Most kids get itchy rashes at one time or another. But eczema can be a nuisance
that may prompt scratching that makes the problem worse.
The term eczema refers to a number of different skin conditions in which the skin
is red and irritated and sometimes has small, fluid-filled bumps that become
moist and ooze. The most common cause of eczema is atopic dermatitis
(sometimes called infantile eczema), which affects older kids as
well as infants.
The word "atopic" describes conditions that happen when someone is overly sensitive
to allergens in the environment. These include pollens, molds, dust, animal dander,
and certain foods. "Dermatitis" means that the skin is inflamed, or red and sore.
Kids who get eczema often have family members with hay
or other allergies. Some
experts think these kids may be genetically inclined to get eczema, which means characteristics
have been passed on from parents through genes
that make a child more likely to get it.
About half of the kids who get eczema will also someday develop hay fever or asthma
themselves. Eczema is not an allergy itself, but allergies can trigger
it. Some environmental factors (such as excessive heat or emotional stress)
also can trigger the condition.
About 1 out of every 10 kids will develop eczema. Typically, symptoms appear within
the first few months of life, and almost always before a child turns 5. But the good
news is that more than half of the kids who have eczema today will be over it by the
time they're teenagers.
Signs and Symptoms
Signs and symptoms of eczema can vary widely during the early phases. Between 2
and 6 months of age (and almost always before they're 5 years old), kids with eczema
usually develop itchy, dry, red skin and small bumps on their cheeks, forehead, or
scalp. The rash may spread to the arms and legs and the trunk, and red, crusted, or
open lesions may appear on any area affected.
They also may have circular, slightly raised, itchy, and scaly rashes in the bends
of the elbows, behind the knees, or on the backs of the wrists and ankles.
As kids get older, the rash is usually scalier than it was when the eczema first
began, and the skin is extremely itchy and dry. These symptoms also tend to worsen
and improve over time, with flare-ups occurring periodically.
Children often try to relieve the itching by rubbing the affected areas with a
hand or anything within reach. But scratching can make the rash worse and eventually
lead to thickened, brownish areas on the skin. This is why eczema is often called
the "itch that rashes" rather than the "rash that itches."
How Long Does It Last?
In many cases, eczema goes into remission and symptoms may disappear altogether
for months or even years.
For many kids, it begins to improve by the age of 5 or 6; others may have flare-ups
throughout adolescence and early adulthood.
In some kids, the condition may improve but then restart as they enter puberty, when
hormones, stress, and irritating skin products or cosmetics are introduced. Some people
will have some degree of dermatitis into adulthood, with areas of itching and a dry,
Eczema is not contagious, so there's no need to keep a baby or
child who has it away from siblings, other kids, or anyone else.
Scientists believe that eczema is inherited, so there's no way to prevent it. But
because specific triggers can make it worse, flare-ups can be prevented or
improved by avoiding possible triggers. These include:
dry winter air with little moisture
skin that gets too dry
certain harsh soaps and detergents
certain fabrics (such as wool or coarsely woven materials)
certain skin care products, perfumes, and colognes (particularly those that contain
some foods (this depends on the person, but dairy products and eggs, wheat, soy,
and nuts can be common culprits)
Also, curbing the tendency to scratch the rash can prevent the condition from worsening
and progressing to cause more severe skin damage or a secondary infection.
Diagnosing eczema can be challenging because:
Each child has a unique combination of symptoms, which can vary in severity.
It's sometimes confused with other skin conditions, such as seborrheic
dermatitis (better known as "cradle cap"), psoriasis (a
genetic disease that causes the skin to become scaly and inflamed), and contact
dermatitis (caused by direct skin contact with an irritating substance, such
as a metal, medicine, or soap).
No test is available to diagnose it definitively.
If your doctor suspects eczema, a thorough medical history is likely to be the
best diagnostic tool. A personal or family history of hay fever, other allergies,
or asthma is often an important clue.
Besides doing a physical examination, the doctor will likely ask about your child's
symptoms and past health, your family's health, any medicines your child is taking,
any allergies your child may have, and other issues.
The doctor will also help you identify things in your child's environment that
might be adding to the skin irritation. For example, if your child began using
a new soap or lotion before the symptoms started, mention this to the doctor because
something in the soap might be irritating the skin.
The doctor also might ask about any stress your child is feeling at home,
school, or elsewhere because stress can lead to eczema flare-ups.
Your doctor will also probably:
Examine the distribution and appearance of the rash.
Ask about how long the rash has been there.
Look for evidence of thickening of the skin from itching or rubbing (called lichenification).
The doctor will want to rule out other diseases and conditions that can cause skin
inflammation. So your child might need to be seen more than once before a diagnosis
is made. The doctor might recommend sending your child to a dermatologist or an allergist.
An allergist can test to see if the rash is an allergic reaction to a substance.
This might involve one or more of the following:
a blood test
a patch test (placing a patch of suspected allergen, such as dyes or fragrances,
on the skin)
scratch/prick tests (placing suspected allergens on the skin or injecting them
into the skin)
Your doctor also may ask you to eliminate certain foods (such as eggs, milk, soy,
or nuts) from your child's diet, switch detergents or soaps, or make other changes
for a time to find out whether your child has a reaction to something.
Topical corticosteroids, also called cortisone or steroid creams
or ointments, are commonly used to treat eczema and are not the same
as the steroids used
by some athletes. These medicines are usually applied directly to the affected areas
twice a day.
Continue to apply the corticosteroids for as long as the doctor suggests. It's
also important not to use a topical steroid prescribed for someone else. These creams
and ointments vary in strength, and using the wrong strength in sensitive areas can
damage the skin, especially in infants.
Nonsteroid medications are also available now in creams or ointments that can be
used instead of — or in conjunction with — topical steroids.
Other prescription treatments your doctor may recommend include:
antihistamines (to help to control itching)
oral or topical antibiotics (to prevent or treat secondary infections, which are
common in kids with eczema)
Some older kids with severe eczema also may be treated with ultraviolet light under
the supervision of a dermatologist to help clear it up and make them more comfortable.
In some cases, newer medications that change the way the skin's immune system reacts
are also prescribed.
Helping Your Child
You can help prevent or treat eczema by keeping your child's skin from becoming
dry or itchy and avoiding known triggers that cause flare-ups. Try to follow these
Avoid giving your child frequent hot baths, which tend to dry
Use warm water with mild soaps or nonsoap cleansers when bathing your child.
Avoid using scented soaps.
Ask your doctor if it's OK to use oatmeal soaking products in the bath to help
control the itching.
Avoid excessive scrubbing and toweling after bathing your child.
Instead, gently pat your child's skin dry.
Avoid dressing your child in harsh or irritating clothing, such
as wool or coarsely woven materials. Dress your child in soft clothes that "breathe,"
such as those made from cotton.
Apply moisturizing ointments (such as petroleum jelly), lotions, or creams to
your child's skin regularly and always within a few minutes of bathing, after a very
light towel dry. Even if your child is using a corticosteroid cream prescribed by
the doctor, apply moisturizers or lotions frequently (ideally, two to three times
a day). But avoid alcohol-containing lotions and moisturizers, which can make skin
drier. Some baby products also can contribute to dry skin.
Apply cool compresses (such as a wet, cool washcloth) on the irritated areas of
skin to ease itching.
Keep your child's fingernails short to minimize any skin damage caused by scratching.
Try having your child wear comfortable, light gloves to bed if scratching at night
is a problem.
Help your child avoid becoming overheated, which can lead to flare-ups.
Eliminate any known allergens such as certain foods, dust, or pet dander from
your household. (This has been shown to help some young kids.)
Have your child drink plenty of water, which adds moisture to the skin.
Although eczema can be annoying and uncomfortable for kids, its emotional impact
can become the most significant problem later — especially during the preteen
and teen years, when your child will need to take responsibility for following the
prevention and treatment strategies.
You can help by teaching your preteen or teen to:
Establish a skin-care routine. Brief, lukewarm showers or baths and moisturizing
regularly will help to avoid or alleviate flare-ups.
Use only "unscented" makeup and sunscreens and facial moisturizers labeled noncomedogenic
Recognize stressful situations (such as taking tests at school or sports competitions)
and how to manage them (like taking deep, calming breaths, focusing on an enjoyable
activity, or taking a break).
Be aware of scratching and minimize it as much as possible.
When to Call the Doctor
Children and teens with eczema are prone to skin infections, especially with staph bacteria and
Call your doctor immediately if you notice any of the early signs of skin infection,
which may include: