Eczema Atopic Dermatitis
What is eczema?
Eczema is an inherited type of sensitive, dry skin. Eczema often starts on the cheeks at 2 to 6 months of age. The rash is most commonly found in the creases of the elbows, wrists, and knees. Occasionally, eczema occurs on the neck, ankles and feet as well.
The rash is red and extremely itchy. If scratched, the rash becomes raw and weepy.
What is the cause?
A personal history of asthma or hay fever or a family history of eczema makes it more likely that your child has eczema. Flareups occur when there is contact with irritating substances (for example, soap or chlorine).
In 30% of infants with eczema, certain foods cause the eczema to flare up. If you suspect a particular food item (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 ever giving this food to your child and talk to your physician about food substitutes.
How long does it last?
This is a chronic condition and will usually not go away before adolescence. The goal is control, not cure. The early treatment of any itching can help prevent a severe rash.
How can I take care of my child?
- Steroid creams Steroid creams 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.
- Hydrating the skin Hydration of the skin followed by lubricating cream is the main way to prevent flare-ups of eczema. Your child should have one bath a day for 10 minutes. Water-soaked skin is far less itchy, but it must be covered by a lubricating 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 can use a nondrying soap such as Dove for these areas. Keep shampoo off the eczema.
- Lubricating 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 applying an outer layer of lubricating cream to the entire skin surface while it is damp (within 3 minutes of leaving the bath). Apply it after you have put steroid cream on any itchy areas. Avoid applying any ointments, petroleum jelly, or vegetable shortening 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, wash your child's hands with water frequently to avoid infecting the eczema.
- Antihistimine Medicine An antihistamine 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. Your child's antihistamine is ___________________. Give _________ at bedtime for _____________ days.
What can be done to prevent eczema?
Wool fibers and clothes made of other scratchy, rough materials make eczema worse. Cotton clothes should be worn as much as possible. Avoid triggers that cause eczema to flare up, such as excessive heat, sweating, excessive cold, dry air (use a humidifier), chlorine, harsh chemicals, and soaps. Never use bubble bath. Also, keep your child off the grass during grass pollen season (May and June). Keep your child away from anyone with fever blisters since the herpesvirus can cause a serious skin infection in children with eczema.
Try to breast-feed all high-risk infants. Otherwise, use a soy formula. Also try to avoid cow's milk products, soy, eggs, peanut butter, wheat, and fish during your infant's first year.
When should I call my child's health care 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).
- The rash hasn't greatly improved in 7 days of treatment.
You have other concerns or questions.
