Eczema or Atopic Dermatitis is a condition that is manifested by dry, itchy skin. It affects 10% to 20% of children younger than 14 years. The skin of individuals with eczema appears dry and it may have a rash with crusting or scaling. If one parent has an atopic condition, there is a 60% chance that the child will have atopy. If both parents are affected, the likelihood the child will be affected is as high as 80%.
Most cases of eczema begin in the first year of life. While we don’t know exactly what causes eczema, we know that the skin has a decreased ability to bind water. Certain triggers may exacerbate eczema. Temperature changes, food allergies, and external irritating soaps or lotions may contribute to the problem.
Infants are commonly affected by eczema on their faces. In some cases, the eczema affects a larger part of the body. Children may have itchy, dry skin in the creases of their elbows and behind their knees. The dry itchy skin can often lead to chronic “itch-scratch” cycles. This scratching may lead to lichenification or an increase in thickness of the skin. The more the child scratches, the worse the itch can get.
Treatment of eczema involves increasing moisture to the skin and controlling the itch. Your health care provider may recommend a topical anti-inflammatory such as hydrocortisone cream or ointment for the inflammation and itching. Topical steroids have been used for many years to treat eczema and other skin conditions. When used as directed, they are very safe.
Infants and children should wear cotton clothing and avoid perfumed soaps and products on their skins. Bar soap without fragrance is typically recommended over liquid soap. It is helpful to bathe your child for a short time daily and upon leaving the bath pat dry and immediately apply a moisturizer or emollient to lock in the moisture. If your provider has recommended a steroid cream or ointment, that should be applied before any emollient. Limit baths to less than 15 minutes to avoid drying out the skin. For infants, it is best to avoid all scented baby products. Those products may make your baby’s skin smell nice but they can be drying and irritating to the skin. The thicker creams and ointments such as Aquaphor and Eucerin cream tend to work better than lotions at sealing in the moisture into the skin. Your provider can discuss a personalized eczema plan at your child’s visit.
Recent research has demonstrated an increased risk for peanut allergy in children who have eczema and use products with nut oil in them. For this reason, it may be worthwhile to avoid products that have nut oil in them. Children with eczema may have an increased risk for allergies and/or asthma. If your family has a strong family history of asthma or allergies, you may want to discuss this with your child’s health care provider.