What’s Red & Dry & Itchy All Over?
When dry, red, scaly patches on a child’s skin signal eczema, a parent’s first reaction is to try and pinpoint the underlying cause of this skin condition.
Also called atopic dermatitis, eczema runs in families and is linked to allergies like asthma and hay fever. Eliminating certain things from your child’s diet or environment doesn’t necessarily prevent eczema, a condition that suggests the skin barrier isn’t working efficiently.
There is no cure for eczema, but many kids outgrow it, usually at about 4 or 5 years old.
What’s the best way to treat eczema?
Eczema flares up, subsides and often gets better on its own. There are several effective steps you can take to prevent and ease the uncomfortable, itchy symptoms:
Moisturize: Apply a cream or ointment-based moisturizer twice a day if possible, even when the skin looks good. Don’t forget! This is the best way to prevent eczema. Choose creams that come in tubs or squeeze bottles. Lotions in pump-based containers are thinner and not as effective. Products that contain ceramides (natural lipids) that repair the skin barrier, such as CeraVe and Cetaphil, can be particularly effective.
Calm with steroid creams: Use an over-the-counter hydrocortisone cream twice a day to control itchiness and reduce inflammation. Your child’s doctor can prescribe a stronger steroid cream if the itching or rash is severe. These prescribed creams are safe and effective as long as they are used as recommended by the doctor.
Ditch the itch with antihistamines: Calm itchiness with an over-the-counter oral antihistamine, like Benadryl, especially if the itching disrupts sleep.
Choose sunscreen with care: When choosing a sunscreen for a child with eczema, avoid products with chemical blockers. Instead, pick one that contains zinc oxide or titanium dioxide as the main active ingredient, without a long list of other ingredients.
Is there anything else I should avoid to help prevent flare ups?
Avoid wool or clothing made of synthetics as these fabrics can irritate the skin. Different types of laundry detergents do not seem to affect the skin as long as there is an adequate rinse cycle on your washing machine. You should, however, avoid fabric softener sheets such as Bounce or Snuggle.
My baby son has eczema but loves his daily bath. Will the water further dry out his skin?
Water is actually hydrating for the skin, so your son can have a bath as often as needed. Make sure the water is lukewarm rather than hot and apply moisturizer all over his face and body within minutes of getting out the bath. If you are also using a steroid cream for your son’s skin, apply this first, then the moisturizer.
For washing, use a mild soap from companies such as Aveeno, California Baby, CeraVe, Cetaphil or Dove, only on the areas where it’s needed, such as around the neck, the armpits and diaper area.
My daughter scratches her skin when she has an eczema flare-up and some patches now look infected. What’s the right treatment?
Eczema is a skin-barrier deficiency, which means that she is prone to skin infections. Scratching compounds the problem, making eczema flare up and the skin vulnerable to staph and other infections. It’s important to address the infection as quickly as possible so it does not spread. Your child’s doctor can prescribe a topical antibiotic cream or oral antibiotic for this.
Regular diluted bleach baths can also be very effective in controlling eczema flare-ups, sterilizing the skin and preventing infections. Add one-eighth or one-quarter cup of regular bleach to the bathwater in a full-sized bathtub three times per week.
Amy Gilliam, M.D., is a board-certified pediatrician, dermatologist and pediatric dermatologist at the Palo Alto Medical Foundation’s Dublin, Fremont and Palo Alto Centers. Advice is not intended to take the place of an exam or diagnosis by a physician.