Eczema (Atopic Dermatitis)

What is eczema?

Eczema is a rash that starts on the cheeks at 2 to 6 months of age. The rash is red and itchy. If scratched, the rash becomes raw and weepy. The rash in older children is most commonly found in the creases of the elbows, wrists, and knees. Sometimes eczema also occurs on the neck, ankles, and feet.

What is the cause?

Eczema is an inherited type of sensitive, dry skin. If your child has asthma or hay fever, or other family members have eczema, it is more likely that your child will have eczema. Flareups occur when there is contact with irritating substances (for example, soap or chlorine). Hot baths or showers also contribute to eczema in children.

In 30% of infants with eczema, certain foods cause the eczema to flare up. If you suspect a particular food (for example, cow's milk, eggs, or peanut butter) is causing your child's flareups, feed that food to your child one time (a "challenge") after avoiding it for 2 weeks. If the food is causing flare-ups, the eczema should become itchy or develop hives within 2 hours of eating the food. If this occurs, avoid giving this food to your child and talk to your healthcare provider about food substitutes.

How long does it last?

This is a chronic condition and may go away during adolescence. The goal is control, not cure. The early treatment of any itching can help prevent a severe flareup of the rash.

How can I take care of my child?

• Steroid creams or ointment

  Steroid creams or ointments are the main treatment of the itch of eczema. Most children need 2 types of steroid creams: one preventive cream to treat mild eczema and another stronger cream to stop a flare-up once it has started.

  • Preventive steroid cream. Your child's preventive steroid cream is _________________________. Apply this cream ________ times a day to any spot that itches. Also use it for mild flare-ups. After the rash quiets down, use it for an additional week. When you travel with your child, always take the steroid cream with you. If it starts to run out, buy some more or get the prescription refilled.
  • Rescue steroid cream. Your child's rescue cream is _______________________. Apply this cream ________ times a day for severe itching or rash. Never apply this more powerful steroid cream to the face.
• Bathing: avoid soaps

  Your child should have one bath a day for 10 minutes. Water-soaked skin is less itchy, but it must be covered by a moisturizing cream within 3 minutes of getting out of the bath. Eczema is very sensitive to soaps, especially bubble bath. Young children can usually be cleaned without any soaps. Teenagers need a soap to wash under the arms, the genital area, and the feet. They should use a nondrying hypoallergenic soap such as Dove, Neutrogena, Tone, or Caress for these areas. Keep shampoo off the eczema.

• Lubricating or moisturizing cream

  Apply a lubricating cream once daily (twice a day during the winter) every day. Some lubricating creams are Keri, Lubriderm, Nivea, and Nutraderm. Children with eczema always have dry skin. After a 10-minute bath, the skin is hydrated and feels good. Help trap the moisture in the skin by putting lubricating cream all over the child's body while still damp (within 3 minutes of leaving the bath). Apply it after you have put steroid cream on any itchy areas. Generally avoid using ointments or petroleum jelly because they can block the sweat glands, increase the itching, and worsen the rash (especially in warm weather). Also, soap is needed to wash them off. For severe eczema, ointments may be needed temporarily to heal the skin.

• Itching

  At the first sign of any itching, apply the preventive steroid cream to the area that itches. Keep your child's fingernails cut short. Also, rinse your child's hands with water frequently to avoid infecting the eczema.

• Antihistamine medicine

  An antihistamine medicine is needed at bedtime for itching that is keeping your child from getting to sleep or causes your child to wake up during the night.

What can be done to prevent eczema?

• Try to breast-feed all infants at high-risk for eczema. Otherwise, use a hydrolyzed formula. If that’s unavailable, use a soy-based formula rather than a cow’s milk based formula. Avoid introducing solids until 6 months of age. Although avoidance of any particular solid foods has never been proven to protect against eczema, try to avoid eggs, peanut butter, fish and shellfish (shrimp etc) during your infant's first year.
• If certain foods cause flare-ups, avoid them.
• Avoid wool fibers and clothes made of other scratchy, rough materials. They make eczema worse.
• Wear clothes made of cotton or cotton blends as much as possible.
• Avoid synthetic fibers and materials that hold in heat. Also avoid overdressing. Heat can make the rash worse.
• Avoid triggers that cause eczema to flare up, such as excessive heat, sweating, excessive cold, dry air (use a humidifier), chlorine, swimming pools and spas, harsh chemicals, and soaps.
• Never use bubble bath. It can cause a major flare-up.
• Keep your child off the grass during grass pollen season (May and June).
• Keep your child away from anyone with fever blisters. The herpes virus can cause a serious skin infection in children with eczema.

When should I call my child's healthcare provider?

Call IMMEDIATELY if:

• The rash looks infected and your child has a fever.
• The rash flares up after contact with fever blisters.

Call within 24 hours if:

• The rash becomes raw and open in several places.
• The rash looks infected (red streaks, pus, yellow scabs), but without a fever.
• The rash hasn't greatly improved in 7 days of treatment.
• You have other concerns or questions.