Eczema (also called "atopic dermatitis") is an ongoing skin problem which causes itchy, red, irritated, bumpy patches of skin.
Approximately 1 in 10 children under 4 years old have this condition.
We don’t know why some children develop eczema, but most children outgrow the condition by 4 years of life.
Children with eczema have more sensitive skin than other children.
This hypersensitive skin is prone to becoming itchy and inflamed.
Eczema often runs in families, so we know there is some genetic component.
Some people with childhood eczema develop other “atopic conditions” when they’re older, such as asthma and allergies (environmental, seasonal, and food).
This is not guaranteed to happen when they’re older.
There isn’t a good way to know which children will develop other atopic conditions when they’re older.
There is little evidence that specific foods cause eczema, even though some children with eczema also have food allergies.
What Does Eczema Look Like?
Eczema can be different for each child, and it frequently changes over time.
Sometimes the patches are all over the body.
Sometimes the patches are just in specific places.
Eczema patches are almost always itchy.
Even infants will scratch if the skin is itchy, so this is a reliable symptom you should be looking for.
Commonly Affected Areas
Infants
Rough, red, itchy patches on the cheeks, forehead, and/or scalp.
May spread to knees, elbows and trunk.
Older Children
Rough, red, itchy patches on the ends of elbows, behind knees, neck, inner wrists and/or ankles.
What to Expect
Before a child outgrows their eczema, it typically comes and goes, with flare-up and remission phases.
Flare-ups - when visible eczema patches develop and cause itchiness.
Remissions - when the skin looks completely normal.
Treatment
The Basics
There is no “cure” for eczema.
Before a child outgrows the eczema, the goal is to prevent flare-ups from happening, and aggressively treat flare-ups when they occur.
Remission Phase
When the skin looks completely normal, the goal is to prevent flare-ups.
Dry skin causes flare-ups, so keeping the skin moisturized is the key.
Ointments (e.g. vaseline) and creams are best.
Lotions are not as effective.
Use only unscented soaps, detergents, and skin care products
Most children with eczema require vaseline applications 4x every day to prevent flare-ups.
Additional Prevention Techniques
Short baths or showers in warm (not hot) water for up to 15 minutes.
Apply emollient (vaseline) immediately after bath, when the skin is still damp.
Pat skin dry gently, leaving a bit damp, then apply moisturizer to damp skin over the entire body.
Keep fingernails trimmed to avoid scratching
Drink lots of water to add moisturization to skin
Avoid known allergens - pollen, mold, smoke
Use a humidifier at night
Flare-Ups
Despite your best prevention efforts, flare-ups will still happen, and this is normal.
Sometimes they return just days after they go away.
This is also normal.
Whenever flare-ups occur, the goal is to aggressively treat those areas in order to return to the remission phase as quickly as possible.
Topical Corticosteroids
These anti-inflammatory medicines are applied to the inflamed eczema patches 2x daily during flares.
Cover the steroid with vaseline, or another emollient.
The goal is to find the lowest strength steroid that still makes the skin look completely normal within 7 days of treatment.
If the skin is not 100% normal after 7 days of twice daily treatment, please let us know right away.
When this happens, we increase the strength of steroid slightly, hoping it will be strong enough to make the skin completely normal within 7 days of treatment.
Skin Moisturizing
Keeping the skin moisturized is just as important during flare-ups as it is during remission.
Ointments (e.g. vaseline) and creams are best.
Lotions are not as effective.
Use only unscented soaps, detergents, and skin care products
Most children with eczema require vaseline applications 4x every day during flare-ups.
Cover the steroid ointment with vaseline as well.
Short baths or showers in warm (not hot) water for up to 15 minutes.
Apply emollient (vaseline) immediately after bath, when the skin is still damp.
Pat skin dry gently, leaving a bit damp, then apply moisturizer to damp skin over the entire body.
Keep fingernails trimmed to avoid scratching
Drink lots of water to add moisturization to skin
Avoid known allergens - pollen, mold, smoke
Use a humidifier at night
Antihistamines
Occasionally oral antihistamines (Children's Zyrtec/Claritin) are necessary to help with intense itching.
Bleach Baths
Bleach baths have been shown to prevent bacterial infections from taking advantage of the compromised skin barrier (eczema patches).
Add ¼ cup of liquid bleach to bathtub after filling with water.
Do this no more than 2x per week.
Wet Wraps
Apply damp clothing on top of the vaseline-covered skin.
Especially useful during naps or overnight sleep.
Reach out to Modern Pediatrics when...
Skin does not clear completely with hydrocortisone protocol above after 7 days.
Signs of infection - redness or warmth of affected skin, oozing or pus filled bumps.
