Pediatrics – Pulmonary & Allergy Clinic
Diseases & Conditions
Allergy – Atopic Dermatitis
Atopic dermatitis, sometimes called eczema, is an allergic skin problem. Between 2-4 % of children have eczema. In eczema, the skin is very itchy and may be red, scaly or rough. At times the skin may bleed from scratching or form a crust from infection. In infants, the rash appears on the face, elbows, trunk and behind the legs. In older children it appears on the insides of the elbows, back of the knees and neck.
*ATOPIC DERMATITIS IS NOT CONTAGIOUS!
No one knows the cause of eczema. However, it usually occurs in children and families who have eczema, asthma or allergies. At the moment there is no cure. However, most children will grow out of it before their teens. Some other children will have the rash into adulthood.
Fortunately, there are many things you and your child's doctor can do to keep the condition under control.
3. What Makes the Rash Worse?
- Dry skin: Skin drying from too much bathing, showering or hand washing and the use of drying soaps and detergents. Also, very humid, or dry conditions, and very hot or cold temperatures.
- Allergens: Foods such as peanuts, eggs, wheat, cow's milk, soy and fish may worsen the rash. Exposure to cats, dogs, rabbits and house dust mites also affects certain children.
- Irritants: Certain cosmetics, skin care products, chlorine in swimming pools, wool clothing, or tight, scratchy clothing, feathers or down in pillows, comforters, or mattresses and skin contact with citrus fruits and tomatoes may cause worsening of the dermatitis.
- Heat and sweating: Activity in hot environments, hot showers and sunbathing may cause sweating which intensifies the itchiness.
- Emotional upset: fatigue, stress, illness and frustration.
- Skin infections: Intense scratching only causes more itchiness and may cause skin damage and infections.
4. What Treatment Helps Atopic Dermatitis?
Skin Care: Bathing and Moisturizing.
Bathe your child every day for 5-10 minutes in lukewarm water using a soap substitute such as Cetaphil lotion, Eucerin, Moisturel cleanser or Aveeno bar. You can also use a mild soap such as Dove fragrance-free but it should be rinsed off immediately. Avoid bubble baths. After leaving the bath or shower gently pat away water and immediately apply a moisturizer such as Vaseline, Hydrated petrolatum, Moisturel, Mineral oil or Cetaphil at least once a day generously all over. Repeat use of moisturizer as needed every day.
Stay away from things that make the rash worse.
- Try to use cotton bedding and clothing instead of wool or synthetic material.
- Avoid cosmetics and alcohol-containing skin care products.
- Wash all new clothing before using it to remove chemicals.
- Use a liquid detergent and add a second rinse cycle to remove detergent. • If your child enjoys swimming, shower after swimming to remove chlorine or salt if swimming in the sea.
- If your child's condition worsens when exposed to certain foods, pets or dust, avoid these things. Your child's pediatrician will advise you if tests can help identify possible triggers for your child's rash.
1. Control the itchiness: Antihistamines are oral medications used to control itching.
- Hydroxyzine (Atarax) and diphenhydramine (Benadryl) are given at bedtime because they may bring on sleepiness.
- Daytime non-sedating antihistamines cetirizine (Zyrtec) and loratidine (Claritin) work quite well.
2. Relieve the inflammation: Topical corticosteroids are the most common anti-inflammatory medications used. Used them during bad flare-ups of the rash.
- For children with mild rash, apply a weak steroid ointment such as 1% hydrocortisone (Nutracort, Hytone, Penecort, or 0.05% desonide (Desowen, Tridesilon) 2-3 times a day to the rash.
- For more severe rash stronger steroids such as fuocinolone acetonide 0.025% (Synalar, Fluonid), hydrocortisone valerate 0.2% (Westcort), mometasone furoate 0.1% (Elocon), aclometasone diproprionate 0.05% (Aclovate) may be prescribed for a few days. However, these should NEVER be used on the face, axillary areas, groin or inner thighs unless directed by your doctor.
3. Treat the infection: If your child's skin is infected (intense redness, yellow crust, and/or pus in the rash) your doctor will prescribe antibiotics.
REMEMBER: There is no cure for eczema, but following these hints will help you control the rash!
5. Where can I find more information?
Thank you to Yolanda Requena-Kassarjian, MD who wrote these patient help pages on Atopic/Dermatitis.