Eczema Awareness Month

What is Eczema? 

Eczema is a common skin condition, primarily atopic dermatitis, which causes red, dry, itchy, and inflamed patches of skin. Children with eczema often have sensitive skin that reacts easily to things like rough fabrics, soaps, or even changes in the weather. Many with eczema can have flares and part of management is understanding a person’s triggers. With proper care and attention, it’s a condition that can be managed to keep your child comfortable.

What causes eczema?

Eczema, especially its common form, atopic dermatitis, is caused by a mix of genetics and environmental factors. According to the American Academy of Dermatology, people with eczema have an overactive immune system that reacts to irritants or allergens, leading to inflammation. Risk factors include stress, family history, dry skin, allergens in products, food allergies, hay fever, and living in cold, damp, or swampy environments. These factors can worsen flare-ups if you're genetically predisposed.

Where and how does eczema present on the body in children?

Eczema appears as rough dry patches on the skin. In darker skinned children, it may not appear as red and can oftentimes be underdiagnosed for this reason. In babies under 2, Eczema tends to show up on the cheeks, scalp, and trunk, often spreading to arms and legs. Diaper areas are usually spared due to moisture retention. In Older Children, Eczema often shifts to the elbows' creases, behind the knees, wrists, ankles, and neck. The skin in these areas becomes thickened (due to constant scratching) and may appear dry, rough, or leathery. The patches are often less red and more scaly. As children grow, the pattern and location may change, but the itching and dryness remain key symptoms across all ages.

What are common eczema triggers? 

• Dry Skin: When skin becomes too dry, it can lead to flare-ups. The child goes through an itch-scratch cycle. The skin gets itchy, they scratch which causes more inflammation and that leads to more itching and the cycle continues. Moisturizing is key to prevention.
• Irritants: Everyday products like soaps, detergents, shampoos, and even natural substances like fruit or vegetable juices can irritate skin. Every child is different so it’s important to watch for triggers
• Weather: Environmental extremes can trigger eczema. Living in cold, damp, or hot, humid places increases the risk, and certain seasons—like hot summers—may cause more flare-ups than cooler months.
• Stress: Emotional stress may worsen symptoms, although the exact link is unclear.
• Children and Babies: Eczema in young children is often genetic, while baby eczema can result from environmental irritants such as cleansers, dry air, or certain lotions.

Of note, food is not known to be an allergen 

Management of eczema 

Moisturize: Eczema-prone skin loses moisture easily, leading to dryness and flare-ups. This is because their skin barrier is compromised. In healthy skin, the outer layer of the skin retains moisture and keeps irritants, allergens, and bacteria out. But in eczema, this is weakened. Many people with eczema also have a deficiency in a skin protein called Filaggrin which helps the skin cells mature properly and form a strong, protective outer layer. This can mean more moisture loss and more likelihood of irritants entering. Finding the right moisturizer may depend on your child, but choosing a balm or ointment or something with less water content is best. The idea is to keep the moisture locked in. Use whenever the skin is dry to reduce flare ups. 

Bathe Smart: Children with eczema have sensitive skin and hot, long baths can strip their skin of natural oils and worsen the eczema or dry out skin. Use lukewarm water and keep baths short. Choose a non-fragranced bath wash and ones for eczema-prone or sensitive skin. Avoid bubble baths as this can irritate sensitive skin. When you take them out of the bath, pat dry gently and do not scrub and rub and then apply a nice ointment or balm to keep moisture in. 

Identify and Avoid Triggers: Finding the triggers for your child may be tricky but it can help. If it’s certain clothing material or ointments, it’s extremely important to stay clear. Keep a diary of daily activities, foods, and products used to track what might be causing flare-ups. Common triggers include certain soaps, laundry detergents, fragrances, and specific foods. Switch to hypoallergenic, fragrance-free products, including laundry detergents and personal care items. When possible, opt for natural fibers like cotton or bamboo in clothing and bedding.

Topical Treatments: Ointments alone may not prevent flares so if your child has a flare; use topical ointments might be needed. Remember that Inflammation during flare-ups can cause severe discomfort and worsen the skin barrier and lead to that itch-scratch cycle that causes the eczema to worsen. Your child’s clinician should discuss options with you but sometimes a topical steroid may be recommended to reduce the inflammation and almost reset the skin. During this time, continue to use your moisturizing ointments as that’s a mainstay. Sometimes a dermatologist might need to get involved for further guidance. 

Anti-Itch Strategies: The itching of eczema makes the inflammatory cascade worse. It can also break the skin leading to infection and entry of bacteria or viruses. Applying a cool, damp cloth to the affected area can help soothe itching. Sometimes, wet wraps can be helpful:

Wet wraps involve applying wet materials (such as bandages or clothing) over areas of the skin affected by eczema. The moisture helps to soothe the skin, lock in hydration, and enhance the effectiveness of topical treatments like steroids or moisturizers.

Prepare the Skin:

• Bathe the child in lukewarm water for 10-15 minutes with a gentle, non-soap cleanser.
• Gently pat the skin dry without rubbing.

Apply Topical Treatments:

• While the skin is still damp, apply prescribed topical treatments (like corticosteroids) or a thick moisturizer per your eczema plan.

Wet the Wraps:

• Wet soft, breathable fabrics (e.g., cotton t-shirts, leggings, or bandages) with lukewarm water.

Wrap the Affected Areas:

• Place the wet fabric over the treated areas, ensuring it's snug but not too tight. Layer dry clothing on top if needed.

Duration:

• Leave the wraps on for several hours or overnight, monitoring for any discomfort.

Change as Needed:

• Replace or re-wet the wraps if they dry out or become uncomfortable.

Keeping your child’s nails trimmed and smooth to reduce skin damage from scratching. Consider mittens or socks on babies’ hands at night to prevent them from scratching. Use anti-itch creams like those containing 1% hydrocortisone or colloidal oatmeal to relieve itching. Always check with your child’s clinician before using any medicated creams on children. During flare-ups, engage your child in activities to keep them distracted from the urge to scratch and positively reinforce when they’re not scratching. 

Navigating the challenges of eczema can be tough, but remember that you're not alone in this journey. Make sure to always speak to your child’s clinician if your child is uncomfortable with their eczema or current management isn’t working for a plan going forward.