You are changing your child’s clothing, and you notice dry, rough skin on the belly area. After further inspection, you also notice dry, rough skin on the wrists, elbow creases, and behind the knees. You take your child to see your pediatric healthcare provider who diagnoses atopic dermatitis, better known as eczema. What is eczema? What should you do?
Eczema is the common term for the medical diagnosis of atopic dermatitis, a type of rough, dry, itchy skin. This skin issue usually starts within the first five years of life and is a quite common skin condition in infants and children. These children have sensitive skin.
Eczema is known as “the itch that rashes.” It can cause dry, red patches, and it may come and go. The itching is worse at night. Nighttime itching can affect sleep, which can in turn affect daytime learning. Disrupted sleep can cause irritability and daytime drowsiness as well.
Infants tend to get eczema patches on the face, wrists, and elbows. It spares the diaper area as the diapers keep the area moist. Children and toddlers tend to get patches on the elbow creases, behind the knees, behind the neck, and on the wrists and ankles.
Itching can be frequent and may cause thickening of the skin or even infection. Signs of infection are redness, warmth, pain, inflammation, and pus. If your child has an area that appears infected, seek immediate medical care with your pediatric healthcare provider.
Although no one is exactly certain about what causes eczema, we know that it tends to run in families and may be associated with allergies. Triggers may include environmental allergens, seasonal allergens, or even a history of asthma.
Eczema, allergies, and asthma are so often seen together that they are known as the “atopic triad” (three things that occur together). Environmental allergens include dust, mold, or pet dander. Seasonal allergen triggers include seasonal allergies such as hay fever. These may cause a worsening of the condition, known as a “flare.” If you can identify what triggers your child, you can work to avoid those particular triggers. Eczema is not contagious.
How do you know if your child has eczema? Well, there are no specific tests to diagnose eczema. Your pediatric healthcare provider will take a careful history and do a thorough physical examination before diagnosing your child with eczema (atopic dermatitis). Although eczema is not curable, it is treatable. While eczema can persist into adulthood as a lifelong skin problem, it usually improves by five or six years of age.
What can you do to help improve your child’s skin? Be certain to use only dye-free, fragrance-free soaps, lotions, and detergents on your child’s skin and clothing. Avoid any fragranced products including perfume. Avoid use of scented fabric softener, scented detergent, or dryer sheets. Use alcohol-free hand sanitizer. Use a gentle cleanser for sensitive skin and a fragrance-free moisturizer.
Since eczema is a condition of dry skin, it is essential that you moisturize the skin frequently. Shower or bathe in warm water (not hot). Limit time in the bath to 5 to 10 minutes. Quickly but gently pat the skin dry. Apply moisturizer to damp skin within a few minutes of bathing to avoid allowing the skin to dry completely. Use a dye-free, fragrance-free moisturizer several times each day. The use of an emollient such as Vaseline or Aquaphor over a moisturizer can help to trap in the moisture.
Cotton fabrics are a better choice than wool or polyester clothing. Avoid allergens such as dust, mold, and smoke. Shower before bedtime to wash off any environmental allergens. Remember to moisturize afterwards. File your child’s fingernails to prevent them from damaging the skin while scratching. Keep the house cool (especially during the night), as warmer temperatures can cause a flare. Encourage your child over one year of age to drink adequate amounts of water to ensure adequate moisturization to the skin. (Safety note: Infants less than 6 months may not have water, only breast milk or formula. For infants from 6 to 12 months, limit water to 1/2 cup daily in addition to breast milk or formula.)
Your pediatric healthcare provider may prescribe a topical corticosteroid. Use this carefully and only as directed. Never use moisturizer or an emollient (Vaseline) over the steroid cream. Antihistamines may be recommended by your pediatric healthcare provider to decrease itching and help control allergy symptoms. If there are signs of infection, your pediatric healthcare provider may prescribe an oral or topical antibiotic as well.
See your pediatric healthcare provider if you feel your child may need treatment for allergies, skin infections, or eczema. With proper care, the symptoms of your child’s eczema will be minimized, allowing for healthy skin and better sleep.