Eczema

Overview

The Basics

  • 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.