By: Sarah Stein, MD, FAAD, FAAP & Sheilagh Maguiness, MD, FAAD, FAAP
Children with eczema (atopic dermatitis) tend to get patches of dry, itchy skin. The itch can be so uncomfortable it interferes with sleep, making your child feel miserable. Plus, scratching can cause the rashes to get infected.
While there is no known cure for eczema, the condition can be treated so your child feels better. There are also ways to help your child avoid eczema flare-ups.
Eczema treatments usually target four common problems: dryness, itching, irritated skin (inflammation), and infection.
Dryness: repairing the skin barrier
For children with eczema, the skin barrier isn't holding in water well. As a result, the skin becomes
dry and cracked, and is more likely to get infected. Dry skin is also very itchy. Gentle skin care daily is important to improve the skin barrier. As part of this:
Give your child a bath (or shower) every day or every other day for 5-10 minutes in lukewarm water. No soap is needed, but a gentle non-soap cleanser can be used on the sweaty areas (armpits, neck, groin) and on the hands and feet. Use only fragrance-free, hypoallergenic cleansers. Avoid scrubbing your child's skin with anything rough. Don't use bubble bath in the bath water.
Pat your child's skin dry after the bath or shower. If your doctor has prescribed any topical medicines, apply these to the areas of rash (BEFORE applying any moisturizers).
Apply a moisturizer to the whole body immediately after bathing (while the skin is still damp) everyday. This helps "lock in" the moisture of the water. The creamier the moisturizer, the better it will work. Ointments such as petroleum jelly or fragrance-free moisturizing CREAMS are good choices (lotions are thinner and less effective). Most importantly, find a moisturizer that your child likes to use. Moisturizers should be applied once or twice every day, even when the rash is gone.
Dress your child in soft fabrics like 100% cotton. Use mild, fragrance-free laundry detergents. Don't use fabric softeners or fabric sheets in the dryer. Minimize your child's exposure to things that are known to commonly be irritating to sensitive skin. This includes fragrance in products and in the air, for example, as well as smoke, dust, wool, and animal dander.
Reducing the itch
Gentle skincare as described above is the first step in making the skin feel less itchy.
Other ways to help reduce the itch:
Prevent scratching. Try to stop your child from scratching as much as possible since scratching can make the skin feel even more itchy. Scratching can also lead to open sores which can lead to skin infections. Keep your child's nails cut short. Wearing cotton gloves at night can also help.
Wet wrap treatments. Apply wet wraps AFTER bathing and applying topical medicines and moisturizers. Here's how:
Apply prescribed medicine to areas of rash and apply moisturizer to surrounding skin.
Soak a pair of pajamas or onesies in warm water.
Wring out the pajamas until they are damp and not dripping.
Put the damp pajamas on your child, with dry pajamas on top.
Make sure the room is warm or provide a warm blanket, so your child doesn't feel cold.
Keep the wet wraps on for at least a half an hour, or leave them on overnight.
After removing the wet wraps, reapply moisturizer.
Antihistamine medicines like
diphenhydramine and hydroxyzine may help your child feel drowsy so they fall asleep more easily instead of scratching their skin. Antihistamines do not usually take away the itch, though. Always follow directions about your child's age and weight and talk with your doctor or pharmacist if you have questions.
Healing irritated skin
Topical steroid medicines ("steroids" or "cortisones") are applied to the skin to heal irritated eczema rashes (inflammation). These prescription medications are usually used twice a day when the rash is flaring. Topical steroids come in different strengths and forms (such as lotions, ointments, creams, gels, and oils). Your doctor will help you find the right combination for your child's skin. When used correctly, topical steroids are very safe and effective.
Non-steroid eczema medicines (tacrolimus ointment, pimecrolimus cream, crisaborole ointment) also help heal irritated eczema rashes using different active ingredients than steroids. They can be helpful on mild eczema and on delicate areas of skin, like the eyelids, armpits and groin.
Managing & preventing skin infections
Bacteria and viruses can make eczema rashes worse, and it's important to watch for signs of infection.
oozing, crusting, pus bumps, blisters or a worsening rash that is not getting better with your usual treatments. Be sure to talk to your doctor if you think your child's skin is infected. Infections may require antibiotic or antiviral medicines.
New treatments for eczema
Biologic therapies ("biologics") are medicines that target the part of the immune system that is causing the irritated skin rash. Dupilumab is the first biologic therapy approved by the U.S. Food & Drug Administration (FDA) for the treatment of eczema in children ages 6 and up. This medication can be very helpful for moderate to severe eczema that is not well controlled with topical medicines and gentle skin care.
Talk to your doctor to learn more about this treatment option.
When can I stop treatment for an eczema rash?
Once your child's skin is no longer itchy and the areas of rash are smooth and soft, you can start to use the medicines less often. It is common for the skin to be discolored after the rash flare heals, but the color will naturally normalize over time. However, since eczema is an ongoing skin problem, it is important to continue your routine of gentle skin care and use of moisturizers every day to minimize future flares and infections.
How can I prevent future eczema flares?
Gentle daily skin care, as described above, is one of the most important things you can do to prevent future eczema flares. Talk with your doctor about a daily routine that is best for your child.
Avoiding triggers is also important to prevent future flares of eczema. Eczema triggers are different for different children. Some parents and physicians may consider allergy testing to further identify triggers that can be avoided. Some
Keep in mind that your child's eczema may still flare despite your best efforts. Eczema is an ongoing skin problem that requires patience and consistent skin care.
About Dr. Stein:
Sarah Stein, MD, FAAD, FAAP, a member of the American Academy of Pediatrics Section on Dermatology, is Associate Professor and Director of Pediatric Dermatology for UChicago Medicine.
About Dr. Maguiness:
Sheilagh Maguiness, MD, FAAD, FAAP, is director of pediatric dermatology at the University of Minnesota in Minneapolis, and an executive member of the Society for Pediatric Dermatology and the American Academy of Pediatrics Section on Dermatology. She is a mom to two boys and is originally from Canada.
*Image provided by Sheilagh Maguiness, MD, FAAD, FAAP