• Eczema in Children

    (Atopic Dermatitis)

    Definition

    Eczema, also known as atopic dermatitis, is an inflammation of the outer layers of the skin. This inflammation leads to a red, itchy, and scaly rash. The eczema rash may be present for a long period of time or it may come and go. It is common in children.
    Eczema
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    Causes

    Eczema rash is caused by inflammation that causes skin irritation and damage. This inflammation is caused by an overreaction of the immune system. It is not known exactly why the immune system has this reaction but is thought to be a combination of genetic and environmental factors.

    Risk Factors

    Eczema is more common in children who are of African or Asian descent.
    Risk factors for eczema include:
    • Asthma or hay fever
    • Urban areas or places with low humidity
    • A family history of eczema or allergic disorders
    • Stress, especially if it leads to scratching
    • Immunosuppressant medications
    • Excess weight or obesity
    Irritants that can initiate flare ups include:
    • Very hot and very cold climates
    • Exposure to allergens such as certain fabrics, perfumes in soaps, dust mites (common), foods, or nickel in jewelry
    • Frequent washing of affected areas
    • Scratching or rubbing of skin—eczema is known as the itch that rashes
    • Use of rubber gloves in persons sensitive to latex

    Symptoms

    Eczema usually begins at 3-6 months of age. It may improve over time, usually by age 5-7 years. For some children, the condition may continue into adolescence and early adulthood.
    The eczema rash may be present for a long period of time or it may come and go. It can appear anywhere on the body or in just a few areas that may vary by age. Symptoms may include:
    • Dry, itchy skin
    • Cracks behind the ears or in other skin creases
    • Red rashes on the cheeks, arms, and legs
    • Red, scaly rash
    • Thick, leathery skin
    • Crusting, oozing, or cracking of the skin
    • Symptoms that worsen in the winter when the inside air is dry due to heating systems

    Diagnosis

    You will be asked about your child’s symptoms and medical history. A physical exam will be done. The diagnosis is made by the appearance and location of the rash. Your child may be referred to a specialist.

    Treatment

    There is no cure for eczema. Treatment is focused on managing symptoms.
    Talk with your doctor about the best treatment plan for your child. The main goals of treatment are to:
    • Heal the skin and keep it healthy
    • Avoid skin infections in damaged skin
    • Identify and avoid triggers to prevent flare-ups
    Treatment options may vary. Your child’s doctor may recommend more than one depending on your child’s condition.

    Skin Care

    Irritation of the skin can start or worsen flare ups. Dry skin is one of the most common culprits. Steps to help decrease dry skin and flare-ups include:
    • Limiting bath time to 1-3 times a week, 5-10 minutes at the most.
    • Avoid using water that is too hot or cold during baths or showers.
    • Using mild, unscented, bar soap or non-soap cleanser.
    • Use moisturizer daily, or more often as needed. These may be lotions, creams, or ointments, depending on the severity and location of the rash.
    • Avoid irritants that trigger your eczema.
    Skin infections and irritations need to be treated right away. The longer the inflammation remains, the more damage is done.

    Medications

    In some cases, medication may also be needed to manage flare ups or symptoms:
    • Prescription creams and ointments containing cortisone or other ingredients to decrease inflammation
    • Prescription or over the counter antihistamines to help prevent itching
    • Oral medications
    Infections may also need to be treated with:
    • Antibiotics applied directly to the skin or taken by mouth

    Phototherapy

    If skin care and medications are not effective, light therapy may be used. This therapy exposes the affected skin to specialized light. Treatment options may include:
    • Treatment with ultraviolet A light and 5-methoxypsoralen (PUVA)
    • Photopheresis—for severe cases

    Prevention

    Eczema is difficult to prevent. This is most true when there is a strong family history.
    You may be able to reduce your child’s risk of eczema by:
    • Breastfeeding
    • For bottle-fed infants who are at high risk for eczema, using a certain kind of formula that contains hydrolyzed casein or 100% whey protein
    • Avoid perfumed products.
    • For newborns who are at high risk for eczema, applying a daily moisturizer may help reduce the risk of eczema.
    • Exposing your child to pets at an early age
    • Taking probiotics while pregnant and after giving birth if you are breastfeeding

    RESOURCES

    Healthy Children—American Academy of Pediatrics http://www.healthychildren.org

    National Eczema Association http://nationaleczema.org

    CANADIAN RESOURCES

    Canadian Dermatology Association http://www.dermatology.ca

    Caring for kids—Canadian Paediatric Society http://www.caringforkids.cps.ca

    References

    Atopic dermatitis. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T115212/Atopic-dermatitis. Updated June 1, 2016. Accessed October 3, 2016.

    Eczema: How to help your child avoid the itch. Healthy Children—American Academy of Pediatrics website. Available at: http://www.healthychildren.org/English/health-issues/conditions/skin/Pages/Eczema.aspx. Updated August 20 2015. Accessed November 10, 2015.

    Eczema. Kids Health—Nemours Foundation website. Available at: http://kidshealth.org/parent/infections/skin/eczema%5Fatopic%5Fdermatitis.html#. Updated May 2012. Accessed November 10, 2015.

    Eczema. National Eczema Association website. Available at: http://nationaleczema.org/eczema. Accessed November 10, 2015.

    Infants and toddlers. National Eczema Association website. Available at: http://nationaleczema.org/eczema/child-eczema/infants-toddlers. Accessed November 10, 2015.

    1/28/2015 DynaMed's Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T115212/Atopic-dermatitis: Horimukai K, Morita K, et al. Application of moisturizer to neonates prevents development of atopic dermatitis. J Allergy Clin Immunol. 2014 Oct;134(4):824-830.

    1/4/2016 DynaMed's Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T115212/Atopic-dermatitis: Zhang A, Silverberg JI. Association of atopic dermatitis with being overweight and obese: a systematic review and metaanalysis. J Am Acad Dermatol. 2015;72(4):606-618.

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