Eczema :: Nationwide Children's Hospital

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Nationwide Children's Hospital
700 Children's Drive
Columbus, Ohio 43205
Phone: (614) 722-5777
Fax: (614) 722-5510


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Pediacast with Dr. Mike featuring Dr. Joy Mosser on the topic of Atopic Dermatitis/ Eczema.

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Eczema (Atopic Dermatitis)

Definition:

Eczema is a chronic skin problem characterized by dry, itchy, rough skin rashes. It is not contagious. “Atopic Dermatitis” is another term sometimes used to describe eczema. This means the rash may be on children who are highly sensitive or allergic to things in the environment and/or have a history of asthma.

Diagnosis:

Eczema is typically diagnosed during an examination by your healthcare provider. No diagnostic testing is needed.

Symptoms:

Eczema may look different depending on the child, severity and areas of the body involved. Skin can become:

  • Thickened
  • Wrinkled
  • Red and Irritated
  • Rough and Dry

If scratched, the skin can bleed. Eczema is always itchy and will get worse when scratched.

Causes:

It is often difficult to find a specific trigger or allergy that flares up a child’s eczema. A child could simply have very sensitive skin. Some children are worse in the winter when the weather is drier, while others are worse in the summer due to getting hot and sweaty which can make them very itchy. Some children do not tolerate moisturizers, body soaps, laundry soaps or sunscreens that have a lot of extra ingredients such as preservatives or fragrances. These may cause them to itch, flaring their eczema. It is best to use bland skin products.

Treatment:

Good Skin Care for Eczema
No matter what a child’s eczema looks like, it is very important to remember this is a chronic or long term, skin problem. It is essential that a child’s skin be taken care of to decrease the severity and extent of flares. This includes

  • Taking daily baths
  • Using bland soaps
  • Applying thick, bland emollient or moisturizer every day

Good skin care is essential because it will strengthen the skin barrier in children. This means the skin will hold moisture better and be less susceptible to external irritants.

Medications for eczema
A variety of medications can be used to treat eczema. These include topical medicines (creams and ointments), oral antihistamines and either topical or oral antibiotics.

  • Topical Medicines: Topical medicines are creams or ointments put on the affected area of skin. Because of the chronic nature of eczema, it is essential to have a topical medication to apply to the areas of rash when they are present. Most often, a hydrocortisone cream or ointment is recommended. Another cream or ointment called a calcineurin inhibitor may also be prescribed. In both cases, it is important to use this medicine directly on areas with eczema and not on normal skin to avoid potential side effects.

  • Oral antihistamines: Oral antihistamines may also be prescribed to help with your child’s itching. These medications are not perfect and do not take the rash away directly, but help decrease scratching and itchiness of the skin. When indicated, a non-sedating antihistamine may decrease your child’s sensation of itching through the day. This medication works best when taken daily. For night time, a sedating antihistamine may be recommended. This medication is effective because it helps your child fall and stay asleep, preventing scratching of the skin all night long. This is an important way to break the itch-scratch cycle that leads to worsening eczema.

  • Antibiotics to prevent or treat infection: An antibiotic ointment or oral antibiotic may be prescribed. Antibiotics are helpful for some children who have open sores on their skin from intense scratching. If the skin infection is not treated, it is more difficult to treat the eczema itself.

Long Term Issues with Eczema:

Once a child’s eczema improves, it is still very important to continue with daily baths and daily thick, bland moisturizer. This will keep the skin as healthy as possible, making the eczema less severe.

Rough itchy patches may return and it is a good idea to have medications handy for flares that may come and go.

Often, skin color changes may stay after rough eczema is gone. The color of the skin where the eczema was may be lighter or darker after the eczema has cleared. These color changes or "footprints" will resolve over time and do not improve faster by putting topical medications on them. Medications should only go on rough, thick, itchy, or red patches of eczema. Continuing to use moisturizer on the footprints several times a day may help prevent new, itchy patches and footprints from forming.

Adjunctive Therapies:

Nationwide Children's Hospital
700 Children's Drive Columbus, Ohio 43205 614.722.2000