Eczema is a common problem in infants and children. It usually begins between two and six months of age with very dry and sensitive skin that will then become red and extremely itchy. It often starts on the forehead, cheeks and scalp and spreads to the trunk, creases of the elbows, knees, and wrists. With scratching the rash may become raw, crusted and weepy.
It is not yet known what causes it, but it does seem to run in families that have a history of asthma, allergies or atopic dermatitis. It is a chronic disease, but only about a third of children with infantile atopic dermatitis will continue to have problems with it as they get older.
There is no cure for this common condition. The main treatments are aimed at controlling and preventing inflammation and itching and include avoiding triggers, frequent bathing and hydrating of the skin, liberal use of moisturizers and lubricants, and the use of steroid creams for flare-ups.
To help with dryness, these creams, such as Eucerin, Nivea, or Lubriderm, should be used every day, even when the eczema isn't flaring-up.
Apply right after baths within 3 minutes (and after the steroid creams) to help trap in moisture and throughout the day as needed. For severely dry skin, try using an ointment, such as Aquaphor.
Alternative lubricants that some parents find useful include Hydrolatum and Vanicream.
Many experts recommend avoiding moisturizing lotions, as they often don't work as well as a cream or ointment.
Bathing and eczema is a controversial topic, but many people think the practice of limiting baths is old school or old fashioned. Many experts now recommend a daily bath for kids with eczema.
A daily bath for at least 15-20 minutes helps to moisturize the skin and make it less itchy. Be sure to use a mild, nondrying soap, such as Dove, Neutrogena, Tone, Caress, Dial, Basis, or Purpose, avoid vigorous scrubbing, use a soft towel to pat the skin dry and immediately (within 3 minutes) apply a lubricating cream afterwards.
If your child's skin is not tolerating a daily bath, limit baths to every other day or try using a soap substitute, such as Cetaphil. Avoid using bubble baths, harsh or drying soaps and keep shampoo off the affected areas.
Atopic dermatitis is a very itchy rash, and scratching usually makes it worse, so it is important to help control itching. You can use an oral antihistamine, such as Benadryl, especially at night to help control irritability and restlessness that the itching may cause. Always apply your steroid cream to areas that itch.
Help prevent flare-ups by avoiding things that are known to trigger your child's eczema. These may include certain foods (cow's milk, eggs, peanut butter, fish), wool fibers and clothes, rough or tight fitting clothing, dry air, sweating, getting too hot or too cold (avoid hot or cold water), harsh soaps or chemicals, and stress.
Swimming is allowed, but immediately shower or bathe to wash off chlorine and other chemicals and apply a moisturizer to help prevent your child's skin from drying out.
As always, consult your physician for more information. For this and other skin-related illnesses, you may also want to consult Dr. Kathy Cook, a dermatologist who practices at the Boone County Hospital Specialty Clinic. To make an appointment with Dr. Cook or any other specialist at Boone County Hospital, please call 433-8300.
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