There are few things more frustrating than an itchy rash. Eczema is an intensely itchy rash that affects about one in 10 children. It is one of the most common skin conditions of childhood and typically starts prior to age 5. Thankfully, it is not a contagious rash, but it is hereditary so it often affects multiple family members.
Eczema has become known as “the itch that rashes.” This is because the rash of eczema tends to worsen with scratching. As the condition progresses, patients will notice dry skin, inflammation (redness), and excoriations (scratch marks); however, these symptoms wax and wane over time. It is considered an allergic disorder and is sometimes found in conjunction with other allergic conditions like asthma or nasal allergies. In some patients, flare ups of eczema may occur with certain food exposures.
The location of eczema varies with age. In infants, it is most often found on the face and scalp, but can also be on the torso, arms, and legs. In young children, eczema tends to be located in the folds of the knees and elbows. By adolescence, the hands and feet are most affected.
Now that we have some background on eczema, let’s talk about how to treat it. As with many medical conditions, prevention is the first step so good skin care provides the foundation of eczema treatment. Fragrance-free and dye-free soaps are recommended for bathing. After a bath or shower, the patient should pat their skin dry, leaving it slightly damp. Over-drying can dehydrate the skin. A moisturizer with a high lipid content should be used immediately after bathing and re-applied as needed. An effective moisturizer should feel greasy when applied to the skin. Petroleum jelly is 100% lipid and is my preference for its high lipid content and affordable price.
Patients should avoid scratching their skin since it can worsen the rash and also lead to infection. Parents should keep their child’s nails short and clean. Avoiding scratchy fabrics is also recommended. Clothing made from soft cotton is a good choice.
Medications for eczema are utilized to achieve two goals: 1) decrease itching and 2) decrease inflammation. Topical steroid creams or ointments achieve both of these objectives. Mild steroid creams or ointments are available over the counter, but more potent ones are only available with a prescription. It is important to remember that medicated creams and ointments are pharmaceuticals, not lotions, and should only be used as directed. They are considered safe, but can have side effects such as skin thinning or irritation. Topical medicines should be applied prior to moisturizers.
Oral antihistamines help control the nagging itch associated with eczema. In many patients, the itching is severe and can lead to decreased sleep, infection, and worsening of the eczema itself.
A third group of medicines used to treat eczema are called topical immunomodulators, which decrease inflammation by altering the immune system. They do not contain steroids and, therefore, do not cause skin thinning. However, these medicines are not considered first line treatment. In addition, since they are a newer group of medicines, there is less known about long term use.
It is important for parents of children affected by eczema to recognize the signs of a skin infection. Yellow crusting, drainage, or pus bumps are potential indicators of a secondary skin infection. Call your doctor if you are concerned about an infection.
Although eczema is a chronic skin issue, there are many simple steps to take to get it under control. Maintain skin hydration with moisturizers, stop the itch-scratch cycle with antihistamines, and manage inflammation with medicated creams or ointments. Talk to your doctor about whether a referral to an allergy or dermatology specialist is appropriate for your child.