Eczema, from the Greek 'to boil out,' describes a wet, swollen and oozing rash. Atopic means it is an allergic disease. It often runs in families. In fact, in 70 per cent of cases, asthma or hay fever or allergies are found in family members. Many children with atopic dermatitis also have allergies, asthma or hay fever.
The rash may appear in infants on the shoulders, chest, abdomen, back, face, ears or scalp beginning between two and six months of age. At about 18 months this itchy rash occurs most often on the front of the elbow joint, back of the knees, front of the ankles and wrists and on the face, neck and upper chest. Although these are the most common sites, any body area may be affected. In an attempt to relieve itching, babies may rub their heads, cheeks and other affected areas with a hand, pillow or anything within reach. This is a good reason to keep the nails well trimmed.
In babies, eczema often improves before two years of age. If the disease continues beyond infancy, the skin is less likely to be red, blistering and oozing. Instead the lesions become dry, red to brownish grey and the skin may be scaly and thickened. An intense itch can continue, becoming almost unbearable at night. Some children scratch at their skin until it bleeds and crusts. When this occurs, the skin may become infected.
Yes, but this only occurs in one in 10 children. Although some foods may provoke attacks, eliminating them rarely brings lasting improvement. A two-week trial diet that does not contain the offending food may be worthwhile to see if the skin improves. However, restricting foods may cause serious gaps in a child’s nutrition and affect growth and development. Parents who wish to try to restrict their child’s diet should do so with utmost caution and in consultation with their family doctor. The usual advice is that food restriction is unlikely to improve atopic dermatitis.
The most important aggravating factor is dry skin. For this reason, it is important to keep your child’s skin moisturized at all times. This should begin with bath time. Since long baths remove natural moisturizing oils from the skin, no more than five minutes should be spent in the water. Soap is not recommended during the daily bath. The skin should be patted gently with a towel (not rubbed dry) so some water droplets are left on the skin. Then, moisturizer should be put on right away to lock in this water. If your doctor has prescribed a steroid cream or ointment, it should be put on before the moisturizer. A mild soap should be used only when the child is particularly dirty.
Moisturizers are a very important treatment for atopic dermatitis. They include ointments, creams and lotions. Ointments work better than creams, and creams work better than lotions at keeping the skin moisturized. Ointments such as petroleum jelly are products that feel greasy or oily to the touch and do not pour out of the bottle. They are often used in winter when skin is especially dry. Creams do not feel greasy and also do not pour out of the bottle. They are more appropriate in the summer and in humid environments. Most lotions can be poured and are too light to give the skin the moisture it needs.
The most useful medicine is a mild steroid cream or ointment. Steroids reduce itching and clear the rash. These medications penetrate moisturized skin much better than dry skin and should be applied within three minutes of bathing. Waiting longer allows the skin to dry through evaporation of water. Hydrocortisone one per cent is safe for daily use. More potent steroids can be used twice a day for two to three days, followed by a milder preparation. Potent steroids on the skin can eventually cause thinning of the skin and are not generally recommended for daily long-term therapy.
Antihistamines (anti-itch medicine) may be taken by mouth. This may relieve scratching and allow your child to sleep at night.