http://www.kidshealth.org/parent/infections/skin/eczema_atopic_dermatitis.html
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, asthma, or other allergies.
Some scientists think these children may be genetically predisposed to
get eczema, which means characteristics have been passed on from
parents through genes that make a child more likely to get it.
About half of the kids who get eczema will also someday develop hay fever or asthma themselves. Eczema is not an allergy itself, but allergies can trigger eczema. Some environmental factors (such as excessive heat or emotional 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 adolescence and early adulthood.
In some kids, the condition may improve and then resurface at the onset of 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 inherited, so there's no way to prevent the condition. However, because specific triggers may tend to make it worse, flare-ups can be prevented or improved by avoiding possible triggers such as:
- pollen
- mold
- dust
- animal dander
- dry winter air with little moisture
- allowing the skin to become too dry
- certain harsh soaps and detergents
- certain fabrics (such as wool or coarsely woven materials)
- certain skin care products, perfumes, and colognes (particularly those that contain alcohol)
- tobacco smoke
- some foods (Which foods may be eczema triggers depends on the
person, but dairy products and acidic foods like tomatoes seem to be
common culprits.) - emotional stress
- excessive heat
- sweating
Also, curbing the tendency to scratch the rash can prevent the
condition from worsening and progressing to cause more severe skin
damage or secondary infection.
How Is It Diagnosed?
Diagnosing eczema can be challenging because:
- Each child experiences a unique combination of symptoms that also tend to vary in severity.
- It's sometimes confused with other skin conditions, such as seborrheic dermatitis (better known as "cradle cap"), psoriasis (a genetic disease that causes the skin to become scaly and inflamed), and contact dermatitis (caused by direct skin contact with an irritating substance, such as a metal, medicine, or soap).
- There's no test available to diagnose it definitively.
If your child's doctor suspects eczema, a thorough medical history
is likely to be the most valuable diagnostic tool. A personal or family
history of hay fever, other allergies, or asthma is often an important
clue.
In addition to doing a physical examination, the doctor will likely
ask you and your child about any concerns and symptoms your child has,
your child's past health, your family's health, any medications your
child is taking, any allergies your child may have, and other issues.
The doctor will also help you identify things in your child's
environment that may be contributing to the skin irritation. For
example, if your child started using a new soap or lotion before the
symptoms appeared, mention this to the doctor because a substance in
the soap might be irritating your child's skin.
Your child's doctor may also ask you and your child about any stress
he or she might be feeling at home, school, or work (for older kids),
because stress can lead to eczema flare-ups.
Your child's doctor will also probably:
- Examine the distribution and appearance of the rash.
- Ask about how long the rash has been there.
- Look for evidence of thickening of the skin from itching or rubbing (this is called lichenification).
The doctor will also want to rule out other diseases and conditions
that can cause skin inflammation, which means that your child may have
to be seen more than once before a diagnosis is made. The doctor may
also recommend sending your child to a dermatologist or an allergist.
Sometimes, the doctor may refer your child to an allergist to
perform allergy testing to find out if the rash is an allergic reaction
to a certain substance.
Allergy testing can involve one or more of the following:
- a blood test
- a patch test (which involves placing a patch of suspected allergen, such as dyes or fragrances, on the skin)
- scratch/prick tests (which involve placing suspected allergens on the skin or injecting them into the skin)
Your child's doctor may also ask you to eliminate certain foods (such as eggs, milk, soy, or nuts) from your child's diet,
switch detergents or soaps, or make other changes for a certain period
of time to find out whether your child has a reaction to a particular
substance.
How Is It Treated?
Topical corticosteroids, also called cortisone or steroid creams or ointments, are commonly used to treat eczema and are not the same as the 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 Staph bacteria and herpesvirus. Call your child's doctor immediately if you notice any of the early signs of skin infection, which may include:
- increased fever
- redness and warmth on or around affected areas
- pus-filled bumps on or around affected areas
- areas on the skin that look like cold sores or fever blisters
Also, call your child's doctor if you notice a sudden change or
worsening of your child's condition or if your child's eczema isn't
responding to the doctor's recommendations.
Even though eczema can certainly be bothersome for kids and parents
alike, taking some preventative precautions and following the doctor's
orders can help to keep your child's eczema under control.
Updated and reviewed by: Barbara P. Homeier, MD
Date reviewed: May 2005
Originally reviewed by: Patrice Hyde, MD
