor.
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.
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.
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.
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.
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.
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.
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.

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.
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