Eczema (Atopic Dermatitis)
What Is Eczema (Atopic Dermatitis)?
The term eczema (EGG-zeh-muh or ig-ZEE-muh) refers to a group of conditions where the skin becomes inflamed, making it irritated, red, dry, bumpy, and itchy. Another word for skin inflammation is "dermatitis."
There are several types of eczema, but the most common is known as atopic dermatitis. The terms "eczema" and "atopic dermatitis" are often used interchangeably.
What Are the Signs & Symptoms of Eczema?
Signs and symptoms of eczema vary with age. Infants less than a year old usually develop itchy, dry, red, scaly or crusty skin on their cheeks, forehead, or scalp. The rash may spread to the knees, elbows and trunk.
In older kids and teenagers, the rash is usually located in the bends of the elbows, behind the knees, on the neck, or on the inner wrists and ankles. The skin is often scalier and drier than when the eczema first began.
These symptoms tend to worsen and improve over time. When they worsen, it is referred to as a flare-up.
Dry skin and itchiness are the main problems with eczema. Children often try to relieve the itching by rubbing the affected areas. But scratching can make the rash worse and eventually lead to thickened, brownish areas on the skin (called lichenification). Eczema is often called the "itch that rashes" rather than the "rash that itches."
Who Gets Eczema?
About 1 out of every 10 kids will develop eczema. Typically, symptoms appear within the first few months of life, and almost always before a child turns 5. But the good news is that more than half of the kids who have eczema today will be over it by the time they're teenagers.
Eczema is not contagious, so there's no need to keep a baby or child who has it away from siblings, other kids, or anyone else.
What Causes Eczema (Atopic Dermatitis)?
The word "atopic" describes a condition where someone is overly sensitive to allergens in the environment, such as pollen, mold, dust, animal dander, and some foods. The allergens, or triggers, cause symptoms of the atopic diseases, which include:
Kids who get eczema often have family members with hay fever, asthma, or other allergies. And more than half of the kids who get eczema will someday develop hay fever or asthma themselves. Some experts think these kids may be genetically inclined to get these diseases, which means characteristics have been passed on from parents through genes that make a child more likely to get them.
Eczema is not an allergy itself, but allergies can trigger it. It's not always triggered by allergies, though. Some environmental factors (such as excessive heat, dry winter air, or emotional stress) also can trigger eczema symptoms.
How Is Eczema Diagnosed?
A doctor will examine the rash and ask questions about the child's symptoms and past health, as well as the family's health. A personal or family history of other atopic diseases is often an important clue to the diagnosis.
The doctor will want to rule out other conditions that can cause skin inflammation. So your child might need to be seen more than once before a diagnosis is made. The doctor might recommend sending your child to a dermatologist or an allergist.
Your doctor also may ask you to eliminate certain foods (such as eggs, milk, soy, or nuts) from your child's diet, switch detergents or soaps, or make other changes for a time to find out whether your child is reacting to something.
How Is Eczema Treated?
There is no cure for eczema, but there are treatments that can relieve the symptoms. The doctor will recommend different treatments based on the severity of the condition, the child's age, and where on the body the rash is located. Some are "topical" which means they are applied to the skin. Others are taken by mouth.
Topical moisturizers. Skin should be moisturized frequently (ideally, two or three times a day). The best time to apply moisturizer is after the skin has been soaked in a bath or shower and then patted dry gently. Ointments (such as petroleum jelly) and creams are best because they contain a lot of oil. Lotions have too much water to be helpful and should not be used.
Topical corticosteroids, also called cortisone or steroid creams or ointments. These reduce skin inflammation. They are commonly used to treat eczema and are not the same as the steroids used by some athletes. It's important not to use a topical steroid prescribed for someone else. These creams and ointments vary in strength, and using the wrong strength in sensitive areas can damage the skin, especially in infants.
Other topical anti-inflammatory medicines. These include medicines that change the way the skin's immune system reacts.
Medicine taken by mouth. These can include antihistamines (anti-allergy medicine) which may not be so effective for itchiness but can help improve sleep at night by making the child drowsy; antibiotics if it looks like the rash has been infected by bacteria; and corticosteroid pills or other medicines that suppress the immune system.
Other types of treatment:
- phototherapy: treatment with ultraviolet light
- wet wraps: damp cloths placed on irritated areas of skin
- bleach baths: bathing in very diluted bleach solution
How Can I Help My Child?
You can help prevent or treat eczema by keeping your child's skin from becoming dry or itchy and avoiding known triggers that cause flare-ups. Try to follow these suggestions:
Avoid giving your child frequent hot baths, which tend to dry the skin. Use warm water with mild unscented soaps or non-soap cleansers when bathing your child.
Ask your doctor if it's OK to use oatmeal soaking products in the bath to help control the itching.
Avoid excessive scrubbing and toweling after bathing your child. Instead, gently pat your child's skin dry.
Avoid dressing your child in harsh or irritating clothing, such as wool or coarsely woven materials. Dress your child in soft clothes that "breathe," such as those made from cotton.
Keep your child's fingernails short to minimize skin damage caused by scratching. Try having your child wear comfortable, light gloves to bed if scratching at night is a problem.
Help your child avoid becoming overheated and sweating, which can lead to flare-ups.
Have your child drink plenty of water, which adds moisture to the skin.
Eliminate any known allergens such as certain foods, dust, or pet dander from your household. Other allergens you can help your child avoid include pollen, mold, and tobacco smoke.
Although eczema can be annoying and uncomfortable for kids, its emotional impact can become the most significant problem later — especially during the preteen and teen years, when your child will need to take responsibility for following the prevention and treatment strategies.
You can help by teaching your preteen or teen to:
- Establish a skin-care routine. Brief, lukewarm showers or baths and moisturizing regularly will help to avoid or alleviate flare-ups.
- Use only "unscented" makeup and sunscreens and facial moisturizers labeled noncomedogenic and oil-free.
- Recognize stressful situations (such as taking tests at school or sports competitions) and how to manage them (like taking deep, calming breaths, focusing on an enjoyable activity, or taking a break).
- Be aware of scratching and minimize it as much as possible.
When Should I Call the Doctor?
Children and teens with eczema are prone to skin infections, especially with staph bacteria and herpesvirus. Call your doctor immediately if you notice any of the early signs of skin infection, which may include:
- increased fever
- redness and warmth on or around affected areas
- pus-filled bumps on or around affected areas
- areas on the skin that look like cold sores or fever blisters
Also, call your doctor if you notice a sudden change or worsening of the eczema, or if it isn't responding to the doctor's recommendations.
Even though eczema can be bothersome for kids and parents alike, taking some precautions and following the doctor's orders can help to keep it under control.
In many cases, eczema begins to improve by the age of 5 or 6. Sometimes it resolves completely. In other kids, it may restart as they enter puberty because of hormones, stress, and irritating skin products or cosmetics. Some people will have some degree of eczema into adulthood.