Eczema

     Eczema or “atopic dermatitis” is a chronic skin condition causing patches of red, dry, itchy, skin. In infants and younger children the red patches are on the face, in the neck folds, on the trunk and on top of the forearms. In older children it is frequently on the hands, in the front of the elbows and behind the knees. 60% of children with eczema develop it before their first birthday. 85% develop it before age 5. Many experts feel that there is a connection between eczema and allergies.  Some 60% of children with eczema have food allergies. Up to 80% of older children with eczema are reported to have hay fever and 50% are reported to have asthma. This is why an infant with eczema needs to be evaluated for food allergy. The most common infant food allergies are milk, soy, eggs and peanut but parents should speak with their caregiver before eliminating a food from the child’s diet.

     Children with eczema have an abnormal skin surface that does not hold moisture as well as normal skin. If normal skin is wet, it is fine, and if it is dry, it is fine, but even normal skin gets chaffed and red if it goes from wet to dry. Children with eczema have a lot of difficulty when their skin goes from wet to dry. This is why eczema is worse in areas of the body where sweat collects or in areas that frequently get wet, like the hands. Moisture in the skin surface is also important for the skin to act as a barrier against chemicals and irritants. Children with eczema have less moisture in their skin and are more sensitive to irritants.

     If a child has food allergies, avoidance of the food will improve their eczema. But all children with eczema are improved with frequent moisturizing of the skin. It is especially important to apply moisturizing lotion or cream immediately after the skin has been wet – immediately after baths and showers, in sweaty areas and right after hand washing. Avoid the skin going wet-to-dry. Any areas of the body that have the dry, red patches need moisturizing even more often.

     The second problem that children with eczema have is itching. Some experts say that the itching is such a key part of eczema that parents need to think of eczema as “an itch that rashes” rather than “a rash that itches”. Parents often report that the child began itching before the rash appeared. Treating the itch involves eliminating any offending allergy agents and giving the child antihistamines. Older antihistamines like diphenhydramine (Benadryl) or hydroxyzine (Atarax) sometimes make children crabby or tired but I have found that the “non-sedating” antihistamines don’t relieve itching as well. Parents should try both (only one at a time). The goal is to eliminate the itch without causing side effects. Another treatment for the itching is steroid creams. Lower percentage steroid creams can be purchased without a prescription and should be tried because they often help. Stronger steroid creams should only be used under the care of a physician.