Managing Your Child’s Eczema

Eczema, also known as atopic dermatitis, is the most common inflammatory skin condition amongst children characterized by inflamed, irritated, and often itchy skin from an impaired skin barrier. Studies have shown a family history of atopic dermatitis, as well as a loss of function mutation in the FLG gene, are strongly associated with the development of atopic dermatitis; however, not all children with these factors develop eczema. Over half of children with atopic dermatitis develop symptoms within the first year of life and about 90% develop symptoms by age 5. Eczema generally resolves by adulthood but some children may continue to exhibit symptoms throughout adulthood. Early diagnosis is vital to prevent progression from atopic dermatitis to other atopic diseases.

What are the symptoms of eczema?

The most common symptom of eczema is pruritus or itchy skin usually caused by overly dry skin. Itching of the skin leads to excoriated lesions that are often seen in patients with eczema. The distribution of these lesions varies with age. Infants tend to have scaly patches on the cheeks, scalp, trunk, thighs, shins, and on the outer surfaces of their extremities. Toddlers tend to have lesions on the scalp, flexural joints, and on the back of the neck. Lesions in adolescents are mainly in the flexural regions, but can also be present on the face, feet, hands, and neck.

What triggers eczema flares?

Daily exposures can cause your child’s eczema to flare or worsen. Potential triggers include, but are not limited to, dust mites, heat, humidity, pet dander, weather fluctuations, pollen, sweat, and baby wipes. It may be beneficial to track what causes your child’s eczema to flare.

What is the best treatment for eczema?

There is not a single treatment that is best for eczema, but rather a combination of treatments that can aid in reducing symptoms of flares. Some may recommend to skip daily baths, but I think daily baths can help to restore hydration to the skin. Keeping the skin moisturized are crucial aspects to restoring the skin barrier, but there are a few important caveats. (1)Baths should be taken in lukewarm water and (2) be limited to 10 minutes, 15 minutes max. (3) Scrubbing of the skin should be avoided as this can make eczema worse. (You can use bath time as a way to remove any possible irritants from your child’s skin.) (4) Application of moisturizers is recommended at least once daily, preferably right after a bath.

I recommend fragrance-free and dye-free creams, lotions, or ointments.  Generally, creams and ointments may be more effective during winter when the weather is more harsh and dry.

Next, during eczema flares, you may want to administer an anti-histamine prior to bedtime to improve sleep and reduce scratching. Non-sedating agents can be used during the daytime, but overall use of antihistamines during the day should be at a minimum.

Third, inflammation should be treated with the use of a corticosteroid ointment or cream bi-daily. Choosing the best steroid depends on the age of the child and should be discussed with your pediatrician. Corticosteroids should be stopped once symptoms have resolved.

Lastly, there are several methods to manage and prevent skin infections. Twice weekly bleach baths lasting about 5-10 minutes is a great method to help manage atopic dermatitis. Other options include the use of sodium hypochlorite body washes or intranasal mupirocin bidaily for five days. The best course of action should always be discussed with your pediatrician prior to treatment.

Why does eczema need to be treated?

Treatment of eczema is so important. When left untreated, eczema can progress to bacterial skin infections due to a compromised skin barrier. Additionally, itchy and inflamed skin can disrupt your child’s quality of life. Eczema can interfere with their sleep patterns, ability to concentrate, and even self-confidence.

Source: AAP

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