Eczema (Atopic Dermatitis)

Photo of mild Atopic dermatitis Photo of mild Atopic dermatitis

What is atopic dermatitis (eczema)?

Atopic dermatitis is a chronic (long-lasting) skin condition that comes in many forms. It is also called eczema.

With eczema, the skin becomes dry, very itchy and rash may appear. There are usually times when the condition is worse and times when the condition is better. When the condition worsens, this is called a flare-up. Flare-ups often occur in the winter months when the air is drier, but it can happen any time throughout the year.

Sometimes, as children with eczema grow older, their symptoms lessen or disappear altogether. Other children may have eczema for life.

The causes of eczema are unclear. Both ​genetic and environmental factors probably play a part. Children who have eczema may also have asthma or allergies such as hay fever.

There is no cure for eczema, but your health care team will work with you to develop a plan to control the symptoms. They will also work with you so that you recognize when your child needs to see a doctor.

Signs and symptoms of eczema

Some children may have very severe eczema, while others may only have a mild form. Here are some signs and symptoms your child may experience:

  • itching (pruritus)
  • dry skin
  • redness
  • eczem​a patches (scaly rash)
  • sleep loss
  • thickening of skin, redness, swelling, scratches and discomfort from scratching
  • skin colour changes
  • in more serious cases, weeping of clear fluid, crusting and scaling
Photo of moderate Atopic dermatitis Photo of moderate Atopic dermatitis

How to manage ecz​ema

Good skin care, including bathing and moisturizing, is a key part of managing your child's eczema.

It is also sometimes possible to figure out what factors cause eczema in your child. If you know the triggers of your child's eczema, help your child stay away from them. However, many flare-ups happen without an obvious trigger.

The doctor may also prescribe one or more medicines to help your child. These medicines may be topical (applied to the skin) or oral medicines (to be taken by mouth).

Skin car​e

Bathin​g

Bathing often is an important step to help manage flare-ups and help prevent infection. Your child should bathe at least once a day, up to three times a day if they have the chance to do so.

  • Bathe your child in lukewarm water for five to 10 minutes. It is important that you use warm water not hot water. Hot water can irritate the skin and trigger itching. Also, bathing for five to 10 minutes is ideal for hydrating the skin. Being in the water any longer does not help and may even make the skin drier. If you need a reminder, try using a timer.
  • Fill up the tub to about hip level when your child is sitting in the tub.
  • Use soap-free cleansers or very mild soap products. If you use soap, use it only on the areas that need it. Do not rub or lather with a cloth, as this can irritate the skin. Rinse off all of the soap well to prevent further dryness.
  • Do not use wash cloths, sponges or loofahs, as these can cause irritation when rubbed along the skin.
  • When you have finished bathing your child, pat their skin dry, do not rub. Try to leave as much water on the skin as you can.
  • Apply a prescribed medicated ointment or cream to all the affected skin areas right away (the rough, red, bumpy spots) as your doctor indicates.
  • After applying the prescribed active ointment or cream, use a product like petroleum jelly or moisturizer over the unaffected skin areas.
  • Use bath time as a chance to inspect your child's skin for redness, irritation or flare-ups.
Photo of severe Atopic dermatitis Photo of severe Atopic dermatitis

If you want to use emulsifying oils

Adding an emulsifying oil can also help keep the skin hydrated. Emulsifying oils work by mixing with the bath water and helping the skin absorb some of the water. Because the oil can make the bathtub slippery, your child could slip and be injured. Be extra-cautious when using emulsifying oils in your child's bath.

Add the emulsifying oil to the bath water before your child gets in the bathtub. Mix the oil into the bath water. When using emulsifying oil, use the same bathing routine as you normally would (as described above).

Ask your pharmacist for these special oils. Emulsifying oils are different from regular bath oil, vegetable oil or other types of oils. These types of oils will coat the skin and prevent water, topical medicated creams, or moisturizer from getting in.

Moisturizin​g

Dry skin is one of the most common features of eczema. When skin is dry, it can be itchy. It also starts to lose its function as a protective barrier. This means that more water is lost from the skin and irritants can get into the skin. Both can trigger an eczema flare-up.

Moisturizers help decrease the itch and soothe the skin. They do this by creating a protective layer over the skin. This helps keep the water in the skin and the irritants out. Moisturizers are a mixture of fats, oils and water. There are three kinds of moisturizers that are used: ointments, creams and lotions.

  • Ointments are thicker, greasier products. Most of them do not contain water. They are the most effective method for hydrating very dry skin and large areas of skin. They are usually well tolerated by patients with eczema.
  • Creams are a mixture of fats and water. They feel light and cool on the skin. Creams are used very often to prevent skin from drying out and when skin is cracked. These products often "burn" or sting the skin of patients with eczema.
  • Lotions contain the most water. They spread easily and can be cooling to the skin. They can be used on the scalp. They are not as effective for moisturizing dry skin as ointments or creams. Lotions can cause skin discomfort or stinging in very dry skin.

Avoid any product that irritates the skin.

No particular brand of moisturizer is better than another. Find one that works well and that your child likes.

Medicines and other treatments

Depending on how severe your child's eczema is, your child's doctor may prescribe one or more medicines.

Topical corticosteroi​ds

Topical corticosteroids are steroid creams or ointments that are put on the skin. Steroids are an effective way to help reduce inflammation in the skin. Inflammation causes swelling, redness, bumpiness and skin irritation. Less inflammation leads to less itching and therefore, less scratching.

These medicines are grouped by strength. Which corticosteroid you use depends on where the flare-up is on the body and how bad it is. For example, your child might need a milder corticosteroid for the face but a stronger one for the body. Your child's doctor will explain which type is best for your child. By carefully following your doctor’s instructions, you will use topical corticosteroids in the optimum way. This will allow for a better control of your child's flare-ups. When used correctly, topical steroids have almost no side effects. If you have concerns about these medications, talk to your doctor about them.

Topical calcineurin inhibi​tors

Their brand names are Protopic and Elidel. These medicines are used in:

  • children who cannot tolerate steroid
  • children whose eczema does not get better with topical steroids

Antihista​mines

Antihistamines may be used in combination with topical ointments to help relieve the itch that happens with eczema. They may not work in all people. Oral antihistamines are preferred over topical antihistamines, as the topical forms can be irritating to the skin.

Some antihistamines can cause sleepiness or drowsiness. This can be helpful for children who have trouble sleeping at night because of itching. If your child needs to take antihistamines during the day, their doctor will review the options with you.

Anti-infectiv​e agents

Having eczema increases a person's risk of infection. Scratching can disrupt the skin barrier, making it easier for bacteria on the skin to enter the body and cause infection. Viruses or fungi can also cross the skin barrier, although this is less common. Infection in the skin can make eczema worse.

Anti-infective agents are medicines used to fight infections caused by bacteria (antibiotics), viruses (antivirals), and fungi (antifungals). The use of anti-infective agents treats infections and prevents complications. If your child needs an anti-infective, your child's doctor will prescribe one.

Coal tar prepar​ations

Crude coal tar can be used to treat skin inflammation and itch. It creates a soothing effect. This treatment has many ingredients that have not all been identified but seem to have a therapeutic effect. Many people avoid using this treatment because it can be messy, it has some odour, it can take a lot of time and it is not very convenient.

Herbal remedies and alternative therapy

Herbal remedies and alternative therapy may include the use of:

  • herbal and dietary supplements
  • vitamins
  • other over-the-counter products

These products have not been proven to help with eczema. Tell your doctor about any alternative therapies and supplements your child is using.

Managing the itc​h

Here are some tips that you and your child can use to help control the itching of eczema:

Tips for moisturizing

  • Moisturize, moisturize, moisturize!
  • Keep moisturizers and medicines cool by storing them in the fridge.
  • Avoid products that contain irritating ingredients such as alcohol and fragrances (perfumes).
  • Try applying a cool washcloth followed by moisturizing the skin.

Clothi​ng tips

  • Have your child sleep with one layer of loose cotton pajamas because sweat can irritate the skin.
  • Have your child wear cotton clothing. Avoid nylon, wool or other rough fabrics as these can be very irritating to the skin.
  • Use cotton linens and bedding.
  • Cut off the tags on clothing as these can sometimes irritate the skin.

Tips for reducing scrat​ching

Do not mistake your child scratching because they are itching for a bad habit. It is rather the sign that your child’s eczema could be better managed. Try the following tips out. If the scratching goes on, ask your child's doctor for advice.

  • Use a washing cloth cooled with cool water when your child feels itchy to help decrease scratching. Avoid using a washing cloth on large parts of the body because it may cause heat loss in babies and small children.
  • Keep your child’s fingernails short and clean.
  • Ask your child to tell you when they are itching. Itching is the sign that your child's eczema is not under control. Itching leads to scratching. This leads to further irritation and inflammation and makes the condition worse.
  • If you notice that your child is scratching at a particular time of day on a regular basis, take the time to apply moisturizer at this particular moment. It will help relieve the itch and it is an opportunity to take a better control of your child's eczema.

Tips for managing your child's environment

  • Keep the environment cool. Use fans.
  • It is better for your child if they sleep alone. When a child is sleeping in the same bed as others, this can lead to flare-ups because the heat created by all the bodies increases and makes your child sweat more. Do not share a bed with your baby. It increases the risk of sudden infant death syndrome​ (SIDS).
  • Help decrease stress by maintaining a regular routine that you and your child can follow. Stress can sometimes cause increased scratching.
  • Use humidifiers in your child's room in the winter​. Humidifiers can also be put in often used rooms such as the family room or basement. Keep the humidifier's filter clean of mould and dust because they could trigger asthma attacks.

Other consideratio​ns

Seasonal ch​anges

You may find that your child's eczema is worse in the colder, dryer months. During this time, the air becomes very dry and holds less moisture. This can cause dryer skin. In the warmer months, the humidity can also worsen eczema for some people.

Laundry C​are

  • Use mild detergent that contains no perfume or dyes.
  • Do not use dryer sheets as they contain irritants.

Coping with ecze​ma

The daily care routine for eczema can be very stressful to you, your child and the rest of your family. It is very important to maintain the routine and be committed to it to manage your child's eczema . Your child's health-care team is a good resource if you need advice. Some children develop self-esteem problems or feel embarrassed by their eczema. That is one of the reasons why it is important to keep your child's eczema under control.

School and​ activities

If your child goes to daycare, talk to the daycare staff and to parents of other children that attend the daycare about eczema. Explain that your child has this condition and that it will not spread to other children.

If your child needs daytime moisturizing, have a doctor’s note allowing your child or a nurse to apply it at school.

School can cause a great deal of stress in children with eczema. Parents, family members and teachers should understand the stress that these children experience and that they may need more emotional support and understanding.

It is important that your child is able to participate in their regular activities as much as they can. You may be able to make some changes to help enable this.

When your child should see a doctor

Contact your child's doctor in the following situations:

  • When medicines are not working or your child's condition is worsening.
  • If you see any sign of infection, such as crusting, oozing, pus or blister.

Reso​urces

Key point​s

  • Atopic dermatitis (eczema) is a chronic skin condition that comes in many forms. Skin becomes dry and very itchy and a rash may appear. There will be times when the skin is worse or better.
  • Scratching the skin causes redness, swelling, damage and discomfort. In more serious cases, weeping of clear fluid, crusting and scaling can occur.
  • There are many things you can do to control the itch and to protect your child's skin.
Miriam Weinstein, MD, FRCPC
Michelle Lee, RN
Jackie Su, RN
Elena Pope, MD, MSc, FRCPC
1/10/2014
DermNet NZ. [http://www.dermnetnz.org]. Hamilton, New Zealand: DermNet NZ; 2008




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