Pediatric Eczema (Atopic Dermatitis)

Atopic dermatitis is a long-term (chronic) skin condition. It causes dry, itchy skin. It’s a very common condition in babies and children. It usually first appears between ages 3 and 6 months.

The exact cause of atopic dermatitis is not known. But some things are linked to it. They include:

• Genes. This skin problem can be passed on from parents to a child. 
• Immune system. An immune system that isn’t fully developed may affect how much protection the skin can give.
• External factors. These include being in winter weather, using hot water for bathing, using soap and being in dry, hot temperatures.

A child has a greater chance of having atopic dermatitis if he or she has:

• Family members with atopic dermatitis
• Allergies

Symptoms may come and go, or occur most or all of the time. Any area of the body may be affected. In babies, symptoms usually affect the face, neck, scalp, elbows and knees. In children, symptoms usually affect the skin inside the elbows, on the back of the knees, the sides of the neck, around the mouth, and on the wrists, ankles and hands.

Symptoms can occur a bit differently in each child. They can include:

• Dry, scaly skin
• Severe itching
• Redness and swelling
• Thickened skin
• Pale skin on the face
• Small, raised bumps that may become crusty and leak fluid if scratched
• Rough bumps on the face, upper arms and thighs
• Darkened skin of eyelids or around the eyes
• Skin changes around the mouth, eyes or ears
• Raised, red areas (hives)

The symptoms of atopic dermatitis can be like other health conditions. Make sure your child sees his or her healthcare provider for a diagnosis.

The skin condition is usually passed on from parents to children, so it may not be possible to prevent it.

Call the healthcare provider if your child has:

• Symptoms that get worse
• Signs of a skin infection, such as increased redness, warmth, swelling or fluid
• New symptoms

The healthcare provider will ask about your child’s symptoms and health history. He or she may also ask if you or other family members have atopic dermatitis, asthma or nasal allergies such as hay fever or allergic rhinitis. He or she will also ask about allergy symptoms in your child. The healthcare provider will examine your child, looking for signs of atopic dermatitis. There is no specific test for atopic dermatitis. Testing is usually not needed, but it may be done. Tests may include:

• Blood tests. Your child’s blood may be checked for levels of immunoglobulin E (IgE). IgE is released by the body's immune system. It’s high in most children with allergies and with atopic dermatitis. Other blood tests may also be done.
• Skin tests. Skin tests may be done to check for allergies or other skin conditions.

Treatment will depend on your child’s symptoms, age and general health. It will also depend on how severe the condition is. There is no cure for atopic dermatitis. The goals of treatment are to ease itching and inflammation, add moisture and prevent infection.

Treatment of atopic dermatitis includes:

• Staying away from irritants, as advised by your child's healthcare provider
• Bathing with a gentle cleaner or body wash advised by the healthcare provider
• Keeping your child's fingernails short, to help prevent scratching that can cause skin irritation and infection
• Using moisturizing lotion advised by the healthcare provider

Your child's healthcare provider may also prescribe medicines. They may be used alone or together. The following are most commonly used to treat atopic dermatitis:

• Corticosteroid cream or ointment. The cream or ointment is put on the skin. This is to help ease itching and swelling. 
• Antibiotic medicine. Your child may need to take liquid or pills by mouth to treat infection.
• Antihistamine. Your child may need to take this medicine before sleep to help ease itching and improve sleep. It comes in liquid or pills and is taken by mouth. 
• Calcineurin inhibitor cream or ointment. Cream or ointment is put on the skin. This is to help ease itching and swelling.
• Ointments that change the immune system. The provider may prescribe crisaborole cream to put on the skin.
• Phototherapy (light therapy). Light therapy may be done in the healthcare provider's office or at home.
• Immunomodulatory medicine. This is a liquid or pill taken by mouth that affects the immune system. It may be used when other treatments don't work well. This medicine may have side effects. Your child will have regular blood tests to check for side effects.
• Biologic medicines. In severe cases, your child may need a new medicine such as dupilumab. This medicine is injected.

Atopic dermatitis can cause thickened skin, bacterial skin infection, and other allergy-related skin inflammation (allergic dermatitis). It can also cause poor sleep because of intense itching. And it can lead to depression. Overuse of steroid creams can lead to thinning of the skin and tissue beneath the skin.

Atopic dermatitis has no cure. But it will usually get better or go away as your child gets older. There may be times when your child has few or no symptoms. And he or she may have times when symptoms get worse. This is called a flare-up. To help prevent flare-ups, make sure your child:

• Stays away from triggers. Common triggers include irritants such as wool, soap or chemicals. Other triggers include allergens such as eggs, dust mites or pet dander. Stress is also a trigger. 
• Doesn’t scratch the skin. Try to keep your child from scratching. It can cause symptoms to get worse. It can also cause infection.
• Always has short fingernails. Trim or file your child’s nails to keep them short and prevent scratching.
• Takes baths or showers with warm, not hot, water. Air dry or gently dry the skin afterward.
• Uses moisturizers. Put creams or ointments on after bathing.
• Wears soft clothing. Don’t dress your child in wool or other rough fabric.
• Keeps cool. Try to keep your child as cool as possible. Getting hot and sweating can make him or her more uncomfortable.
• Doesn’t get the smallpox vaccine. It’s not a common vaccine, but people with atopic dermatitis should not get the smallpox vaccine.

Talk with your child's healthcare provider about other ways to help your child’s skin condition.

Tips to help you get the most from a visit to your child’s healthcare provider:

• Know the reason for the visit and what you want to happen.
• Before your visit, write down questions you want answered.
• At the visit, write down the name of a new diagnosis, and any new medicines, treatments or tests. Also write down any new instructions your provider gives you for your child.
• Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.
• Ask if your child’s condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if your child does not take the medicine or have the test or procedure.
• If your child has a follow-up appointment, write down the date, time and purpose for that visit.
• Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.