Pediatric Eczema (Atopic Dermatitis)

Atopic dermatitis is a long-term (chronic) skin condition. It causes red, dry, itchy, scaly skin. It’s a very common condition in babies and children. It usually first appears between ages 3 and 6 months.

The exact cause of atopic dermatitis isn't known. But some things are linked to it. They include: 

• Genes. This skin problem can be passed from parents to a child. 
• Immune system. An immune system that isn’t fully developed may affect how much protection the skin can give.
• External factors. These include being in winter weather, using hot water for bathing, using soap, and being in dry, hot temperatures.

A child has a greater chance of having atopic dermatitis if they have:

• Family members with atopic dermatitis
• Allergies

Symptoms may come and go, or they may occur most or all of the time. Any area of the body may be affected. In babies, symptoms usually affect the face, neck, scalp, elbows, and knees. In children, symptoms usually affect the skin inside the elbows, on the back of the knees, the sides of the neck, around the mouth, and on the wrists, ankles, and hands.

Symptoms can occur a bit differently in each child. They can include:

• Dry, scaly skin.
• Severe itching.
• Redness and swelling.
• Thickened skin.
• Pale skin on the face.
• Rough bumps on the face, upper arms and thighs.
• Darkened skin of eyelids or around the eyes.
• Skin changes around the mouth, eyes or ears.
• Increased skin creasing on the palms or an extra fold of skin under the eye.

In people with dark skin, atopic dermatitis may show up as darker brown, purple or gray areas on the skin. The symptoms of atopic dermatitis can be like other health conditions. Make sure your child sees a health care provider for a diagnosis.

The skin condition is usually passed from parents to children, so it may not be possible to prevent it.

Call the healthcare provider if your child has:

• Symptoms that get worse
• Signs of a skin infection, such as increased redness, warmth, swelling or fluid
• New symptoms

The health care provider will ask about your child’s symptoms and health history and will examine your child, looking for signs of atopic dermatitis.

They may also ask if you or other family members have atopic dermatitis, asthma, or nasal allergies, such as hay fever or allergic rhinitis.  

There is no specific test for atopic dermatitis. Testing is usually not needed, but it may be done. Tests may include:

• Blood tests. Your child’s blood may be checked for levels of immunoglobulin E (IgE). IgE is released by the body's immune system. It’s high in most children with allergies and with atopic dermatitis. Other blood tests may also be done.
• Skin tests. Skin tests may be done to check for allergies or other skin conditions.

Treatment will depend on your child’s symptoms, age and general health. It will also depend on how bad the condition is. There is no cure for atopic dermatitis. The goals of treatment are to control symptoms, ease itching and inflammation, add moisture and prevent infection.

Treatment of atopic dermatitis includes:

• Staying away from triggers, as advised by your child's health care provider. This can help to control the symptoms. Possible triggers may include:
  
  • Cold or dry environments.
  • Sweat.
  • Emotional stress or anxiety.
  • Rapid temperature changes.
  • Being exposed to certain chemicals or cleaning solutions, including soaps and detergents, perfumes and cosmetics, wool or synthetic fibers, dust, sand and cigarette smoke.
• Bathing with a gentle cleanser or body wash as advised by the health care provider. This can help relieve itching. Don't take hot or long (more than 10 to 15 minutes) baths and showers, since they can dry out the skin.
• Keeping your child's fingernails short to help prevent scratching that can cause skin irritation and infection.
• Using emollients, such as lotions, creams and ointments, that moisturize the skin and prevent it from drying out. The best emollients for eczema are thick creams or ointments that contain little to no water. Emollients work best when applied right away after bathing.

Your child's health care provider may also prescribe medicines. They may be used alone or together. These are most often used to treat atopic dermatitis:

• Corticosteroid cream or ointment. The cream or ointment is put on the skin This can help ease itching and swelling.
• Antibiotic medicine. Your child may need to take liquid or pills by mouth to treat infection.
• Antihistamine. Your child may need to take this medicine before sleep to help ease itching and improve sleep. It comes in liquid or pills and is taken by mouth. 
• Calcineurin inhibitor cream or ointment. Cream or ointment is put on the skin. This is to help ease itching and swelling.
• Topical PDE4 inhibitors. The provider may prescribe crisaborole cream to put on the skin. It helps relieve inflammation, itching, and rash.
• Phototherapy (light therapy). This may be done in the health care provider's office or at home.
• Immunomodulatory medicine. This is a liquid or pill taken by mouth that affects the immune system. It may be used when other treatments don't work well. This medicine may have side effects. Your child will have regular blood tests to check for side effects.
• Biologic medicine. In severe cases, your child may need a medicine, such as dupilumab. This medicine is injected. This drug is reserved for adults and children age 6 months and older with moderate to severe eczema that has not responded to other treatments.

Atopic dermatitis can cause thickened skin, bacterial skin infection, and other allergy-related skin inflammation (allergic dermatitis). It can cause poor sleep because of intense itching. And it can lead to depression. Overuse of steroid creams can lead to thinning of the skin and tissue beneath the skin.

Atopic dermatitis has no cure. But it will usually get better or go away as your child gets older. There may be times when your child has few or no symptoms. And they may have times when symptoms get worse. This is called a flare-up. To help prevent flare-ups, make sure that your child:         

• Stays away from triggers. Common triggers include irritants, such as wool, soap, and chemicals. Other triggers include allergens, such as eggs, dust mites and pet dander. Stress is also a trigger. 
• Doesn’t scratch the skin. Try to keep your child from scratching. Scratching can make symptoms worse. It can also cause infection.
• Keeps fingernails short. Trim or file your child’s nails to keep them short and prevent scratching.
  
• Takes baths or showers with warm, not hot, water. Gently dry the skin afterward.
• Uses moisturizers. Put creams or ointments on after bathing and several times a day
• Wears soft clothing. Don’t dress your child in wool or other rough fabric.
• Keeps cool. Try to keep your child as cool as possible. Getting hot and sweating can make them more uncomfortable.

Talk with your child's health care provider about other ways to help your child’s skin condition.

Tips to help you get the most from a visit to your child’s healthcare provider:

• Know the reason for the visit and what you want to happen.
• Before your visit, write down questions you want answered.
• At the visit, write down the name of a new diagnosis, and any new medicines, treatments or tests. Also write down any new instructions your provider gives you for your child.
• Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.
• Ask if your child’s condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if your child does not take the medicine or have the test or procedure.
• If your child has a follow-up appointment, write down the date, time and purpose for that visit.
• Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.