I see many children for itchy, irritated skin at the office.
One of the more frequent causes is commonly referred to as “eczema.” Eczema can be very frustrating for parents and children alike, and below I hope to clarify what it is, what causes it and some initial steps to treatment.
Eczema actually refers to a number of conditions in which the skin becomes red and irritated and may develop small, fluid-filled bumps that ooze. It often begins around 2 to 6 months of age, but almost always appears by 5 years of age. The typical complaint is dry, red, itchy, bumpy skin. Any part of the body may be involved, but eczema often occurs behind the knees, in the bends of the elbows and on the cheeks.
Officially, eczema is called atopic dermatitis. Atopic refers to conditions that result when someone is overly sensitive to allergens in their environment. It is thought the dermatitis, or inflamed, red skin results from the body’s reaction to these allergens. As a person will have varying reactions to different allergens, each child has different triggers for his or her eczema. Some common triggers include pollen, dust, dry winter air, certain soaps and detergents, tobacco smoke, stress and heat.
Since eczema has a genetic link, many kids with eczema will have family members with other allergy-related conditions such as hay fever, asthma or food allergies. Researchers feel such children may be genetically predisposed to develop eczema.
Eczema affects one in 10 children. The good news is that eczema clears in almost 40 percent of children by adulthood. Children typically try to relieve the itch by rubbing the areas on anything they can find, but this often makes the skin worse.
My goals for children with eczema are to establish a good skin care regimen to minimize symptoms and prevent flare-ups. The mainstay of treatment is continually moisturizing the skin and avoiding any known triggers. In cases of mild eczema, I will ask parents to use a fragrance-free moisturizer (Eucerin and Aquaphor are popular brands, but petroleum jelly works just as well). The moisturizer should be thick enough that it has to be scooped out of the container rather than dispensed with a pump. This can be applied liberally and as often as parents remember, but we typically aim for two to three times per day, depending on the severity of symptoms.
To avoid triggers and minimize skin irritation, parents are advised to give children short, lukewarm baths, use fragrance-free hypoallergenic soaps and be mindful of other exposures (i.e. tobacco smoke, certain foods, excessive heat), which trigger eczema in their children.
For more severe cases, I will add a topical steroid. The strength of the steroid depends upon the severity of symptoms. The steroid is used for short-term treatment to decrease the inflammation and irritation of the skin and get the symptoms under control. Once this is achieved, I ask parents to stop the steroid, but continue application of a moisturizer two to three times per day.
If children experience flares in their eczema after exposure to a trigger, the steroid may be used again. Many parents are appropriately concerned about the use of topical steroids, which may cause skin discoloration or skin thinning from overuse. However, the constant irritation from poorly treated eczema may also cause skin discoloration, thickening of the skin (lichenification) and secondary skin infections. I like to reinforce getting control of eczema when it flares by using a well-established skin care regimen. This helps prevent repeated and severe flare-ups, which otherwise might require steroids.
If you think your child has eczema, it is a good idea to see his or her doctor. Eczema may be confused with other skin conditions such as cradle cap and psoriasis. Though there is no test available to make the diagnosis, a thorough history and examination will allow the doctor to come up with a good management plan for your child.
In addition to what is mentioned above, there are numerous other strategies to improve eczema control that the physician may suggest (drinking adequate water, keeping fingernails short to avoid scratching). Cases of severe eczema that do not respond to routine treatment may require referral to an allergist or dermatologist. Lastly, parents should be aware that eczema is not contagious, so there is no need to keep children with eczema away from others.
For parents dealing with eczema, it is an annoyance, but that itch can be managed with a good skin care routine and guidance from your child’s physician.
Dr. Deepa Sekhar is a pediatrician at the Penn State Milton S. Hershey Medical Center.
