Eczema! Oh Eczema!

Eczema. What is it?

Eczema is a very common skin condition that many of our children will have to deal with, either as a baby, or as an older child. So let's learn all about eczema and how to best manage it.

Eczema, also know as atopic dermatitis, is a skin condition that leads to areas of dryness, inflammation, redness, and/or itching of the skin. This skin condition will usually come and go causing periods of "flares" and periods of improved skin.

What does it look like?

The appearance of eczema can vary depending on the level of severity. Mild eczema usually consists of a few scattered, itchy, red, or skin-colored bumps or small dry patches on the skin that may or may not be itchy. More severe eczema involves thick, dark, very itchy patches, that may appear lichenified (like tree bark), usually in multiple common locations on the skin but can occur anywhere and everywhere on the body. Moderate eczema can consist of anything in between the above descriptions.

In babies, eczema most often presents on the face, upper back, and neck. In older children, eczema most often occurs in creases of the body, such as the bend of their elbows or behind their knees. However, in babies and older children alike, eczema can really occur anywhere on the body.

What causes it?

Eczema is an inflammatory and sensitive skin condition. However, there is often no one specific trigger found to cause eczema in any particular individual. It is linked to other types of atopic disease, such as asthma and environmental or food allergies. This means that a child with eczema is more likely to have or develop asthma and/or environmental or food allergies. While allergy testing may be considered, specific allergens are often not directly linked to flares of eczema. There also seems to be a familial or genetic component to eczema. A child who has one or both parents with eczema, is more likely to develop eczema themselves.

If your infant has very severe eczema, especially if they have any issues with feeding or gaining weight, you should talk to your baby's doctor about the possibility of a milk allergy. A milk allergy is one of the few specific identifiable and treatable triggers that can lead to severe eczema. A milk allergy more commonly occurs with formula (cow's milk), but can sometimes occur with breastmilk as well. This may mean you need to change your baby's formula to a milk-free formula or try decreasing or eliminating dairy in your diet if your baby is breastfed. However, you should consult with your baby's doctor first before making these changes.

What treatments are available?

The first and most important treatment for eczema is good skin care. Babies and children with eczema have sensitive skin that may respond badly to scented or fragranced products. For any child with eczema, all products that come into contact with their skin, including lotions or creams, soaps, and laundry detergent, should be unscented. There are many brands of unscented or hypoallergenic skin products available that work well for eczema.

Secondly, eczema is a dry skin condition. So, good moisturization of the skin is essential. Moisturization is important at least once or twice daily, preferably with a thicker, unscented lotion or ointment. Prior to moisturizing, your child's skin should be cleansed with an unscented soap and water. This helps to remove any irritants from your child's skin. You may have heard or read that washing the skin less helps to retain natural moisture. However, a child with eczema will need their skin cleansed regularly to remove irritants that build up through normal daily routines and activities. This makes just after bathtime an ideal time to moisturize your child's skin. Soaps that have moisturizing components already added in work well for eczema.

If supportive care (good moisturization and avoidance of scented products) do not improve your child's eczema, it is time to talk to your child's pediatrician, especially if your child is scratching their skin often. Scratching the skin often can lead to skin infections so it is important to prevent this when possible.

Steroid creams or ointments are often needed to help treat eczema. These products vary in strength and are usually prescribed with this in mind, considering your child's age and the severity and location of their eczema. Topical steroids are the main type of prescription treatment for eczema as oral steroids typically only offer temporary relief and have much greater potential for side effects for your child.

It is important not to overuse steroid creams or ointments. This can lead to thinning and discoloration of your child's skin. However, when used appropriately, steroid creams and ointments are safe and the best treatment for eczema that does not respond to the supportive treatments mentioned above.

Steroid creams and ointments should be used only when your child has an eczema flare and a thin layer should be applied to the affected areas only. These products should not be used as a general daily moisturizer or for preventive treatment. However, they can be used in conjunction with your child's general moisturizer to prevent future flares while at the same time treating the current flare. You can achieve this by applying your child's steroid cream or ointment to the affected areas first, then apply a layer of their general moisturizer on top of the steroid and everywhere else on their skin.

When used properly, steroid creams or ointments will often resolve an eczema flare within a few days for mild to moderate eczema. This may not always be the case with more severe eczema. Children with more severe eczema will often require stronger or alternative prescriptions and may require the input of a specialist, such as a dermatologist or allergist. If your child's eczema does not seem to respond to their prescription cream or ointment, talk to your child's doctor.

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