Symptoms, Management and Treatment
Is your child constantly scratching at her dry skin? Has the dry skin turned into a red rash that no lotion or cream seems to improve? If so, it may not be just simple dry skin. Your child may have eczema, also known as atopic dermatitis.
Eczema is a common skin condition that is characterized by a red, itchy rash that improves or worsens depending on how skin is cared for and to what it is exposed. The rash can occur all over the body, but is common in the folds of the arms or legs, or on the face of babies. About 10 to 20 percent of infants and 5 to 7 percent of children have eczema. The good news: As infants and children grow older, the severity of the eczema usually decreases. In fact, most children eventually grow out of eczema, although the condition can persist into adulthood.
Dry Skin vs. Eczema
Eczema often looks and feels like dry skin at the beginning. However, dry skin usually improves with most lotions or creams, while eczema does not. Eczema looks like a red rash with small, raised bumps. Dry skin is not typically red. At its worst, eczema can become a scaly rash that flakes or weeps. Eczema always itches and, unfortunately, scratching will make the rash worse. Scratching can cause the rash to ooze or bleed and possibly become infected.
Eczema can be mild, moderate or severe. You will see more severe flare-ups in certain conditions or times of the year. Factors such as excessive heat or cold can make eczema worse. Excessively moist or dry environments can also aggravate symptoms.
Common causes of flare-ups are hot showers or baths, overdressing, excessive bathing or hand washing, lip licking, sweating or swimming. Tight-fitting clothes or certain fabrics, such as wool, can cause friction on the skin and worsening symptoms. Contact with irritants — such as certain perfumes, dyes, detergents, soaps, deodorants or cosmetics — can also cause flare-ups.
Children with eczema commonly also have asthma, allergies or hay fever. Skincare Dry skin improves with most lotions or creams, while eczema does not Allergies to foods such as milk or eggs and environmental allergens such as dust mites, mold, pollens or animal dander are often associated with eczema and can cause flare-ups.
Your child can be tested for allergies with either a blood test or skin prick test to help diagnose what your child is allergic to and may be contributing to his eczema. Avoiding the food or environmental allergen that your child is allergic to, along with proper skin care, can dramatically improve eczema symptoms.
Good daily skin care is essential in managing eczema. Children should bathe regularly with lukewarm — not hot — water. However, they need to be careful not to bathe excessively or for long periods of time, which can irritate the skin. Avoid bubble baths or fragrance in soaps and body washes, as these can be irritating to the skin. Instead, use a mild cleanser and avoid scrubbing the skin harshly. Body washes especially formulated for eczema are available at drug and grocery stores. Immediately after bathing, pat the skin partially dry and apply lotion, cream or ointment gently. As a rule, look for fragrance- and dye-free products (even detergents) made for sensitive skin.
If your child has allergies, he should avoid exposure to that particular food or environmental allergen.
If proper skin care and the use of over-the-counter products still do not improve the eczema, your provider can prescribe a topical steroid cream. You should not apply the cream to areas of thin skin, such as the neck, face, armpits or groin. Use it in small amounts and only when needed.
An antihistamine, such as diphenhydramine, can help with itching. Children often scratch at night when they are tired or sleeping. The antihistamine can also make your child drowsy, so you might want to consider giving this at bedtime. Skincare After bathing, pat the skin dry, and apply lotion, cream or ointment gently
When to See Your Provider
You should visit your child’s provider if you suspect his rash is eczema. Your provider will be able to determine if the rash is eczema, simple dry skin or another skin condition. She may prescribe a topical steroid cream or provide recommendations for over-the-counter treatments and skin care. If necessary, your provider can test your child for allergies with a blood draw in the office, or refer your child to an allergist for skin-prick allergy testing.
It’s important to see your provider if the rash increases in redness, starts weeping or if your child runs a fever. These may indicate the rash has become infected and your child may need antibiotics. If the eczema is severe, your provider may refer you to a dermatologist for further evaluation.
Cathy Carman, MSN, NP-C, is a NP in Atlanta, GA, and has worked in a variety of pediatric settings. She currently is a clinical educator for a medical diagnostics company and enjoys seeing patients at an urgent care facility.