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We go out of our way to provide the comprehensive care our patients with eczema need. On a case-by-case basis, we communicate with one another whether in allergy, dermatology, psychology or infectious disease to put together the best course of treatment for each child.We are optimistic that future therapies and approaches to care for those with even severe eczema are going to be greatly improved with more research and that the creation of the Eczema Day Treatment Unit will help us conduct cutting edge research and answer questions we face every day seeing and treating patients.
Is Eczema A Gateway Rash
Not every kid with eczema hits each stop on the atopic march. There are children who never develop any of the other related conditions, says Dr. Neeta Ogden. Although not all journeys progress in this order, here are some of the diagnoses that can follow eczema.
Food allergies: Research has shown that Black and Latinx children have higher rates of food allergies compared with white kids. Common ones associated with eczema are egg, peanut, soy, and dairy, with symptoms including hives, itching, swelling of lips, face, tongue, or throat, and nausea or vomiting.
Asthma: According to data from the CDC, compared with white children, Black kids are 2.6 times more likely to have asthma, and Latinx kids are 1.4 times more likely. There are many reasons for the disparities, including genetics, environmental pollution , limited access to good health care, and distrust in medical establishments. Kids with asthma may experience any number of symptoms, including a cough that is worse at night or triggered by exercise, cold air, viral colds, or flu and wheezing, congestion, trouble breathing, shortness of breath, or a tight or uncomfortable feeling in the chest. Asthma might not be diagnosed until a pattern of chronic breathing issues is observed.
This article originally appeared in Parents Latina’s October/November, 2021 issue as “What to Do About Eczema.”
Diagnosis And When To See A Doctor
People who experience symptoms of eczema should see a doctor or dermatologist. Eczema can indicate a new allergy, so it is important to determine what is causing the reaction.
Eczema can also increase the likelihood of staph infections and have a severe effect on a personâs mental health. A doctor can recommend a treatment plan to manage symptoms and flare-ups.
There is no specific test to diagnose most types of eczema. The doctor will want to know the individualâs personal and family medical history. They will also ask about recent exposures to potential allergens and irritants. It is essential that people let the doctor know if they have hay fever or asthma.
The doctor may also ask about:
- sleep patterns
- any previous treatments for skin conditions
- any use of steroids
A physical examination of the rash will help the doctor to diagnose which type of eczema it is.
The doctor may also perform a patch test, which involves pricking a personâs skin with a needle that contains potential irritants and allergens. A patch test can determine whether or not someone has contact dermatitis.
There is no cure for eczema, so treatment involves managing the symptoms and trying to prevent further flare-ups.
Some treatment options for eczema include:
Some general tips that may help to prevent eczema flare-ups include:
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What Causes Atopic Dermatitis In A Child
The exact cause of atopic dermatitis is not known. But some things are linked to it. They include:
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Genes. This skin problem can be passed on from parents to a child.
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Immune system. An immune system that isnt fully developed may affect how much protection the skin can give.
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External factors. These include being in winter weather, using hot water for bathing, using soap, and being in dry, hot temperatures.
How Do I Treat Hives
If hives are accompanied by any lip or tongue swelling, breathing difficulties or profuse vomiting, your child may be having an anaphylactic reaction. Call 911 immediately. Otherwise, hives are harmlessbut very itchy. To calm the skin, your doctor may recommend an oral non-sedating kids antihistamine, like Aerius or Reactine. Benadryl is an option, but it does have a sedative effect.
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What Does Baby Eczema Look Like
Eczema doesn’t look the same on every baby. In babies with light skin, it usually shows up as patches of red skin. In darker-skinned babies, the rash might look purplish, brownish, or grayish. Eczema can be harder to see on babies with dark skin.
These patches are almost always dry, itchy, and rough.
Babies can get the condition just about anywhere on their body. Most often, it affects their cheeks and the joints of their arms and legs.
Its easy to confuse baby eczema with cradle cap. But there are some key differences.
Cradle cap is much less itchy and irritated. It generally clears up by age 8 months and usually appears on the scalp, sides of the nose, eyelids and eyebrows, and behind the ears. See a photo of what cradle cap looks like.
Keep Itchy Skin Covered
Kids may be less likely to scratch their skin when it’s covered up.
“For some reason, young children often start to scratch as soon as their clothes are removed,” Eichenfield says.
Choose loose-fitting, comfortable outfits. Cotton and cotton blends are best. Wool and some synthetic fabrics can cause irritation and cause kids to scratch more.
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Avoid Triggers And Treat Infection
Stay cool
Getting too hot from clothing or heating can make eczema worse – stay cool.
Avoid soap and fragrances
Soap and fragrances are the most common triggers of eczema. Only use skin care products designed for eczema. Many are available on prescription from your doctor or nurse prescriber.
Prevent skin infections
Eczema is made worse by infection such as from:
- school sores
- the cold sore virus which can cause severe painful infection of eczema
Avoid contact with cold sores. See your family doctor urgently if your child gets an infection from cold sores.
Removing foods from your child’s diet does not usually help eczema
Removing foods from your child’s diet does not usually help eczema and can be dangerous, leading to anaphylaxis.
Please talk with your doctor about this.
When To Call A Doctor
Make the call if your babys eczema doesnt begin to get better within a week of starting over-the-counter hydrocortisone creams. It may be time for a prescription medicine.
Also check with your doctor if yellow or light brown crust or pus-filled blisters appear on top of the eczema. This could be the sign of a bacterial infection that needs antibiotics.
You should call your doctor if your baby is around anyone who has cold sores or genital herpes. Eczema can make your little one more likely to pick up those germs.
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Does Your Child Need To See A Doctor About Eczema
Yes. Take your child to see your GP if your child:
- might have eczema for the first time
- is very itchy and uncomfortable
- has eczema thats weeping or bleeding
- has eczema that hasnt improved much after a few days, even though youve been treating it as usual
- is having trouble sleeping because the rash is so itchy
- has painful or eczema that has developed pus
- has eczema and is generally unwell for example, has a fever and/or is sweating, feeding poorly or tired.
You should also take your child to the GP if youre not sure whether the rash is eczema.
If your childs eczema doesnt improve with a combination of medical treatment and management at home, your GP might refer your child to a dermatologist. If the GP thinks your childs eczema might be from allergies, they might also refer you to an allergy and immunology specialist.
Instructions To Soak And Seal
Dont limit moisturizing to just bath time. Slather it on your child throughout the day whenever their skin starts to itch or feel dry. Try using an ointment or a cream rather than a lotion and apply it with your palms, stroking lightly in a downward direction.
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Helping Your Child Cope With Eczema At School
Its a good idea to discuss your childs eczema diagnosis with the teacher at the start of the school year. A teacher who is familiar with eczema can help your child cope with the practical aspects of the condition and any social or emotional issues that may arise in the classroom.
To help the teacher make your childs school experience as normal as possible, set up a meeting to discuss your childs eczema and what you have learned about coping. Below are some topics you may wish to cover in your meeting.
Complementary And Alternative Treatments
There are several natural treatments that have been shown to be effective controlling eczema symptoms. Many of these studies looked the effects on adults, so be sure to consult with your childs doctor prior to starting any natural treatments for eczema.
- National Eczema Association | 505 San Marin Drive, #B300 | Novato, CA 94945
- 415-499-3474 or 800-818-7546
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Try Wet Wrap Treatments
Wet wraps can increase moisture intake. A caregiver can take the following steps to apply a wet wrap to the toddler after bathing them and before putting them to bed:
Toddlers with eczema may be more prone to infections that require treatment with antibiotics. However, a caregiver can help prevent infections by giving a toddler diluted bleach baths 23 times a week.
The American Academy of Pediatrics gives the following instructions for a diluted bleach bath:
Triggers Of Eczema Flare
- Soaps. Never use bubble bath. It can cause a major flare-up.
- Pollens. Keep your child from lying on the grass during grass pollen season.
- Animals. Avoid any animals that make the rash worse.
- Foods. If certain foods cause severe itching , avoid them.
- Wool. Avoid wool fibers and clothes made of other scratchy, rough materials.
- Dry Air. Use a humidifier if the air in your home is dry.
- Herpes Virus Infection . Keep your child away from anyone with fever blisters . The herpes virus can cause a serious skin infection in children with eczema.
- Eczema is not caused by laundry soap you use to wash clothing.
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How Can You Prevent Baby Eczema
If your baby has contact dermatitis, you can try your best to prevent a flare-up by identifying and avoiding common triggers, which might include:
- Moisture . Dress your baby in lightweight cotton clothing. Gently pat drool away when you see it.
- Scratchy fabrics. In addition to clothes and rugs, even your babys stuffed animals can trigger eczema.
- Allergens. Think pet dander, pollen or dust.
- Harsh detergents and soaps. Consider using a sensitive detergent when washing babys clothes and crib sheets.
How Is Eczema Treated
There is no cure for eczema. But treatments can help with symptoms. The doctor will recommend different treatments based on how severe the symptoms are, the child’s age, and where the rash is. Some are “topical” and applied to the skin. Others are taken by mouth.
Topical moisturizers. Skin should be moisturized often . The best time to apply moisturizer is after a bath or shower, with the skin patted dry gently. Ointments and creams are best because they contain a lot of oil. Lotions have too much water to be helpful.
Topical corticosteroids, also called cortisone or steroid creams or ointments. These ease skin inflammation. It’s important not to use a topical steroid prescribed for someone else. These creams and ointments vary in strength, and using the wrong strength in sensitive areas can damage the skin, especially in infants.
Other topical anti-inflammatory medicines. These include medicines that change the way the skin’s immune system reacts.
Medicine taken by mouth. These can include antihistamines to help itchy kids sleep better at night, antibiotics if a rash gets infected by bacteria, and corticosteroid pills or other medicines that suppress the immune system.
Other types of treatment can include:
- wet wraps: damp cloths placed on irritated areas of skin
- bleach baths: bathing in very diluted bleach solution
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Rethink Clothesand How To Wash Them
Fragranced products of any kind that come in contact with the skin can potentially cause an allergic reaction, says Yale Medicine dermatologist Christine Ko, MD. Any residue left on clothing can also lead to skin irritation. If you or your child has sensitive skin, adjust how you wash clothing, sheets and blankets to help prevent allergic and irritant reactions, she says.
- Dont use fragranced detergents, fabric softeners, dryer sheets or antistatic sheets.
- Always wash clothes before wear to remove finishing chemicals such as formaldehyde, flame retardants and dyes that can trigger sensitivity or allergic skin reactions.
- Opt for 100 percent cotton or silk clothing, mittens and hats as opposed to wool, which can be prickly, or polyester, which can cause sweating .
- Avoid overdressing your child in heavy clothing. Its better to dress them in layers and to open or remove jackets, as necessary, to avoid excessive sweating.
As If Itchy Flaky Skin Wasn’t Bad Enough This Chronic Rash Often Ushers In Food Allergies Asthma And Other Conditions According To Research Heres Everything We Know About Baby Eczema And How To Keep These Troubles At Bay Plus How Black And Latinx Kids Are More Likely To Experience Severe Cases Of The Skin Condition
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A few years ago, when Alexandra Torres Fung’s infant son started showing signs of eczema, she thought she had it under control. After all, the Nicaraguan American mom’s older kids have the skin condition , and so does she. Torres Fung, the cofounder of the parent-to-parent recommendations site Upparent.com, knew to use gentle detergents and moisturizers, and to avoid dabbing colonia para bebés on his skin . She put tiny mittens on his hands at night to curb his scratching. But the red and pink patches on his cheeks, which arrived when he was a few months old, only worsened.
Then other sensitivities began to appear. Eating dairy exacerbated his rash and made him fussy. He had a reaction to eggs at 10 months, then another to peanuts at 1 year. She took her son to an allergist, who diagnosed the boy with several food allergies, some mild, others severe, and made an unexpected correlation: “That’s when I first learned that eczema is closely related to those allergies.”
That all sounds alarming, of course. But even if your child is already acquainted with the skin ailment, there’s no need to panic. New insights about preventive care, early intervention, and diligent maintenance are revealing that eczema may be more treatable, and the allergic progression less inevitable, than previously thought. By equipping yourself to know the signs, you can be your child’s own best advocate.
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How Eczema Is Connected To Food Allergies Asthma And Hay Fever
The process by which eczema can lead to the other steps in the atopic march can be hard for people to understand, says Dr. Skotnicki. Picture eczema, food allergies, asthma, and hay fever as dominoes. Each can fall on its own, but they are all more likely to be knocked over if the first dominoeczemafalls. According to a review of studies in the Journal of Allergy and Clinical Immunology, 81 percent of kids with eczema go on to develop at least one food allergy. If this occurs, they are then seven times more likely to be diagnosed with asthma and nearly 12 times more likely to develop seasonal allergies.
Why is this so? “Essentially, atopic eczema is a skin-barrier disruption, leaky skin, if you will,” Dr. Skotnicki explains. The skin is supposed to keep water in and irritants and allergens out. But eczema-affected skin fails to provide such a barrier, and its susceptibility to dryness and irritation can cause tiny tears that allow miniscule amounts of allergens to enter the body. Think peanut dust on a bakery table that hasn’t been wiped down thoroughly enough, on which your little one puts their forearm. Think pollen floating through the air or chemicals in your laundry detergent, which touch your baby’s face when they rest their cheek on your shoulder.