By: Joseph Mechak, MD
Eczema, also known as Atopic Dermatitis, is a common pediatric condition and one that we treat often in our office. Below is some basic information about eczema and it’s treatment. If you are concerned that your child is suffering from eczema make an appointment today!
What is Eczema – Eczema is a chronic, inflammatory/allergic condition of the skin. Eczema usually develops before age 5 and can start as young as 4-6 months old. It is typically characterized by red, itchy, patches of skin that come and go in flares. In babies it often present on the face, scalp, or trunk. In older children it is most often found in creases like behind the knees, ankles, inside the elbows, and wrists. It can range in severity from a mild nuisance to a more serious condition.
What are risk factors for developing eczema – Eczema is a member of the ‘atopic triad’ which also includes asthma and seasonal/environmental allergies. Atopic conditions tend to run in families. Rates of eczema are higher when family members have any of the atopic triad. In some, but not all cases, food or environmental allergies and other skin irritants can also trigger or worsen eczema flares.
Will eczema go away – Importantly, eczema is a chronic and recurring condition. It usually comes in flares and is very likely to return time and time again despite our best efforts. It can be lifelong but in many cases, children will ‘outgrow’ their eczema to a large degree by preschool or elementary school.
How do we treat eczema – There are three main priorities in treating eczema and each plays a different and important role in eczema management. Importantly, the goals of treatment are not to cure eczema but rather to 1) decrease inflammation and discomfort during flares, and 2) make the skin as healthy as possible to prolong the time between inevitable flare-ups. The three main phases of basic treatment are:
- Promote skin health – Your doctor will discuss a daily moisturizer routine for your child’s eczema. Usually something as simple as Vaseline can help in a big way. Importantly, this is more of a preventative measure than a treatment. The goal of this routine is to keep the skin hydrated and healthy to hopefully prolong the time between flares. Sometimes, tools like bleach baths, wet wraps, and special moisturizers are also utilized if basic over the counter ointments are not enough.
- Topical steroids – The goal of a topical steroids regimen is to ‘put out the fire’ when the skin is in a flare. Steroids reduce inflammation which helps heal damaged skin and provide relief from the itchiness associated with eczema. There are many steroids to choose from and your doctor will help select the right one for your child’s skin. Make sure to use these as prescribed because there can be side effects to these creams if not used appropriately. (note: there are also other types of topical therapies like biologics and calcineurin inhibitors that can be used in select cases)
- Eliminating triggers – In some cases, there are identifiable triggers to childhood eczema. For example, dairy is a common trigger for infantile eczema. Sometimes removing the trigger is another tool in controlling your child’s eczema.
Do I need to see a dermatologist? – All of us at Potomac Pediatrics are well equipped to treat most mild and moderate cases of eczema. For stubborn or severe cases, we may refer you to a dermatologist who has a special skills set and comfort level with more potent or specialized steroids or immune modulating creams that can be used in eczema treatment.
Here are some great additional resources: