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Getting the red out: How to manage your child's eczema

Dry, red, itchy and scaly patches on your child’s skin may be signs of eczema, a condition caused by skin inflammation. Also called atopic dermatitis, eczema often runs in families and is linked to allergic conditions such as asthma and hay fever.

While there’s no cure for eczema, your child’s skin will often improve substantially by the time he or reaches school age (around 4 or 5), and many children outgrow this uncomfortable condition.

Eczema flares up, subsides and often improves on its own. The rough, scaly and occasionally oozing patches that signal eczema usually appear on babies’ cheeks, forehead and scalp at three or four months of age.

Older children typically have the patches inside their elbow creases and wrists, at the back of the knees and on their necks.

Managing eczema

Following are some tips to help manage your child’s eczema.

• Moisturize frequently. Apply a cream or ointment-based moisturizer twice a day if possible, even when the skin looks good. Products that contain ceramides (natural lipids) that repair the skin barrier, such as CeraVe and Cetaphil, may be particularly effective. Other options include products made by Aquaphor, Aveeno, Eucerin and Vaseline.

• Apply steroid creams. Use an over-the-counter hydrocortisone cream or ointment twice a day to help control itching and reduce inflammation. Your child’s doctor can prescribe a stronger topical steroid medication if the itching or rash is severe.

• Try antihistamines. Calm itchiness with an over-the-counter oral antihistamine, like Benadryl or Zyrtec, especially if the itching disrupts your child’s sleep.

• Choose the right sunscreen. Avoid products containing “chemical blockers.” Instead, pick a sunscreen that contains zinc oxide and/or titanium dioxide (“physical blockers”) as the active ingredients and doesn’t include a long list of other ingredients

• Try these bathing tips. Daily baths or showers are recommended, keeping in mind that the goal is to “soak and seal.” Use lukewarm instead of hot water, with a gentle soap product from Aveeno, California Baby, CeraVe, Cetaphil or Dove. Immediately after the bath, apply the topical steroid medication (if you use one) followed by moisturizer.

• Stop the scratching. Children with eczema are sometimes more prone to skin infections. Scratching compounds the problem, making skin vulnerable to staph and other infections. When the skin is raw, scabbed or oozing, skin infection might be playing a role in driving the eczema. In this case, consider trying diluted bleach baths to control eczema flare-ups. These baths can sterilize the skin and prevent as well as treat infections. Add one-eighth to one-quarter cup of regular bleach to the bathwater in a full-sized bathtub three times per week. It’s also important to see a doctor in order to treat infections as quickly as possible so they don’t spread.

• For severe eczema, try wet-wrap therapy. After bathing and applying the topical steroid medication and moisturizer, put your child in a barely damp pair of pajamas, then add a pair of dry pajamas over the top. This may help improve sleep and calm the inflamed skin.

• Learn about long-term therapy options. Under a doctor’s supervision, children older than 3 or 4 with chronic and severe eczema may benefit over the long term from systemic therapies, including ultraviolet light therapy and oral medications.

Dr. Amy E. Gilliam is a pediatric dermatologist at the Palo Alto Medical Foundation’s Palo Alto, Dublin and Fremont centers.

The Palo Alto Medical Foundation and column editor Arian Dasmalchi provide this monthly column.

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