Most parents and caregivers have had to help soothe a child’s itchy skin and stop them from scratching at some point in their caregiving careers — whether from a rash, poison ivy, or a mosquito bite. Unfortunately, itchy skin is a regular occurrence for the more than 9.6 million children in the U.S. with eczema. Eczema is an ongoing skin disease that requires patience and consistent skin care. A consistent skincare routine and correct treatment can help manage your child’s eczema. Once you and your child find the right bathing and moisturizing routine, possible triggers, and effective medications (if needed), you can both live a more comfortable (and less-itchy) life.
What is eczema?
Eczema also called atopic dermatitis, is a skin condition with inflammation, itching, pain, and sometimes rashes. It is not contagious (it can’t be spread from one person to another). In infants and children, eczema typically causes dry, itchy skin patches. Your child’s healthcare provider or a specialized skin doctor (dermatologist) will diagnose your child’s eczema and help you find the best way to treat it.
How is eczema treated?
There is no cure for eczema, but a treatment plan can limit how much it impacts your child. Eczema treatments usually target four problems: dryness, itching, irritated skin (inflammation), and infection. Childhood eczema is best controlled by a regular bathing and moisturizing routine, treating flares (times when eczema worsens), and avoiding triggers (those things that cause flares). The goal of treating eczema is to reduce your child’s discomfort, help them sleep better if itching keeps them awake at night, and reduce scratching, so they don’t cause skin infections or scarring.
For several reasons, eczema can be tricky to treat, especially in infants and children.
- Eczema symptoms can vary from child to child.
- It can cause severe itching, especially at night, disrupting infants’, children’s, and (let’s face it) your entire family’s sleep.
- It can be stressful as a parent to try to stop your child from scratching the uncontrollable itch of eczema rashes.
- It can be frustrating and time-consuming to treat. Sometimes it can still get worse, despite treatment efforts.
Which medications treat childhood eczema?
Healthcare providers treat eczema with medications called corticosteroids, applied to your child’s skin (topically). Topical steroid medications are the most effective treatment for eczema. They work because they reduce inflammation. Corticosteroids should be applied twice a day during an eczema flare. Only apply the steroids to your child’s irritated or itchy areas, avoiding other skin areas. Corticosteroids have different strengths and forms (lotions, ointments, creams, gels, and oils). When used as prescribed, topical steroids are very safe and effective — but you should speak to your provider about the right fit for your child.
Non-steroid eczema medicines (tacrolimus ointment, pimecrolimus cream, crisaborole ointment) also help heal eczema rashes for children over 2. They have different ingredients than corticosteroids. They work well for mild eczema and delicate areas of skin, like the eyelids, armpits, and groin (between the legs).
Biologic therapies target your child’s immune system to decrease the allergic response. Dupilumab is the first biologic therapy approved by the U.S. Food & Drug Administration (FDA) to treat eczema in children ages six months and up. Dermatologists use Dupilumab to treat moderate to severe eczema that corticosteroids failed to improve.
Continuous scratching may leave your child’s skin raw, sensitive, and swollen. If their scratching has caused open areas that have become infected, your pediatric provider may prescribe antibiotics. Signs of a skin infection include oozing, crusting, pus bumps, blisters, or a worsening rash that does not improve with your usual treatments. These are important to get treatment for right away. If your child is prone to frequent infections, there are special baths that may be recommended by your healthcare provider as part of a prevention strategy.
Antihistamine medicines like diphenhydramine (Benadryl) and hydroxyzine (Atarax, Vistaril) can help your child feel drowsy so they fall asleep instead of scratching their skin. Follow directions based on their age and weight, and talk with their pediatric provider or pharmacist if you have questions about how to give your child the correct dose of these medications. These medications should only be given exactly as directed and with the approval of your healthcare provider if your child is under age 6.
Bathing and moisturizing: Two key pieces of your child’s eczema puzzle
Infants and children with eczema have a skin barrier that isn’t working effectively — meaning that their skin does not work as well to keep moisture inside and dries out more easily. Skin dryness is a trigger for eczema symptoms. Bathing and moisturizing help strengthen your child’s skin, making it more eczema resistant. A healthy skin barrier also keeps out bacteria, viruses, and irritants. Applying moisturizer (also called an emollient) after a bath is crucial because it provides an artificial barrier preventing water loss. Giving your child a bath and not putting moisturizer on afterward might do more harm than good, leaving their skin drier than it was before the bath. Here’s a suggested bathing and moisturizing treatment plan for eczema:
- Give your infant or child a lukewarm bath every day. Let them soak for at least 5-10 minutes (with supervision, of course). Longer than 20 minutes risks further skin drying.
- While in the bath, only wash their dirty or smelly areas with a gentle cleanser. Do not use any soap or cleanser on the skin areas with eczema.
- When they are out of the bath, gently dry them off, leaving their skin still damp and patting with the towel rather than rubbing.
- Smear a thick layer of moisturizing lotion or ointment twice daily all over your child’s skin. When the skin is very itchy, using an eczema-friendly ointment provides more relief than a cream or lotion.
- If your child uses topical corticosteroids to treat their eczema, apply them to the eczema-affected areas after your child’s bath but before the moisturizer to increase their absorption.
- Put PJs on immediately to help seal in moisture. Use non-synthetic fabrics like cotton or bamboo.
Remember, all soaps, shampoos, conditioners, and moisturizers should be fragrance-free, specially formulated for sensitive skin, and without dyes or other irritating chemicals. Do not use bubble baths or bath oils.
Although it seems counter-intuitive, do not use anti-itch creams or lotions. The American Academy of Dermatology says that these products do not relieve the eczema itch and can sometimes contain ingredients that cause flares.
What makes my child’s eczema worse?
Things that make your child’s eczema worse (called a flare or flare-up) are triggers. Some of the items listed below may trigger your child’s eczema:
- Dry skin
- Dry air
- Indoor heat (indoor temperatures hotter than 75 degrees F)
- Tight-fitting clothing or clothes with irritating seams or tags
- Scented laundry detergents and fabric softeners
- Soaps, shampoos, or lotions that are scented or contain irritating dyes and chemicals
- Dust mites (found in old pillows, carpets, and bedding)
- Pet dander
- Pollen
- Saliva (infants’ drool can irritate cheeks, chin, and neck)
- Sweat
- Fragrances from indoor candles, air fresheners, and incense
- Insect bites and stings
- Tobacco smoke
- Wool and synthetic fabrics
Avoiding triggers will help prevent eczema flares. Some parents and healthcare providers consider allergy testing to identify triggers better.
Can changing my child’s diet help treat my child’s eczema?
Maybe, but it’s complicated. Having eczema (AD) is closely linked with food allergies (as well as asthma and hayfever). Restrictive or fad diets are never a good plan for babies and children, who have specific nutrient needs and can also be picky. If you’ve noticed flares around certain foods, discussing this with your child’s providers is a great idea. No two cases of eczema are the same or have the same triggers. It can be so tempting to hunt a cause, but often flares are a result of many different external and internal factors.
Healthcare providers advise against changing your child’s diet or avoiding any foods without first talking to them. The American Academy of Dermatology recommends allergy testing for foods only when a child has an immediate allergic skin reaction after eating a specific food. In addition, there is no conclusive scientific research to demonstrate any dietary supplements, including probiotics, help treat eczema. Instead, keep your child (and their skin) healthy by feeding them a complete, balanced diet
Home remedies can help break the itch-scratch cycle.
Increasing how often you apply emollients or the strength of the corticosteroid medication are usually the ways your child’s pediatrician or dermatologist will treat flare-ups. Unfortunately, the medication can take a couple of days to work. In the meantime, here are some tips from the American Academy of Dermatology to help your child itch and scratch less:
- Apply a cool compress (a cold face cloth, cold pack wrapped in a towel) to itchy areas
- Take a colloidal oatmeal bath (usually sold at pharmacies or health food stores, pick unscented, and add to running lukewarm water, then let your child soak for 10-15 minutes)
- Keep your child’s nails cut short, or have infants and toddlers sleep in pajamas with hand covers so they cannot scratch while asleep.
- Try a wet-wrap treatment if your provider recommends it.
Can eczema be cured?
Unfortunately not. Some children outgrow eczema. For most, eczema improves with age. Others will continue to have flare-ups mixed with symptoms-free times for the rest of their lives.
The best way to manage your child’s eczema is to learn more about their symptoms and triggers to keep flare-ups under control. Treating symptoms right when they first start can help your child feel better and prevent sleep disruptions, irritable behavior, and skin infections. Working with your child’s healthcare provider to create a stepped eczema treatment plan with effective treatment options will help your entire family feel better.
Dealing with eczema can be so overwhelming for families and if you’re struggling to manage the physical and/or emotional aspects of it — please reach out to a provider to get some support.
Sources
“Baby eczema: Causes, symptoms, treatment, and more.” National Eczema Association. National Eczema Association. https://nationaleczema.org/eczema/children/
“Can food fix eczema?” American Academy of Dermatology. American Academy of Dermatology. 2022. https://www.aad.org/public/diseases/eczema/childhood/treating/food-fix
“Childhood Eczema.” American Academy of Dermatology Association. American Academy of Dermatology Association. https://www.aad.org/public/diseases/eczema/childhood
Stein, S. and S. Maguiness. “How to treat and control eczema rashes in children.” Healthychildren.org. American Academy of Pediatrics. April 19, 2021. https://www.healthychildren.org/English/health-issues/conditions/skin/Pages/How-to-Treat-and-Control-Eczema-Rashes-in-Children.aspx
“Treating your child’s eczema can help the whole family.” Mayo Clinic. Mayo Clinic. March 21, 2019. https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/treating-your-childs-eczema
