Living with eczema, and the red, irritated skin that causes constant itching, can make life miserable for you and your kid. “It’s not just a skin rash. It can have serious effects on your child’s health and quality of life,” says A. Yasmine Kirkorian, MD, interim Chief of Dermatology, Children’s National Health System, and Associate Professor of Dermatology and Pediatrics at George Washington University School of Medicine and Health Sciences. “Eczema can interfere with your child’s ability to sleep and concentrate in school, and may lead to frequent skin infections.”
Eczema affects about 11 percent of kids in the US, but the cause isn’t clear. “We do know there’s a genetic predisposition,” says Marc Glashofer, MD, a dermatologist at The Derm Group in West Orange. “Kids who have parents with a history of eczema or asthma are more likely to develop it.” Research shows that the immune system may also play a role. Irritants in the environment can aggravate your child’s immune system, triggering a rash. Fortunately, there’s plenty you can do to help your child feel better, including a new medication.
WHAT ARE THE SYMPTOMS?
Atopic dermatitis, the most common type of eczema, is a scaly rash that typically appears for the first time on a baby’s face or scalp. Early signs may be subtle, like seeing your infant rub his head against a parent in an attempt to scratch an itch.
In school-age kids, eczema commonly surfaces in the form of a red, itchy rash on the face, back, chest or inside the folds of elbows and knees. It can range from dime-sized to large, connected patches, says Dr. Glashofer. Eczema’s known to flare up for the first time later in life, too. Both teens and adults can get eczema, especially if they’re consistently stressed out or have weaker immune systems.
“As a parent you’re trying to identify the triggers, but you sometimes can’t tell,” says Dr. Kirkorian. “Eczema is unpredictable and can change overnight.” It can also be easily confused with other skin conditions, like scabies, a contagious condition of very itchy skin caused by tiny mites, and allergic contact dermatitis. That’s why it’s best to have your pediatrician or dermatologist diagnose your child.
WHAT ARE THE TRIGGERS?
Anything that disrupts the skin barrier can trigger a flare-up, says Kirkorian. These irritants include perfumed soaps, shampoos, bubble bath or any products that contain fragrances, like laundry detergent or dryer sheets. Products with dyes or alcohol, like hand sanitizer, can also irritate sensitive skin.
Not using moisturizer after taking a bath or showering can lead to problems, too. Some kids suffer in hot weather, especially when they sweat, while others get worse during the winter when humidity is low indoors and it’s cold outside. As is the case with most skin conditions, stress seems to worsen eczema. Hot water is especially irritating. Bathing once a day is fine, but make sure the water’s lukewarm, and limit baths and showers to 10 minutes. Don’t scrub or use washcloths, which are too rough. Wash with a mild cleanser rather than soap. Try products like Cetaphil Skin Cleanser and focus on cleaning the “stinky parts,” such as armpits, privates and feet, advises Kirkorian. Pat skin dry after bathing and then apply a thick moisturizer. Finally, dress kids in breathable cotton, not wool or synthetic fabrics.
HOW DO YOU RELIEVE THE ITCH?
The most important step in controlling discomfort is keeping your child’s skin hydrated. Teach her that moisturizing should be part of her daily routine, just like brushing her teeth. Slather on fragrance-free creams or ointments (lotions don’t seal in moisture as well). Look for those that contain ceramides, a kind of oily wax that our skin naturally produces.
Kids should also steer clear of anything greasy. You can also calm the itch by using colloidal oatmeal products in the bath and applying cool compresses to your child’s rash. If your child doesn’t get relief from over-the-counter products, your dermatologist may recommend prescription topical corticosteroids to be dabbed on the rash. “Topical steroids put out the fire,” says Glashofer. “They’re usually used for a week or two and then again when there’s a flare.” You can expect relief within days. Other options are topical calcineurin inhibitors, which are steroid-free medications that stop the immune system from reacting with eczema symptoms.
For kids with moderate to severe eczema, a new medication, dupilumab, was recently approved by the FDA for kids as young as age six (it’s also in clinical trials to age six months). “It can be a life-saver,” says Glashofer. “I have seen impressive results in patients [whose conditions] are not controlled by other means. The medicine is injectable and well-tolerated.” You might be tempted to try holistic remedies, but there’s little evidence they work—and some natural products can actually cause irritation. “I’m skeptical about natural and homeopathic remedies,” cautions Kirkorian. “These products aren’t regulated by the FDA, and many natural substances, such as olive oil, can be quite irritating.” Though the jury’s still out, virgin or cold-pressed coconut oil is the one substance that’s okay to try, adds Kirkorian.
WHAT ELSE CAN YOU DO?
With less moisture in the air in the winter, run a humidifier in your child’s bedroom, says Glashofer. It may not prevent symptoms but it certainly can’t hurt. If he’s still scratching all night, your doctor may suggest a sedating antihistamine at bedtime to help him sleep, says Glashofer. Though it’s a natural reaction, nagging him not to scratch isn’t helpful. “Eczema must be medically treated, but there’s a behavioral component to the itching, too,” says Kirkorian. “Sometimes we partner with a psychologist to teach kids techniques to recognize the itch and distract themselves. When your mind isn’t on the itch, you won’t scratch.”
Though eczema is a recurring condition, you can manage symptoms with a healthy skin care regimen. If you’re struggling to control your child’s symptoms, make sure to follow up with your child’s pediatrician or dermatologist, says Kirkorian. “We have tips we can share and medications to use as needed to improve your child’s quality of life.”