The medical name for eczema is atopic dermatitis. "Dermatitis" means inflammation of skin. "Atopic" dermatitis is a kind of inflammation that causes dry itchy skin. It occurs in as many as 17% of children.
The exact cause of eczema is unknown. In many patients, there is a family history of allergies, such as hives, hay fever, asthma or atopic dermatitis. Many people with atopic dermatitis may also have one of these other conditions. In most cases, no allergic factors can be found that trigger or cause eczema.
Progression of the Condition with Age
Eczema usually begins in infancy between the ages of 2 to 6 months. The skin is dry and the rash is itchy. Infants may be restless, rubbing against their sheets or other objects. They will try to scratch if they are able. The rash may involve only the face, or it may cover a large part of the body.
As the child gets older, the rash may become more localized (more concentrated in one place). In early childhood, the rash is commonly found on the legs, feet, hands and arms. As a person becomes older still, the rash may be limited to areas such as the bend of the elbows and knees, on the backs of the hands and feet, and on the neck and face. As the rash becomes more established, the dry, itchy skin may become thickened, leathery and sometimes darker in color.
The more the person scratches, the worse the rash gets and the thicker the skin gets.
Most children with atopic dermatitis outgrow the condition before school age; some continue to have problems as an adolescent or even as an adult.
Complications & Irritants
Patients with eczema usually have sensitive and dry skin. Many patients find that during the winter months when the humidity is very low, the dryness and itchiness is worse.
Some patients are very easily irritated by sweat and may have more problems during the summer months.
Sudden changes in temperature are irritating to patients. Use of harsh soaps or detergents and exposure to wool may also cause itching and irritation.
Sometimes a “secondary infection” develops with eczema. Infections can be caused by bacteria, fungus or viruses. A bacterial infection is the most common, and most often occurs as the result of scratching. The rash gets very red with pus-pimples and scabs. If this occurs, your doctor will prescribe an antibiotic to control the infection.
Certain viruses can cause a more serious complication. The "cold sore" virus (herpes simplex) may cause a severe rash. If this happens, immediately contact your doctor. Molluscum is another virus that tends to spread rapidly in patients with atopic dermatitis.
There is no permanent cure for eczema. The main goal is to decrease the skin eruption and relieve the itching. There are a number of different types of medicine that you can use for eczema. The specialists in our Division of Dermatology can help treat children with eczema. Learn how to make an appointment.
Your doctor will order the medicines that they feel are best for your child. Most often your doctor will prescribe "topical medicines" (medicines that are applied to the skin).
Cortisone-derived ointments or creams are very important in decreasing the itching and inflammation. Your doctor will suggest a cortisone treatment that is most appropriate for the severity and location of your child's rash.
When the area is clear, it is best to discontinue the use of the cortisone preparation, but continue the vigorous use of moisturizers to try to prevent new areas of inflammation from occurring. Of course, if itching or a new rash begins, you may have to use the cortisone preparation again.
Antihistamines also help control itching. They also introduce some degree of drowsiness and help children sleep better at night. Systemic antibiotics are often useful as well for controlling the secondary infection, and often enable infected dermatitis to be controlled.
Dry Skin Care
- Baths should not exceed 5-10 minutes.
- Use lukewarm water. Avoid hot or cold water.
- Do NOT vigorously scrub skin with a washcloth, sponge or brush. Use your hands to clean your child.
- Use a mild soap (your doctor will have suggestions).
- To dry your child, pat them dry with a towel, then apply the recommended prescriptions. Then use a moisturizer.
- Do not use bubble bath or other fragranced soaps or washes.
Moisturizing the Skin
- Apply the moisturizer twice daily to the entire body. This should be done after prescription medications are applied.
- Creams and ointments come in jars and tubes. They contain more oil, and are often preferred. Lotions most often come in pump dispensers. (Lotions are best in the hot summer; creams and ointments are better for very dry skin and winter use.)
- Do NOT use colognes, perfumes, sprays or powders on your skin or your child's skin.
- Use a small amount of unscented laundry products such as Cheer-Free, All, Dreft, Trend or Purex. Double rinse clothes if possible after washing.
- Your child should not wear tight or rough clothing. Wool clothes and new clothes can be irritating. Wash new clothes before your child wears them.
- For extreme dryness and winter weather, a humidifier or vaporizer may help.