Eczema

Most kids get itchy rashes at one time or another. But eczema can be a nuisance that may prompt scratching that can only make the problem worse.

The term eczema refers to a number of different skin conditions in which the skin is red and irritated and occasionally results in small, fluid-filled bumps that become moist and ooze. The most common cause of eczema is atopic dermatitis, sometimes called infantile eczema although it occurs in infants and older children.

The word "atopic" describes conditions that occur when someone is overly sensitive to allergens in their environment such as pollens, molds, dust, animal dander, and certain foods. "Dermatitis" means that the skin is inflamed, or red and sore.

Kids who get eczema often have family members with hay fever, allergies. Some scientists think these children may be genetically predisposed to get eczema, which means characteristics have been passed on from parents through stress) can also trigger the condition.

About one out of every 10 kids develops eczema. Typically, symptoms appear within the first few months of life, and almost always before a child turns 5. But the good news is that more than half of the kids who have eczema today will be over it by the time they're teenagers.

What Are the Signs and Symptoms?

Signs and symptoms of eczema can vary widely during the early phases. Between 2 and 6 months of age (and almost always before the age of 5 years), children with eczema usually develop itchy, dry, red skin and small bumps on their cheeks, forehead, or scalp. The rash may spread to the extremities (the arms and legs) and the trunk, and red, crusted, or open lesions may appear on any area affected.

Kids with eczema may also experience circular, slightly raised, itchy, and scaly rashes in the bends of the elbows, behind the knees, or on the backs of the wrists and ankles.

As children get older, the rash is usually less oozy and scalier than it was when the eczema first began, and the skin is extremely itchy and dry. These symptoms also tend to worsen and improve over time, with flare-ups occurring periodically.

Children often try to relieve the itching by rubbing the affected areas with a hand or anything within reach. But scratching can make the rash worse and can eventually lead to thickened, brownish areas on the skin. This is why eczema is often called the "itch that rashes" rather than the "rash that itches."

How Long Does It Last?

In many cases, eczema goes into remission and symptoms may disappear altogether for months or even years.

For many children, the condition begins to improve by the age of 5 or 6; but others may experience flare-ups throughout puberty when hormones, stress, and irritating skin products or cosmetics are introduced (or due to other factors that scientists don't yet understand). And some people will experience some degree of dermatitis into adulthood, experiencing areas of itching and a dry, scaly appearance.

Is It Contagious?

Eczema is not contagious, so there's no need to keep a baby or child who has it away from siblings, other children, or anyone else.

Can It Be Prevented?

Scientists believe that eczema is

Your child's doctor may also ask you to eliminate certain foods (such as eggs, milk, soy, or nuts) from your child's steroids used by some athletes. These medicines are usually applied directly to the affected areas twice a day.

Continue to apply the corticosteroids for as long as your child's doctor suggests. It's also important not to use a topical steroid prescribed for someone else. These creams and ointments vary in strength, and using the wrong strength in sensitive areas can damage the skin, especially in infants.

Nonsteroid medications are also available now in creams or ointments that can be used instead of - or in conjunction with - topical steroids.

Other prescription treatments your child's doctor may recommend could include:

• antihistamines (to help to control itching)
• oral or topical antibiotics (to prevent or treat secondary infections, which are common in children with eczema)

Some older children with severe eczema may also be treated with ultraviolet light under the supervision of a dermatologist to help clear up their condition and make them more comfortable. In some cases, newer medications that change the way the skin's immune system reacts are also prescribed.

What Can I Do to Help My Child?

You can help prevent or treat your child's eczema by keeping your child's skin from becoming dry or itchy and avoiding known triggers that cause flare-ups. It may help to follow these suggestions:

• Avoid giving your child frequent hot baths, which tend to dry the skin.
• Use warm water with mild soaps or nonsoap cleansers when bathing your child.
• Avoid using scented soaps.
• Ask your child's doctor if it's OK to use oatmeal soaking products in the bath to help control the itching.
• Avoid excessive scrubbing and toweling after bathing your child. Instead, gently pat your child's skin dry.
• Avoid dressing your child in harsh or irritating clothing, such as wool or coarsely woven materials. Dress your child in soft clothes that "breathe," such as those made from cotton.
• Apply moisturizing ointments (such as petroleum jelly), lotions, or creams to your child's skin regularly and always within a few minutes of bathing, after a very light towel dry. Even if your child is using a corticosteroid cream prescribed by the doctor, apply moisturizers or lotions frequently (ideally, two to three times a day). But be sure to avoid alcohol-containing lotions and moisturizers, which can make your child's skin drier. Some baby products can also contribute to children's dry skin.
• Apply cool compresses (such as a wet, cool washcloth) on the irritated areas of your child's skin to ease itching.
• Keep your child's fingernails short to minimize any skin damage caused by scratching.
• Try having your child wear comfortable, light gloves to bed if scratching at night is a problem.
• Help your child avoid becoming overheated, which can lead to flare-ups.
• Eliminate any known allergens such as certain foods, dust, or pet dander from your household. (This has been shown to help the condition in some young children.)
• Have your child drink plenty of water, which adds moisture to the skin.

Although eczema can be annoying and uncomfortable for children, its emotional impact can become the most significant problem as your child gets older - especially during the preteen and teen years. And your child will need to take responsibility for following the strategies described above.

You can help by teaching your preteen or teen to:

• Establish a skin care routine. Brief, lukewarm showers or baths and moisturizing regularly will help to avoid or alleviate flare-ups.
• Use only hypoallergenic makeup and sunscreens and facial moisturizers labeled noncomedogenic and oil free.
• Recognize stressful situations (such as taking tests at school or sports competitions) and how to manage them (such as by breathing, focusing on an enjoyable activity, or taking a break).
• Be aware of scratching and minimize it as much as possible.

When Should You Call Your Child's Doctor?

Children and teens with eczema are prone to skin infections, especially with herpesvirus. Call your child's doctor immediately if you notice any of the early signs of skin infection, which may include:

• increased Barbara P. Homeier, MD
  Date reviewed: May 2005
  Originally reviewed by:
  Note: All information is for educational purposes only. For specific medical advice, diagnoses, and treatment, consult your doctor.
  
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