Eczema

Signs and Symptoms

• Eczema looks different in infants. It can show up as a weepy rash on the cheeks and around the mouth.
• In toddlers and older children, often affects the inside of elbows, inner wrists, backs of knees, and the face.
• Eczema usually itches a lot. Children may scratch until they bleed, be irritable, and have problems sleeping.
• Patches come and go. During flare-ups, seeping or crusted sores may develop.
• Over time, patches of skin can become thick like leather and darker-colored.

Triggers

Eczema affects everyone differently. Your child’s triggers may change over time or be different than someone else’s.

• Pollen, dust, grass, and pet dander can be environmental triggers for some children. Keeping a child away from these can be hard and may not help their eczema.
• Things that irritate the skin can cause a flare-up. Common triggers include: 
  • Harsh soaps, detergents, scented products
  • Illness, including common colds
  • Extreme temperature changes
  • Cigarette or vape smoke
  • Spit (saliva) or drool
  • Harsh fabrics like wool
• A child with eczema may also have allergies and asthma. Allergies can make eczema worse, but they rarely cause eczema. If you think your child has an allergy, tell their doctor or health care provider. They can be referred to a pediatric allergist for testing.

Treatment

There is no cure for eczema. Things you can do to help control it, keep it from getting worse, and prevent flare-ups are:

• Daily skin care. This is the most important treatment.
  • Bathe each day for 5 to 10 minutes. Use warm water. Hot water can cause dry skin.
  • Do not put any soap in bath water. Only use a small amount of mild soap, like Aveeno^®, Cerave^®, or Cetaphil^®, Dove^® for Sensitive Skin, or Vanicream^® on the dirty areas. Do not use scented soaps.
  • Avoid scrubbing the skin. Pat it dry but leave it slightly damp.
  • Apply a thick layer of moisturizer (cream or ointment) to your child’s skin within 3 minutes after bathing, before the skin dries. Apply the cream to the whole body. These moisturizing creams work well:  Aquaphor^®, Aveeno^®, Cerave^®, Cetaphil^®, Eucerin^®, Vanicream^®, and Vaseline^®.
  • Reapply the same moisturizer to the  whole body 2 to 3 times a day. If you can’t bathe each day, still apply moisturizer to your skin.
• Wash all clothes and bed linens in a mild detergent.
• Help your child avoid scratching. It can cause open sores and lead to infection. To help, keep their fingernails and toenails clean and cut short.
• Ask your child’s doctor or health care provider about other treatments, like bleach baths or wet wraps. These are not good for all children.
• For flare-ups, your doctor or health care provider may also prescribe these medicines:
  • Topical (on the skin) anti-inflammatory creams, like a corticosteroid or a calcineurin inhibitor.
    • Apply a thin layer 2 times each day to the raised, rough, itchy areas only.
    • Don’t use the prescription cream more often than prescribed. Putting it on too often can thin and damage the skin.
    • Put a moisturizer cream over the prescription cream.
  • Oral (by mouth) antihistamines to help control itching and sleep problems. These will make your child sleepy.
  • Your child’s doctor or health care provider may suggest other prescription medicines, like shots (injections) or pills. These affect the immune system. They will monitor your child closely while on these.

When to Call the Doctor

Call your child’s doctor or health care provider if they have:

• No improvement or their eczema gets worse even with treatment.
• Severe itching that keeps them from resting or sleeping.
• Signs of infection: open sores, drainage, or crusting, pain instead of itching, or a fever:
  • Under 3 months old and has a rectal temperature over 100.4° Fahrenheit (F) or 38° Celsius (C).
  • Over 3 months old and has temperature over 102°F or 38.9°C.

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