Atopic dermatitis in children

What is...
Symptoms
Complications
Home treatment
Prevention

What is...

What is atopic dermatitis?

Atopic dermatitis, or eczema, is a chronic, inflammatory condition of the skin that causes redness, dryness, scaling, and itching.

The exact cause of atopic dermatitis is unknown, although it tends to run in families with a history of allergic conditions such as hay fever and asthma. Around half of all children with atopic dermatitis will develop asthma or hay fever during childhood. A number of factors, such as weather, food or environmental allergies, can affect eczema and cause the rash to worsen. Eczema cannot be passed from one person to another!

Atopic dermatitis is commonly seen in infants and young children, affecting approximately 15% of infants. Eczema can appear throughout childhood, but usually starts during the first year and almost always before the age of 5. The rash is a long term (chronic) condition, but in most cases it disappears before adulthood. It can be mild or severe, and symptoms may come and go.

Symptoms

Symptoms of atopic dermatitis

Children with atopic dermatitis usually have dry skin, which is particularly sensitive and easily irritated by various detergents, soaps, and perfumes.

The dry skin rash itches and scratching only makes it worse. This can easily develop into a cycle of rash, itch, scratch, and more rash. The skin appears dry, red, and irritated with crusted patches and is susceptible to infection.

If the skin becomes infected, it may look even more red and irritated and fluid may ooze from the area.

In people who have had eczema for a long period of time, the skin will become thicker, dry and may turn brown from scratches and previous sores. The eczema will have times when it is worse and periods when it has almost disappeared.

In infants, the eczema rash usually begins on the face, the forehead or scalp and can spread toward the hands and feet, before possibly spreading over the body. The diaper area usually is spared because this area is always protected and often moist.

Infant with eczema on the face In older children the usual location of eczema is the back of the knees and the inside of the elbows, as well as around the wrists and ankles.

Complications

Complications of atopic dermatitis

When the skin is torn from scratching eczema, the sores can become infected.

These infections most commonly result from staphylococcus bacteria, which often cause a discharge of pus.

The skin also becomes redder than usual, warm and often tender to the touch. The child may also have a fever.

If a child with atopic dermatitis gets chicken pox or a herpes virus skin infection, those rashes usually become much more severe and the child's overall condition looks worse.

If this happens, you should contact your doctor immediately.

Home treatment

Atopic dermatitis: Treatment / What you should do

If you suspect that your child may have atopic dermatitis, you should contact your doctor.

In some cases, it may be appropriate to have the child tested for allergies that could be triggering the eczema rash.

In cases of widespread eczema, a dermatologist or pediatrician should follow the child with regular check-ups.

The basic treatment for eczema consists of avoiding things that irritate the skin, moisturizing frequently to lessen the dryness, and using medications to calm any inflammation when necessary.

It is important to have a written treatment plan for your child, because the treatment will change depending on how severe the eczema flare is.

During good periods, moisturizing cream or ointment should be applied every day and the use of bath oil can keep the skin soft enough to prevent the eczema from flaring up.

In more severe phases of eczema, it will be necessary to use a topical steroid ointment or cream for a short period. When eczema does not improve with these therapies, other medications may be recommended, such as antihistamines or oral steroids.

If you suspect that the eczema has become infected (the skin is more red, warm, tender or oozing; perhaps your child has fever) your doctor should be consulted.

The child may need to be treated with oral or topical antibiotics.

Prevention

Prevention of atopic dermatitis

Many cases of atopic dermatitis are hereditary and therefore cannot be prevented. However, exclusive breastfeeding without introducing other foods for the first six months of life may prevent some cases of atopic dermatitis.

For children with atopic dermatitis, you can limit the flare-ups of eczema by keeping the child away from things that make the eczema worse such as dust, pollen, pet dander and certain foods.

Avoid using strong soaps, detergents or anything that can irritate your child's skin. Make sure that your child does not shower or bathe too often because this can dry out the skin. Your child should also avoid too much scrubbing or rough drying after a bath as this can also irritate the skin and cause the eczema to worsen.

Soft cotton clothing is the most gentle for skin affected by eczema. Apply moisturizing cream 2-3 times a day and especially after bathing. This should be done even when your child does not have an eczema flare.

Encourage your child to drink plenty of fluids to supply moisture to the skin. Keep your child's fingernails short so they do not tear the skin when your child scratches. Clothing that is too tight should be avoided because it may make the skin very warm and make the itching worse.

Your child's doctor may also recommend an oral antihistamine by mouth to reduce the itching.

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