What is eczema?

Eczema (also called atopic dermatitis) is a skin rash that usually appears before age 5. In babies it tends to show up on the cheeks and scalp, but it may spread to the arms, legs, chest, or other parts of the body. After a child's first year, it's most likely to show up on the insides of the elbows, the backs of the knees, the wrists, and the ankles, but it can also appear elsewhere.

The rash might look like dry, thickened, scaly skin, or it might be made up of tiny red bumps that ooze or become infected if scratched. Scratching can also cause thickened, darkened, or scarred skin over time.

Eczema typically comes and goes. It isn't contagious, but because it's intensely itchy, it can be very uncomfortable, and scratching can be a problem. If untreated, the rash can be unsightly, so it may present a social challenge for a child, too.

Your doctor can diagnose eczema by examining your child's skin. He may send you to a dermatologist for confirmation and treatment.

No one knows for sure what causes it, but the tendency to have eczema is often inherited. So your child is more likely to have it if you or a close family member has had eczema, asthma, or allergies.

Eczema is not an allergic reaction to a substance, but allergens or irritants in the environment (such as pollen or cigarette smoke) can trigger it. Less frequently, it can be triggered by allergens in your child's diet or in your diet if your child is breastfeeding.

The rash can also be aggravated by heat, irritants that come in contact with the skin (like wool or the chemicals in some soaps, fragrances, lotions, and detergents), changes in temperature, and dry skin. Stress can also trigger a flare-up of eczema.

Dr. P. Marazzi / Science Source

About 20 percent of babies and young children have eczema. It usually starts in infancy, with 65 percent of patients developing symptoms in the first year of life and 90 percent developing symptoms before age 5.

There's no way to know ahead of time whether a child will outgrow eczema, but fortunately the condition usually becomes less severe with age. Many children outgrow eczema by age 2, and many others outgrow it by adulthood.

Taking good care of your child's skin and avoiding triggers can help treat and prevent flare-ups.

Bathing and moisturizing Talk with the doctor about how often to bathe your child. Many experts now believe that daily bathing can be helpful for children with eczema. Just don't make the water too warm, because very warm water dries out the skin faster than lukewarm water.

Use a mild soap or non-soap cleanser, and wash and shampoo your child at the end of the bath so he isn't sitting in soapy water. As soon as you get your child out of the tub, pat (don't rub) excess water from his skin with a soft towel or washcloth.

Then, while the skin is still damp, promptly apply a liberal amount of moisturizer or emollient an ointment, cream, or lotion that "seals in" the body's own moisture to your child's skin. Ointments and creams contain more emollient and less water than lotions and are usually best for children with eczema.

"I recommend emollients for children of all ages," says Michael Smith, an associate professor of medicine and pediatrics in the division of dermatology at Vanderbilt Medical Center in Nashville. He suggests testing the emollient for a short time to make sure it doesn't irritate your child's skin.

The most effective approach, according to Smith, is to hydrate and lubricate the skin at the same time by applying emollient to damp skin. The emollient won't improve the red, inflamed, itchy areas, but it will help restore the skin's invisible protective barrier. (This barrier makes up part of the normal outer layer of the skin and is impaired in kids with eczema.)

Allowing skin to breathe and stay cool Dress your child in smooth natural fabrics, like cotton. Avoid wool and other scratchy materials, which can irritate very sensitive skin. Don't overheat your child by bundling him up more than necessary.

Soaps and cleansers Switch to mild, fragrance-free soaps or non-soap cleansers and shampoos, or those made for sensitive skin. Use mild, fragrance-free detergent for washing clothes and bedding. Don't use fabric softeners.

Prevent scratching Your child may try to get relief by scratching with his hands or by rubbing his face against the sheet during sleep. But scratching and rubbing can further irritate or inflame the skin and make matters much worse.

Use the softest sheets possible in the crib or bed, and keep your child's nails short. Put him to bed with cotton mittens or socks on his hands if he'll tolerate them.

If your child has a lot of trouble sleeping because of the itching, consult your doctor. He may suggest an antihistamine to help your child rest better.

Soothe flare-ups During a flare-up, you can try applying cool compresses to the area several times a day, followed by a moisturizer.

A study published in the May 2009 issue of Pediatrics tested treatments on children with severe eczema. The kids ranged in age from 6 months to 17 years.

Researchers found that soaking for five to ten minutes twice a week in a diluted bleach bath was five times more effective at treating eczema than plain water (used by the placebo group). The improvement was so dramatic that the researchers stopped the study early to allow children in the placebo group to benefit from the method.

Amy Paller, senior author of the study and the Walter J. Hamlin professor and chair of the department of dermatology and professor of pediatrics at Northwestern University Feinberg School of Medicine, says that with their doctor's approval parents of children with moderate to severe eczema might want to try this method, especially if their child gets skin infections.

Paller recommends a scant two teaspoons of bleach per gallon of bathwater (or 1/2 cup per full tub) at least twice a week, taking these precautions: 1) Make sure your child doesn't drink the water. 2) Disperse the bleach in the water before putting your child in the tub (you don't want undiluted bleach to get on her skin).

Nashville pediatrician Smith agrees with Paller's approach. "It's safe and easy to do," he says. "It's basically like a freshly chlorinated swimming pool, which serves to kill germs in the pool. It is very useful for kids with recurrent skin infections related to eczema, but it has also been shown effective just to eliminate bacteria, making the eczema easier to treat."

Smith tells parents to use 1/3 to 1/2 cup for a full tub or 1 teaspoon per gallon. He also suggests rinsing off briefly afterward, to get rid of the bleach smell.

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Eczema in children | BabyCenter