Eczema, also known as atopic dermatitis, is a chronic skin disorder characterized by intermittent flares. These flares tend to subside as the child ages. We don’t know exactly what causes eczema, but it seems to be related to the immune system and often patients will also have seasonal allergies, asthma or other allergic conditions. The goals of treatment are:
Hydrating the Skin – the goal is to restore the natural barrier functions of the skin. Daily warm water baths (at least one per day) with a small amount of an emulsification agent, such as Aveeno Colloid Oatmeal, RoBathol, Maypo, or Mineral oil. Use any of the following mild cleansing creams or soaps:
- Creams – Vanicream moisturizing cream, Eucerin eczema cream, CeraVe moisturizing cream, La Roche-Posay Lipikar Balm
- Soaps – Vanicream gentle body/facial wash, CeraVe hydrating cleanser, dove sensitive body wash, Eucerin cleansing wash
- Shampoo – Any mild baby shampoo
After bathing, pat the skin dry. Apply a moisturizing agent within approximately 3 minutes to seal in the moisture. We recommend at least 3 applications of moisturizer throughout the day to help maintain a high level of hydration.
- Ointments – tend to be greasy but really work – CeraVe healing ointment, Vanicream moisturizing ointment, Aquaphor, Vaseline
- Cream-based alternatives – tend to be more expensive and less effective – DML Forte, Moisturel, Aveeno, Curel, Purpose
Reducing Redness – When your child’s skin is actively inflamed, we will recommend using a topical anti-inflammatory medicine – a corticosteroid ointment or cream. These corticosteroids should not be confused with anabolic steroids sometimes used by athletes. Although corticosteroids are powerful medications and must be used with care, we will prescribe an appropriate strength and tell you exactly how long to use the medication.
Controlling Itching – Scratching can damage the already delicate skin – increasing inflammation and opening the door to infection. An important aim of treatment is to break the “itch-scratch” cycle. Loose fitting clothes can help. Also, closely clipping fingernails or light cotton mittens at night can help control scratching. Diphenhydramine (Benadryl Elixir) can help decrease itching, this medication is only for ages 2+ without calling the doctor first. Common side effects are excessive fatigue and sometimes, excessive hyperactivity.
Eliminating Aggravating Factors – Stress, allergens, and environmental factors such as an overheated bedroom, perfumes, antiseptics, and wool clothing can aggravate eczema. Efforts should be made to eliminate these factors. Eczema flare-ups can be very difficult for child and parent alike. It may seem like a lot of work to comply with the management plan. Rest assured that the plan is designed to speed healing and that a simpler routine will follow once the eruption has subsided.