Eczema skin care

Atopic Dermatitis, also known as eczema, affects about 1 in every 5 children. Most people start having symptoms before they turn 5 years old. This is a skin disease that may have an allergic component in some people. It causes itching, affects sleep and can negatively impact your child’s life every day.

THERE IS NO CURE FOR ATOPIC DERMATITIS. Fortunately, most children will outgrow this condition by the time they reach adulthood. The goal is to just KEEP IT UNDER CONTROL!

Bathing tips

  • Bathe with lukewarm water, 5-15 minutes. Avoid scrubbing and rubbing the skin as this can cause flare-ups. No soap or bubbles, just toys for playing.
  • Use mild soap only where needed. If not too dirty, use soap only on hands, feet, armpits, and genital area. I suggest Dove for Sensitive Skin, Cetaphil Cleanser, or Aveeno for Dry Skin.
  • Avoid Zest, Coast, Ivory, Irish Spring, Dial and other scented, deodorant or antibacterial soaps.
  • Usually even baby soaps are more irritating than Dove because of the smells and colors added.
  • Use shampoo on hair only.
  • Always rinse completely with clean water.
  • Just pat or lightly wipe dry with a damp washcloth, leaving small drops of water on the skin. Even if there are no rashy or itchy areas, apply moisturizing cream immediately after every bath (within 3 minutes) and at least 2 times a day (even if no bath is taken). Cover the whole body.
  • Cetaphil or Eucerin cream are good choices; Cetaphil feels a little less greasy. Always use the thick cream in the jar, not lotion from a pump.
  • Keep fingernails short and clean with a nail scrub brush, and avoid irritating clothing such as wool or other scratchy fabrics.
  • For all products, the store brand or generic is completely acceptable.

Daily treatments

Moisturize at least twice daily: The best way to hydrate skin is to soak in lukewarm water for 15-20 minutes (until the fingertips turn wrinkly) ONCE a day, preferably before bedtime. Avoid hot water, vigorous scrubbing, harsh soaps or bubble baths. Wash hair in the sink before the bath to avoid skin contact with shampoo which can be irritating to the skin. In babies, use a mild, unscented soap (such as Dove) only in the diaper area. In older children, use the same mild soap in the groin and armpit areas. (Keep in mind that many girls are sensitive to soap in the groin area, and therefore it should be avoided in these children). After bath, gently pat skin but keep it a little bit wet, then APPLY MOISTURIZER WITHIN 3 MINUTES. The best moisturizer is plain, white petroleum jelly. In the cold months, from October to March, petroleum jelly is best. However, in the warmer months, from March to August, you may use a light moisturizer such as Cetaphil Cream, (store brand is fine). Use the moisturizer again in the morning, and any other time you can.

Maintain control: Frequent, liberal use of moisturizers will help keep the skin under control. Also, you might use a steroid twice a week to the problem areas if the moisturizing alone isn’t working.

For eczema flares [If there are any itchy or scaly areas]:

Treat flares as quickly as possible: Topical steroids are creams or ointments which are either purchased Over-the-Counter or prescribed. Apply a topical steroid to the affected skin twice a day AS SOON AS THE RASH STARTS; once after the bath, and once in the morning. You can use these treatments for up to 3-10 days on the face, and up to 3 or 4 weeks on very thickened skin on the rest of the body. When the skin is flared up, it is more effective to apply only the steroid to the red, inflamed skin, and moisturize the normal skin. Steroids are better absorbed after a good soak.

  • Immediately after every bath and before applying moisturizing cream, apply 1% hydrocortisone ointment to all rough or scaly areas, or where your child is scratching. Then cover the rest of the body with the moisturizing cream as above.
  • If the rash is severe and you have been prescribed a stronger steroid, apply this to the red, itchy, rashy areas on the body (but not the face) 2 times per day before you apply moisturizer.
  • If you are using the stronger ointment regularly (for more than 1-2 weeks,) you need to see a doctor to recheck if the rash is worsening or not improving, and every few months even if the rash is controlled. Call the office if any weepy, “honey-crusted”, very red or painful spots appear; these might be a sign of infection.
  • For cradle cap or seborrhea in the scalp: Use Neutrogena T-gel or T-sal or Selsun Blue shampoo on the scalp up to 3 times a week instead of regular shampoo. If possible leave it on the scalp for up to 5 minutes, and avoid the eyes.

Special circumstances and additional information

  • Rubbing and scratching makes the rash worse. Treat the itch with an oral antihistamine such as diphenhydramine (Benadryl) or hydroxyzine (Atarax), especially at bedtime.
  • When the rash has become infected, often called “Impetigo”, oral antibiotics may be prescribed. In addition, people with atopic dermatitis are more likely to have an overgrowth of bacteria on the skin which may lead to frequent bouts of impetigo or staph infections. You can add 1/4 cup of bleach into a full tub of lukewarm water to cut down on these infections.
  • Sometimes, children will complain that soaking in the bath burns their inflamed skin. One way to decrease the discomfort would be to apply petrolatum to the skin BEFORE the bath, and/or add sodium bicarbonate to the bath water.
  • In toddlers with atopic dermatitis, the face is often greatly affected because of drooling or frequent wiping up messes! Apply petroleum jelly before meals and after wiping.

The average 4 year old with atopic dermatitis should go through a ONE POUND TUB of petroleum jelly each week if you’re applying the correct amount of moisturizer!

Many lotions contain urea or lactic acid. These are very irritating on inflamed skin, so avoid them.

What causes Atopic Dermatitis to flare? Systemic infections, emotional stress, and low humidity (in the winter). Allergies are difficult to prove, especially in those less than 2 years of age. It is a controversial trigger, but it is possible that allergy to milk or eggs can lead to hives which can then cause itching and rubbing, resulting in a flare-up!

If you have pale or dark spots or pale spots where rashes were, these will fade with time, and no medicines will change the color back to normal. Avoiding sun exposure will help the spots be less obvious, and preventing new rashes by practicing good skin care is the best way to avoid more spots.