Different than normal dry skin, eczema (atopic dermatitis) is a medical condition common among infants and children.
Eczema is a chronic condition that has often been referred to as ‘the itch that rashes’. It is comprised of intense itchiness of the skin and red, raw rashes that appear in areas that are scratched. The skin becomes very inflamed and often hurts. As the skin barrier is the major protectant against invasion of bacterial and viral invaders, areas disrupted by rash are often prone to infection.
In infancy, the most common places to see eczema are the cheeks, scalp, trunk and extremities. In early childhood, it is common in skin folds, such as the bend of elbows or back of knees. Adolescents and adults often break out on hands or feet. Eczema flares have an impact on the entire family, as children experiencing these flares are often cranky, do not sleep well and may be teased about their rashes by peers. The encouraging news is that most children will either outgrow or have milder symptoms over time.
Many factors contribute to eczema. One of the most common questions regarding causation of eczema revolves around food. The relationship between food allergies and eczema is complicated. It is confusing, but experts believe food allergies are more common in children who have eczema but don’t, necessarily, cause the eczema. In other words, the allergy may be there, but removing the allergen won’t necessarily improve the rash. It is estimated that 90% of parents inappropriately blame foods as the sole source of their child’s rashes. Often this leads to elimination diets that often leave kids lacking in essential nutrients or proteins. The one exception, experts note, may be egg allergies. Nearly 50% of infants with egg allergies had documented improvement in skin when an egg-free diet was followed. Please check with us before eliminating foods from your child’s diet, especially infants and young children.
Eczema treatment should focus primarily on the skin. The AAP proposes a 4 step approach:
- Maintenance skin care to promote a healthy skin barrier
- Topical anti-inflammatory medicines to suppress the immune response
- Itch control
- Managing infection triggers
Getting hydration to the skin is critical to repairing and maintaining the skin. The best moisturizers are those that are a labeled ‘fragrance free’ and have the least number of preservatives. Ointments, such as Vaseline or Aquaphor, are the most moisturizing, followed by creams, then lotions. One way to help moisturize your child’s skin is to give them a bath. Daily baths followed by subsequent full body ointment/moisturizer application can help lock in moisture. When giving baths to children with eczema, you should only use soap twice a week. When it comes to the soap, remember that lather comes from detergents, which are drying and irritating to the skin. Look for a non-lathering, conditioning soap for sensitive skin. It is also important to avoid irritants in laundry. Look for laundry soaps with no dyes or perfumes which are usually labeled “free and clear. It is also important to skip the fabric softener as it can irritate the skin
Flared, itchy skin won’t always improve with emollients/moisturizers alone. Topical steroids are often used to decrease inflammation and are safe when used sparingly and appropriately. Often, low potency steroids such as 1% hydrocortisone, available over the counter, are a good first line treatment. We usually recommend using these twice a day for 3-5 days to help acute flares. If these aren’t helpful, we will sometimes prescribe more potent steroid preparations. It is important to remember that these medicines should be used only on the inflamed or ‘flared’ areas of skin, not as an all- over treatment. A good rule of thumb is that a dab of medicine the size of a pearl should be sufficient to treat all affected areas. You shouldn’t be able to see the medicine, once it has been appropriately applied.
Thirdly, itch control is important. Often, parents may not appreciate how much their child is scratching because it is usually worse at night. Of course, keeping the skin in good shape may alleviate some itch, but may not be enough. Oral anti-histamine, readily available in over the counter forms, may often be useful to reduce the sensation of itching. Topical antihistamine creams are not effective and can be dangerous. Please consult our providers to find a preparation that would be the right choice for your child.
Finally, bacteria living on the skin may play a role in both the flares of eczema and in ‘super-infection’ or infections occurring in already irritated skin. Please contact our office right away if you notice pustules, oozing or a yellow crusting around eczema lesions, as these may be a sign of secondary infection and may need antibiotics. In addition, children with eczema are also prone to other types of skin infections, or experience more severe skin symptoms with common childhood infections. One such viral skin infection, molluscum contagiosum is more frequent and may be more widespread in children with eczema. We are able to treat some patients with molluscum in our office.
Dilute bleach bathes may help those patients who experience frequent infections and flares of eczema. If instructed by your provider, we would recommend adding 120 mL or ½ cup of household bleach to a full bathtub of water and bathing for 5-10 minutes once to twice weekly. Please seek our advice on whether this is an appropriate treatment for your child.
Eczema is often frustrating and challenging for affected families. Fortunately, there are many ways to help ease the suffering of this chronic condition. Please call our office for an appointment to discuss your child’s skin care and treatment options.