Eczema

Itch, Itch, Go Away

One of the most common skin disorders in children, atopic dermatitis, aka: eczema, can be aggravating for both children and parents because of its chronic and often uncomfortable symptoms.

The features of atopic dermatitis are that of a chronic condition which has periods of remission and exacerbation.  During periods of exacerbation, skin is often dry, itchy, with small red bumps distributed over the body.

·         Infantile eczema – occurring between 2 months and 5 years old.

o   Typically is found on the face, back of the arms, and chest.

·         Eczema in older children (between 4 and 12 years) is more commonly located in the groove of the elbows (antecubital), behind the knees, or on the wrists and hands.

Most children have remission of their eczema by 3 to 5 years old and approximately 75% of patients out grow the condition by the time they are adolescents.

While eczema is an extremely common entity seen in the pediatrician’s office, the treatment can be difficult because of the need for numerous applications of creams or ointments, discomfort associated with having itchy skin, and the risk of superimposed skin infections.

Identifying triggers

Certain children have identifiable triggers for their eczema, which if removed can significantly improve and even prevent future flare ups.

·         An article from 2010 in Pediatrics in Review states that food allergies are found in up to 40% of children with eczema

o   Keep a food journal which diaries everything your child eats to try and determine which food or foods trigger eczema flare ups.

§  Still can’t figure it out?  Ask your pediatrician if a referral to an allergist or food allergy testing is appropriate.

·         Changes in temperature, whether from an air conditioned home to outside or with changes in the season can bring out eczema flare ups.

o   Determine what season is worst for your child so that preventative measures can begin early.

·         Allergies to common items which children come in contact with can also trigger eczema.

o   Items which are frequently implicated are soaps, shampoos, fragrances, detergents, nickel, dyes, and rubber.

Treatment options

Keeping the skin moist is probably the most important way to prevent eczema from getting worse and helps to prevent additional skin drying and cracking which can lead to infections of the skin.

• Moisturizers (i.e. creams and ointments – Yes, there is a difference) help to prevent dryness and improve skin protection.
•  These work best when applied to already dampened skin.
• After a bath, just pat the skin dry and then apply an unscented moisturizer to the damp skin, helping to keep the moisture locked in. 
• Putting on a long sleeve shirt and pants to keep the area covered also helps prevent drying out of the skin.
• Ask your pediatrician which moisturizer they recommend for children with atopic dermatitis.
• Know what works for your child -- some children do better with multiple baths in a day and others better when bathed less frequently. 
• Avoid hot water while bathing which also tends to worsen eczema.  Instead, opt for a bath with cool to slightly warm water.
• Avoid rubbing the skin hard with a towel, as this can actually worsen eczema.
• More tips on bathing infants from All Things Pediatric.
• If you're not going to bathe your child, dampen the areas involved with cool water before putting on a moisturizer.

• Topical steroids, like hydrocortisone cream, also help to relieve acute exacerbations
• Before using topical steroids, have your pediatrician examine your child to avoid putting any steroid cream on the area which may have an overlying infection.
• Other medications available by prescription, such as topical nonsteroidal creams or topical calcineurin inhibitors, have been shown to help reduce symptoms of atopic dermatitis.
• Ask your pediatrician if a medication from these classes would help improve your child’s symptoms.

Control the itch

Many pediatricians like to use the phrase, “itch-scratch cycle”, which essentially means that itchy skin leads to scratching which leads to more itching in other areas and possibly causing an infection by allowing bacteria, viruses, or fungus through the broken skin.

• Anti-histamines like Benadryl® among others also work to relieve flare ups of eczema and treat the itching associated with the condition as well.
• Ask your pediatrician if a short course of an anti-histamine may help to relieve your child’s itch-scratch cycle.
• Oatmeal baths can also provide relief to itching skin, but only if your child is not already allergic to oats.

Have a physician examine your child immediately if they begin to show any sign of skin infection, including but not limited to, warm and red skin, fevers, changes in activity levels, or oozing from skin lesions.

Talk with your pediatrician before starting any medical regimen on your child or if you have more questions about eczema or other dermatologic conditions.

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