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Eczema

Is this your child's symptom?

  • An itchy rash that your doctor told you was eczema
  • Eczema is a chronic skin disease
  • Recurrent flare-ups of severe itching occur
  • The medical name for eczema is atopic dermatitis

If NOT, try one of these:

Symptoms of Eczema

  • The main symptom is itching. If it doesn't itch, it's not eczema.
  • With flare-ups (itching attacks), the rash becomes red or even raw and weepy.
  • Onset: Average onset at 3 months old. Range: 1-6 months old. Usually begins by 2 years old.
  • Location: Classic eczema starts on the cheeks at 1 to 6 months of age. It can spread to the rest of the face. In infants, the outer surfaces of the arms and legs also become involved.
  • In older children, eczema is found in the joint creases. The elbows, wrists, and knees are the most common places.
  • The rash is usually the same on both sides of the body.

Cause of Eczema

  • A type of dry, sensitive skin that children inherit.
  • Flare-ups are from skin contact with soap, shampoo, pollen or other irritating substances.
  • About 30% of babies with severe eczema also have food allergies. The most common is cow's milk.
  • Over 10% of children have eczema. It's the most common skin condition of the first 10 years.

Triggers of Eczema Flare-Ups

  • Soaps. Never use bubble bath. It can cause a major flare-up.
  • Pollens. Keep your child from lying on the grass during grass pollen season.
  • Animals. Avoid any animals that make the rash worse.
  • Foods. If certain foods cause severe itching (flares), avoid them.
  • Wool. Avoid wool fibers and clothes made of other scratchy, rough materials.
  • Dry Air. Use a humidifier if the air in your home is dry.
  • Herpes Virus Infection (Serious). Keep your child away from anyone with fever blisters (cold sores). The herpes virus can cause a serious skin infection in children with eczema.
  • Eczema is not caused by laundry soap you use to wash clothing.

Itching Scale

  • Mild: doesn't interfere with normal activities
  • Moderate: interferes with child care or school, sleep, or other normal activities
  • Severe: constant itching that can't be controlled

Food Allergy and Eczema Flare-Ups

  • Food allergies are a factor in 30% of young children with severe eczema. This factor is mainly seen in babies.
  • The main allergic foods are cow's milk and eggs.
  • The main symptoms are increased skin redness and itching. Some parents report these symptoms start during or soon after the feeding.
  • The eczema becomes easier to control if you avoid the allergic food.

Diagnosing Food Allergy and Eczema Flare-Ups

  • Your child's doctor may suggest the steps listed below:
  • Remove the suspected food or foods from your child's diet for 2 weeks. The eczema should greatly improve.
  • Then give your child that food when the eczema is under good control. This is called a "challenge."
  • If the food is causing flare-ups, the eczema should become itchy and red. The flare-up should occur quickly within 2 hours of eating the food.
  • If this occurs, avoid giving this food to your child. Talk to your child's doctor about the need for any food substitutes.
  • If the eczema does not flare-up, your child isn't allergic to that food.

When to Call for Eczema

Call 911 Now

  • You think your child has a life-threatening emergency

Call Doctor or Seek Care Now

  • Age less than 12 weeks old with fever. Caution: do NOT give your baby any fever medicine before being seen.
  • Looks infected (spreading redness, pus, soft oozing scabs) and fever
  • Many small blisters or punched-out sores occur
  • Your child looks or acts very sick
  • You think your child needs to be seen, and the problem is urgent

Contact Doctor Within 24 Hours

  • Eczema is very painful to touch
  • Looks infected but no fever
  • Itching is severe after using steroid cream for more than 48 hours
  • You think your child needs to be seen, but the problem is not urgent

Contact Doctor During Office Hours

  • Itching flare-ups occur often
  • Eczema diagnosis was never confirmed by a doctor
  • You have other questions or concerns

Self Care at Home

  • Eczema with no other problems
  • Questions about prevention of eczema flare-ups

Care Advice

Treatment for Eczema

  • What You Should Know About Eczema:
    • Eczema is a chronic skin disease. So, you need to learn how to control it.
    • Itching attacks (flare-ups) are to be expected.
    • The goal is to treat all flare-ups quickly. Reason: To prevent skin damage.
    • Here is some care advice that should help.
  • Treatment is Based on Severity of Eczema:
    • Mild Eczema. Just need to use a moisturizing cream and to avoid flare-up triggers.
    • Moderate Eczema. Also need to use a steroid cream and bedtime allergy medicine.
    • Severe Eczema. Also may need antibiotics for a skin infection caused by Staph bacteria. This infection starts in open skin from severe itching.
  • Moisturizing Cream or Ointment for Dry Skin:
    • All children with eczema have dry sensitive skin.
    • The skin needs a moisturizing cream (such as Eucerin) Apply once or twice daily.
    • Apply the cream after a 5 or 10-minute bath. To trap moisture in the skin, apply the cream while skin is still damp. Do this within 3 minutes of leaving the bath or shower.
    • The steroid cream should be applied to any itchy spots first. Then use the moisturizing cream as the top layer.
    • While most parents prefer creams, moisturizing ointments are sometimes needed in the winter. An example is Vaseline.
    • Caution: Never stop the moisturizing cream. Reason: The rash will come back.
  • Steroid Cream or Ointment for Itching:
    • Itchy skin is the main symptom of eczema.
    • Steroid creams or ointments are essential for controlling red, itchy skin.
    • Apply steroid creams only to itchy or red spots (not to the normal skin).
    • Most children have 2 types of steroid creams. (1) A mild steroid cream is used to treat any pink spots or mild itching. This is often 1% hydrocortisone cream (such as Cortaid). No prescription is needed. (2) Another stronger steroid cream is needed to treat any spots with severe itching. This is a prescription steroid cream such as Synalar. Never apply this stronger cream to the face.
    • Apply these creams as directed or 2 times per day.
    • After the rash quiets down, apply it once per day. After 1 good week just use moisturizing cream.
  • Bathing - Avoid Soaps:
    • Give one bath a day for 10 minutes in lukewarm water. Reason: Water-soaked skin feels less itchy. Follow the bath with a moisturizing cream (such as Eucerin) to all the skin.
    • Avoid all soaps. Reason: Eczema is very sensitive to soaps, especially bubble bath. There is no safe soap for young children with eczema. They can be cleaned using warm water.
  • Allergy Medicine for Itching at Bedtime:
    • Many children with eczema need an allergy medicine by mouth at bedtime.
    • Reason: Scratching in bed can cause severe skin breakdown. It may also interfere with falling sleep.
    • Give the med your child's doctor wanted you to use for itching.
    • If none was suggested, you can try Benadryl at bedtime. No prescription is needed.
    • Caution: Do not use if age is under 1 year. Reason: Benadryl is a sedative. Give your doctor a call for advice.
  • Itching Attack - Shower to Remove Irritants:
    • Playing in the grass, being around animals, or swimming can cause increased itching.
    • For itching from these causes, give your child a quick shampoo and shower.
  • Itching Attack - Treatment:
    • At the first sign of any itching, use the steroid cream. Put it on the areas that itch. If unsure, apply 1% hydrocortisone cream (such as Cortaid). No prescription is needed.
    • Keep your child's fingernails cut short and smooth.
    • Ask older children to try not to itch, but never punish for itching.
    • For constant itching in young children, cover the hands with socks or gloves. Use for a day or until the itching is brought under control. Provide extra cuddling during this time.
  • Return to School:
    • Eczema cannot be spread to others.
    • Children with eczema do not need to miss any child care or school.
  • What to Expect:
    • Eczema is a chronic condition. Around the teen years, about half get over their eczema.
    • Many children who have severe eczema as babies develop asthma and nasal allergies.
  • Call Your Doctor If:
    • Itching is not under control after 2 days of steroid cream
    • Rash looks infected (spreading redness, yellow scabs or pus)
    • You think your child needs to be seen
    • Your child becomes worse

Prevention of Eczema Flare-Ups

  • Tips to Help Prevent Flare-Ups:
  • Call Your Doctor If:
    • You have other questions or concerns

And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.

Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.

Copyright 2000-2020 Schmitt Pediatric Guidelines LLC.

 

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