Coastal Allergy & Asthma, P.C.

Eczema or atopic dermatitis is a chronic skin problem characterized by xerosis (dry skin) and pruritis (marked itching). Eczema is often described as the “itch that rashes” Because eczema is chronic and difficult to control, it is a frustrating disease for both patients and their caretakers. The cause of eczema is not known, and hence there is no cure; however, eczema can be managed by following a daily skin care routine. Proper skin care helps control both the daily symptoms and prevention of complications. Additionally, many children’s eczema will improve with age.

Symptoms of eczema 

Sufferers of eczema generally have dry skin. Because dry skin itches, patients often scratch. Scratching, however, can cause the skin to crack and become infected. When patients with eczema have “flare-ups”, the skin may appear irritated and red.

On infants and young children, patches of eczema may ooze and appear red. The predominant sites of affected skin include the face, body and the outside of arms and legs. 

In older children the skin may appear thick and scaly (lichenified). The skin areas predominantly affected include skin folds – such as the neck, under the arms and the arm folds, and behind the knees. In adults, the appearance is similar to that of an older child but predominantly involves the hands and sometimes the feet.

Eczema and allergies 

Children with eczema frequently have allergies and/or asthma. Some children with eczema may have food allergies. Both respiratory allergens and food allergens may cause eczema flare-ups. Identification of these allergens may therefore be helpful in controlling flare ups. Not all patients have an identifiable allergy trigger, however. 

Managing eczema 

The most important management issue is providing adequate moisture to the patient’s skin. Remember, dry skin is itchy skin, so moisturizers must be used daily, 6 to 8 times per day.

Skin care routine

Bathing is ok, but should be limited to durations of less than 10 minutes.

• Do not use very hot water; hot water decreases natural skin oils and moisturizers. Run baths at a lukewarm temperature.
• Use as little soap as possible. Use mild soaps. Soaps may also remove the skin’s natural oils.
• Add mineral oil. 1 to 2 tablespoons added to bath water will act as an added moisturizer.
• BE CAREFUL – THE BATH TUB WILL BE SLIPPERY.
• Pat your child dry after a bath. Rubbing irritates the skin and removes moisture.
• Apply moisturizer immediately to the entire body, not just to the affected skin area.
• Apply moisturizer a minimum of 3 additional times during the day; more if the patient’s skin appears dry, scaly, or flaky. Also, apply moisturizer any time the patient is itching.
• Reserve the use of topical steroid creams only for acute eczema flare-ups (i.e. red, irritated skin).
• Apply the steroid cream only to the red area and apply 2 to 3 times a day for only 3 to 5 days at a time unless directed by a physician.
• Do not apply any steroid cream stronger than hydro-cortisone 1% to the patient’s face, groin or armpits.

Choosing a soap 

Recommended soaps that can be found at grocery/drug stores include:

• Dove (unscented)
• Purpose
• Basis 

Avoid Ivory soap and anti-bacterial soaps Acceptable soap substitutes include: 

• Cetaphi1
• Aquanil
• Moisturel Cleanser

Choosing a moisturizer

Moisturizers come in lotions, creams, or ointments. Ointments generally work the best because they stay on the skin longer. However, they tend to be thick and greasy. Ointments may be reserved for bedtime, with creams and lotions preferred for the daytime. Recommended moisturizers found in pharmacies and some grocery stores include: 

• Eucerin (cream or lotion)
• Cetaphil (cream or lotion)
• NutraDerm (lotion)
• Cure (lotion)
• Moisture] (cream or lotion)
• Dermovan (cream)
• Vanicream (cream or lotion)
• Aquaphor (ointment)
• Vaseline petroleum jelly (ointment)

These moisturizers have no perfumes or fragrances and are less likely to irritate a child’s skin.

Itching 

The daily skin care regimen described above may control all of the patient’s itching; however, frequently, the use of oral antihistamines is additionally required to control pruritis. Some antihistamines will cause sedation, which can be a benefit at bedtime to control itching and scratching. Avoid the use of synthetic clothes fibers (polyester) and wool, and opt for loose fitting cotton clothing. 

Flare-ups

These are the times when the patient’s eczema worsens. Flare-ups may be characterized by:

• skin becoming red or irritated
• skin looks weepy or oozes
• skin appears thick and scaly
• increase in itching

Flare ups can happen at any time, and may occur for no reason at all. Some triggers may include:

• weather changes
• contact with or ingestion of an allergen

When flare-ups occur, use the topical steroid creams. Remember though: apply them sparingly and only to the red flared areas, and only continue using for 3 to 5 days.

Infections

• Children with eczema are more likely to get skin infections. These can be caused by bacteria, virus or fungi. Signs of infection may include: fever, redness, swelling, draining skin, or blisters. Call your physician if these symptoms develop.