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How to Treat & Control Eczema Rashes in Children

How to Treat & Control Eczema Rashes in Children How to Treat & Control Eczema Rashes in Children

by Sarah Stein, 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). This helps “lock in" the moisture of the water. The thicker the moisturizer, the better it will work. Ointments such as petroleum jelly (or a similar “greasy" alternative) are good choices. Most importantly, find a moisturizer that your child likes to use. Moisturizers should be applied 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.

Reducing the itch

Gentle skincare 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:

    • 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.

  • 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 up. 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). These are also prescription medicines that 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.

Look for 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.

Diluted bleach ba​ths

Soaking in a tub with a small amount of bleach added to the water 2-3 times per week can help prevent infections. Bleach baths, which are similar to swimming in a chlorinated pool, are easy to do at home:​​

  • Add 1/2 cup of plain household bleach (sodium hypochlorite) OR 1/3 cup of concentrated household bleach to a full tub of lukewarm bathwater and stir the water to dilute the bleach. Make sure you use PLAIN bleach; splash-free or scented bleach products are not effective and could lead to more irritation.

  • If using an infant tub, use 2 tablespoons of bleach to a full tub of water.

  • Have your child soak​ in the bath for 10-15 minutes. Try to soak the entire body. Since the bath is like a swimming pool, it is safe to get your child's face and scalp wet as well. For babies and young children, use touch supervision to avoid drowning as you would during regular bath time.

  • Rinse the dilute bleach water off at the end of the bath and apply a moisturizer right away.

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. 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 red, you can start to use the medicines less often. However, since eczema is an ongoing skin problem, it is important to continue a routine with gentle skin care every day to minimize future flares and infections.

How can I prevent future eczema flares?

  • Gentle daily skincare, 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 triggers include:

​In rare cases, certain foods can flare an eczema rash. If you t​hink this might be the case, talk to your doctor before trying any restrictive dietary changes.​

Remember​

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 skincare.

Additional Information:


 

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.




Last Updated
3/6/2020
Source
AAP Section on Dermatology (Copyright @ 2020 American Academy of Pediatrics)
The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.
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