Eczema (Dry, Itchy Skin)

What is eczema? (Atopic Dermatitis)

Eczema is an inherited type of sensitive skin. It presents as a red, itchy rash that often starts on the cheeks at 2-6 months of age. Eczema is very common on the flexor surfaces (creases) of the elbow, wrist, and knee. Occasionally, the neck, ankles, and feet are involved.

What causes eczema?

A strong family history of asthma, hay fever, or eczema makes it more likely that your child may develop eczema. Flare-ups occur when there is contact with irritating substances (i.e. soaps or chlorine). In 30% of infants with eczema, certain foods can cause flare-ups. If you suspect a particular food, avoid it for 2 weeks, and then re-introduce it ("challenge") to see if it is the cause. If a flare-up does occur, avoid ever giving that food to your child until you talk to your doctor.

Home Treatment

Keeping skin moisturized is the best way to prevent flare-ups. Your child should bathe once a day for about 10 minutes. Eczema is very sensitive to soaps. We recommend a mild soap like Dove. Only use soap in areas that seem dirty. Washing with water should be sufficient. Never use bubble bath, baby soap, or perfumed shampoo on your child's skin. After bathing, gently pat your child dry with a towel, try not to rub his skin too vigorously. To help trap the moisture after the skin is hydrated, we recommend a lubricating cream such as Aquaphor. Other options are Vaseline, petroleum jelly, or Eucerin cream. This is to be applied on top of the steroid cream, if ordered.

Steroid cream is the main treatment of eczema. Over-the-counter hydrocortisone 1% ointment (Cortaid) is extremely mild and is safe for you to apply twice a day, every day, to any rough patches on your child's body. Do not apply hydrocortisone to the diaper area, or the area around the mouth or eyes without first speaking to our office. Apply the steroid cream to rough or itchy patches twice a day until the patch goes away. Continue with the bathing and moisturizing to try and prevent flare ups. Remember that eczema is a skin type, so dry patches will likely reappear. Immediately restart the steroid cream to the affected area. Also use on any itchy spots to prevent patches. Keep your child's fingernails short and wash their hands frequently to avoid infection.

Many children will need something stronger than over-the-counter hydrocortisone. If your child's rash is not improving within one week of using the ointment, call our office to discuss.

Once the dry patch has resolved, it is common for the skin underneath to look either lighter or darker than the surrounding skin. This is the skin's reaction to healing from inflammation. If the skin is smooth, but darker or lighter than the surrounding skin, don't use the steroid cream anymore. It will likely take many months, but the skin pigment will even out over time.

Avoid triggers that can cause flare-ups, such as excessive hot or cold air (use a humidifier) or harsh chemicals. Clothes made of cotton are more comfortable than wool fibers or other scratchy materials.

Call the doctor if:

• The rash looks infected (yellow pus or scabs, red streaks, or fever).
• The rash becomes open or raw.
• The rash flares up after contact with someone who has fever blisters (herpes virus can cause a serious skin infection in children with eczema).
• The rash has not improved after 7 days of treatment, or sooner if it worsens.