Soothing Your Child's Eczema

Eczema, also called atopic dermatitis, causes dry, red, scaly patches on the skin. Find out how to manage and ease your child’s eczema.

Contributor

Amy E. Gilliam, M.D.

Palo Alto Medical Foundation

If you see dry, red, scaly patches on your child’s skin, it may be eczema, a condition caused by inflammation. Also called atopic dermatitis, eczema often runs in families and is linked to allergic conditions, such as asthma and hay fever.

Amy Gilliam, M.D., a pediatric dermatologist at the Palo Alto Medical Foundation, counsels many Northern California parents on how they can manage their children’s eczema.

“Although eczema is linked to allergies, eliminating potential allergens from your child’s diet or environment may not necessarily improve eczema,” she says.

The rough, scaly and occasionally oozing patches that signal eczema usually appear on babies’ cheeks, forehead and scalp at around 3 to 4 months of age. Older children typically have the patches inside their elbow creases, on the wrists, behind the knees and on their necks.

“There is no cure for eczema. However, your child’s skin will often improve substantially by the time he or she has reached school age (usually around 4 or 5), and many children outgrow this uncomfortable condition,” Dr. Gilliam says.

How Can I Ease Symptoms for My Child?

Eczema flares up, subsides and often gets better on its own, Dr. Gilliam explains. That said, there are several effective steps you can take to prevent flare ups and ease the uncomfortable, itchy symptoms when they do appear.

“Moisturize, moisturize, moisturize!” is Dr. Gilliam’s first advice. Apply a cream or ointment-based moisturizer twice a day if possible, even when the skin looks good. Products that contain ceramides (natural lipids that repair the skin barrier,) such as CeraVe and Cetaphil, can be particularly effective. Other options include products from Aquaphor, Aveeno, Eucerin and Vaseline.
Ease itchiness and inflammation with steroid creams. An over-the-counter hydrocortisone cream twice a day can make your child more comfortable by reducing symptoms. Although the amount of steroid absorbed through skin is small, always follow the instructions on the cream package and consult your doctor if you are treating a very large area in a very young child for an extended period of time. Your child’s doctor can also prescribe a stronger steroid cream if the itching or rash is severe, Dr. Gilliam notes.
Use oral antihistamines for additional itch relief. To ditch that itch, ask your doctor about pairing the steroid cream with an over-the-counter oral antihistamine, like Benadryl. Because antihistamines can make a child drowsy, this treatment can be especially effective for itching that disrupts your child’s sleep. Get dosing instructions directly from your doctor if your child is under 2.
Choose the right sunscreen. “Sunscreen is an important part of protecting your child’s health, but sunscreens that use chemicals to block damaging ultraviolet rays can make eczema worse,” Dr. Gilliam says. “Instead, pick a sunscreen that contains zinc oxide or titanium dioxide as the main active ingredient and that does not include a long list of other ingredients.”
Avoid irritating fabrics and softeners. “Avoid dressing your child in wool or synthetic fabrics, as these can irritate the skin,” Dr. Gilliam says. “Also, when washing clothes, do not use fabric softener sheets in the dryer, as these work by leaving a small amount of chemicals and fragrance on clothing.”

Eczema Bathing Tips

Many patients Dr. Gilliam sees wonder about the frequency of baths. Children often love daily baths, and they can soothe itching. In fact, “soaking and sealing” the skin daily is a very effective means of preventing eczema.

“Water is actually hydrating for the skin, so your children with eczema can have a bath as often as needed,” Dr. Gilliam says. “To avoid drying the skin, make sure the water is lukewarm rather than hot and apply moisturizer all over your child’s face and body within minutes of getting out the bath. If you are also using a steroid cream for your child’s skin, apply this first, then the moisturizer.”

Because soaps may dry skin, she adds that you should select a very mild soap and use it only on the areas where it’s needed, such as around the neck, in the armpits and diaper area.

Eczema and Skin Infection

Eczema is a result of a skin barrier deficiency, so having the condition means that your child is probably also more prone to skin infections, Dr. Gilliam says. Scratching compounds the problem, making the skin vulnerable to the staph bacteria and other infections.

“It’s extremely important to address the infection as quickly as possible so it does not spread,” she says. “Your child’s doctor can prescribe a topical antibiotic cream or oral antibiotics for this.”

A simple home remedy for regularly sterilizing the skin and preventing infections in children with eczema is diluted bleach or apple cider vinegar baths. Dr. Gilliam often has parents of her patients add one-eighth or one-quarter cup of regular bleach or apple cider vinegar to the bathwater in a full-sized bath tub three times per week.

Treatment for Severe Eczema

For some children, eczema can be a severe and extremely uncomfortable condition. In these cases, Dr. Gilliam sometimes advises wet-wrap therapy before bedtime. After bathing and applying moisturizer and steroid cream, the child is dressed in a barely damp pair of pajamas with a pair of dry pajamas over the top. This can provide some immediate relief of symptoms, helping the child get a more restful night’s sleep, and can improve his eczema.

For children older than 3 or 4 with chronic and severe eczema, ultraviolet light therapy and oral medications may also help reduce inflammation of the skin over the long term. Talk to your doctor about these options, as these treatments should be performed under medical supervision, Dr. Gilliam says.