Eczema, also known as atopic dermatitis, is a problem causing dry, red and itchy skin. It is caused by a flaw in the skin barrier that lets moisture out and can sometimes allow allergens and bacteria in. People with eczema have dry, sensitive skin that needs extra protection from irritation.
Eczema is very common in children. Eczema can start in infancy and last for many years. The redness, scaly skin, and itching can be a very annoying problem for children, even affecting their sleep.
What parts of the body are most affected?
Eczema can occur anywhere but is most common in the elbow and knee creases, neck, wrists, ankles, behind the ears, and on the face.
What is the usual course for eczema?
Eczema symptoms will come and go, but it is a chronic skin problem, so the symptoms are long-lasting. Times when the skin gets a little better or clears up completely are called remissions. Times when the symptoms are worse are called exacerbations, or flares. There is nothing that “cures” eczema, but it can be managed and many children outgrow it eventually.
Over time, affected areas may become thicker, even leathery, in appearance from rubbing and scratching. They may also get darker or lighter in color.
How do I prevent eczema flares?
- Keep your child’s skin moisturized! Moisturizing is the mainstay of your child’s daily treatment plan.
- You will need to moisturize multiple times per day, using fragrance-free and dye-free moisturizers.
- As a general rule: the greasier the moisturizer, the better. Ointments work better than creams. Creams work better than lotions.
- Keep baths and showers brief and use warm (not hot) water.
- Use mild fragrance-free and dye-free cleansers for bathing and washing hands.
- Avoid bubble baths.
- After bathing or washing, gently pat skin dry and while still damp, moisturize all over. This should be within 2 minutes of your child exiting the shower or bath.
- Bleach baths may be recommended by your pediatrician as well to decrease the risk of affected skin getting infected. Do not use them unless directed by your child’s doctor.
- Wear soft fabrics, such as 100% cotton.
- Pay attention to those items that touch the skin directly.
- Avoid polyester or other synthetic fabrics.
- Remove clothing tags that may irritate the skin.
- Wash all clothing in unscented detergent.
- Avoid using fabric softeners and dryer sheets.
- Remind your child not to scratch.
- Keep fingernails cut short and filed smooth.
- Try to distract your child from scratching or keep skin covered.
- Use medicines for itching if prescribed.
What cleansers and moisturizers should I use?
Here are a few examples of brands we have found work well. You may have to try several before you find one that works best for you. Avoid products with colors or perfumes.
Recommended daily moisturizers include Vaseline®, Neutrogena®, Vani Cream®, Mustela®, Eucerin®, CeraVe®, Aquaphor® and Aveeno®.
Recommended mild cleansers include Dove®, Cetaphil®, Neutrogena® and Oil of Olay®.
What medications should I use during a flare?
Ask your doctor before using steroids or antihistamines.
Topical steroids are creams or ointments that have steroid medication in them to treat the skin inflammation directly. They are sometimes prescribed to reduce pain, itching, redness and swelling
Your doctor may prescribe them in a “burst and taper” pattern with instructions such as “use twice daily for two weeks and then no more than two days per week.” This is to prevent thinning of skin, stretch marks, or acne that may occur if it is used for long periods.
Oral antihistamines are medications taken by mouth to reduce itching by blocking the histamine process in an allergic reaction.
When should I call my doctor?
You should see your doctor if the eczema looks infected (blisters, weeping fluid or pus, raised areas, spreading redness, fevers). Areas where the skin was scratched are often the sites of infection. You should also call your doctor if the medications your doctor prescribes are not helping, or if there is no response to a steroid treatment after one week.
- National Eczema Association
- American Academy of Allergy, Asthma & Immunology
- American Academy of Dermatology
Reviewed by Alison Dickson, MD and Kelly Orringer, MD
Updated March 2017