Eczema (Atopic Dermatitis)
Eczema is a chronic skin problem that causes dry, red, itchy skin. It is also called atopic dermatitis or AD. Anyone can get eczema, but it's most common in babies to young adults.
Your pediatrician can help you and your child relieve and keep the symptoms under control. The following is information about eczema and how to help your child avoid the itch.
Who gets eczema?
Eczema is the most common skin problem treated in pediatric dermatologist's offices. About 65% of patients develop symptoms before age 1, and about 90% develop symptoms before age 5. The symptoms can come and go. There are times when the symptoms are worse (called exacerbations or flares) followed by times when the skin gets better or clears up completely (called remissions).
Many babies outgrow eczema by age 4. Some children outgrow eczema by early adulthood, although their skin remains dry and sensitive. A few may have it all their lives.
Eczema often runs in families with a history of eczema or other allergic conditions such as hay fever and asthma. It is not contagious.
What are the symptoms?
Symptoms are different with each child. Common symptoms include dry, red, itchy skin and rashes. The rash can be oozing or very dry.
Eczema can appear anywhere on the body or can be limited to a few areas. In babies, a rash often appears on the face and scalp. In teens and young adults, a rash often appears on the hands and feet.
How to prevent flare-ups
One of the most helpful things you can do is prevent flare-ups before they happen.
Remind your child not to scratch. Scratching can make the rash worse and lead to infection. Also, the more your child scratches, the more itchy the area will be. Keep your child's fingernails short and smooth, and try to distract your child from scratching.
Keep your child's skin moisturized. Moisturizing should be part of your child's treatment plan when the skin is dry.
Use fragrance-free moisturizers.
After a bath, gently pat skin with a towel and then apply moisturizer to damp skin. Apply a moisturizer at least 2 times each day or more often if needed.
Avoid irritants. People who are sensitive to scratchy fabrics or chemicals in soaps and detergents should
Wear 100% cotton clothing.
Use mild, fragrance-free body cleansers.
Take short baths with room temperature water.
Use mild laundry detergent with no dyes or perfumes.
Rinse clothing 2 times to remove laundry detergent residue.
Not use dryer fabric softener.
Ask your child's doctor if allergies could be a cause. Sometimes allergies, like ones to food, pets, pollens, or dust mites (in bedding), can trigger or make the rash worse. If your child's eczema is caused by an allergy, it's important to avoid the trigger if possible.
Ask your child's doctor about other triggers. Other things that can trigger a flare-up include overheating or sweating and stress.
Use of medicines
Your pediatrician may recommend medicines to help your child feel better and to help keep the symptoms under control. The type of medicine recommended will depend on how severe the eczema is and where it appears on the body. The medicine can be given in 2 ways: applied to the skin (topical) or taken by mouth (oral). Topical medicines are available as creams or ointments; oral medicines are available in pill or liquid form.
Medicines that only a doctor (and some other health professionals) can order are called prescription medicines. Over-the-counter (OTC) medicines are available without a doctor's order. This doesn't mean that OTCs are harmless. Like prescription medicines, OTCs can be very dangerous to a child if not taken the right way. Before you give your child any medicines, be sure you know how to use them. Talk with your pediatrician if you have any questions or concerns about giving your child medicines.
Topical steroidHydrocortisone creams or ointments may help relieve itchy skin and decrease inflammation. They may become less effective and may damage the skin when used for long periods.
Steroid-free topical itch reliefMay give fast relief of dry, itchy skin with few side effects. Some of these have alcohol, which can cause a burning sensation.
Oral antihistaminesMay help relieve the itch (particularly the ones that make some people sleepy).
Topical steroidsUsed to reduce inflammation and stop the itch. Side effects, including thinning of the skin, stretch marks, or acne, may occur if not used as recommended and if used for long periods.
Topical immunomodulatorsSteroid-free medicines used to reduce inflammation and stop the itch. They are a new class of medicines shown to work in 80% of studies done in children older than 2. Studies are currently being done to test the safety of their use in younger children.
Oral antihistaminesThere are several prescription types that may be more effective in certain children.
Oral antibioticsMay be prescribed if there is a secondary infection.
Oral steroidsRarely recommended, especially for young children because there are many health risks. Also, there are often rebound flare-ups after patients stop taking them.
For more information
American Academy of Allergy, Asthma & Immunology
American Academy of Dermatology
American College of Allergy, Asthma & Immunology
National Eczema Association
National Institute of Arthritis and Musculoskeletal and Skin Diseases
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Copyright © 2007 American Academy of Pediatrics