Atopic Dermatitis in Children
What is atopic dermatitis?
Atopic dermatitis, also called eczema, is a skin disorder that usually appears in babies or very young children. It may last until the child reaches adolescence or adulthood. Eczema causes the skin to itch, turn red, and flake.
Parents with eczema are more likely to have children with eczema. Different triggers can make eczema worse. These include environmental stress, allergies, sweating, and cigarette smoke. Of children who have eczema, most will show signs of eczema in the first year of life and 85% will show signs of eczema within the first 5 years. Atopic dermatitis is not contagious.
Eczema occurs in approximately 10% to 20% of all infants. Of these children, nearly half will improve as they grow and develop between ages 5 and 15. Roughly 60% of children may have some form of eczema throughout their lifetime.
What are the symptoms of eczema?
The distribution of eczema may change with age. In infants and young children, eczema is usually located on the face, outside of the elbows, and on the knees. In older children and adults, eczema tends to be on the hands and feet, the arms, the back of the knees, and the folds of the elbows. The following are the most common symptoms of eczema. However, each child may experience symptoms differently. Symptoms may include:
Dry, scaly skin
Small bumps that open and weep when scratched
Redness and swelling of the skin
A thickening of the skin (with chronic eczema)
Seasonal allergies and asthma are common in those with eczema
Excessive rubbing and scratching can tear the skin and result in an infection. Some children only have a few episodes of flare-ups, while other children will have atopic dermatitis throughout adulthood.
The symptoms of eczema may resemble other skin conditions. Always talk with your child's health care provider for a diagnosis.
How is eczema diagnosed?
Atopic dermatitis is very common. In addition to a complete medical history and physical examination, diagnostic procedures for eczema may include the following:
Treatment for eczema
Specific treatment for eczema will be decided by your child's health care provider based on:
Your child's age, overall health, and medical history
Extent of the disorder
Your child's tolerance for specific medicines, procedures, or therapies
Expectations for the course of the reaction
Your opinion or preference
There is no cure for eczema. The goals of treatment are to reduce itching and inflammation of the skin, moisturize the skin, and prevent infection.
Management of eczema symptoms
The following are suggestions for the management of eczema:
Avoid contact with irritants, as decided by your child's health care provider.
Bathe your child regularly, use moisturizers. Practice good skin care techniques.
Do not use harsh soaps. Ask your child's health care provider to recommend a brand.
Make sure your child's fingernails are short, as scratching may contribute to an infection.
Use lubricating lotions at least once a day. Ask your child's health care provider to recommend a brand.
Avoid being too hot or sweating too much. Also avoid sudden temperature changes.
Avoid polyester and synthetic fabrics
Avoid scented soaps and skin products.
Your child's health care provider may also prescribe medicines in severe cases. The following medicines are most commonly used to treat eczema:
Antihistamines. These medicines help to decrease the amount of itching. Some examples include diphenhydramine or hydroxyzine. These medicines may cause drowsiness. Some new antihistamines are also available that do not cause drowsiness. Talk with your child's health care provider for more information.
Steroid creams.These topical medicines help to decrease the inflammation in the skin, thus decreasing the itching and swelling. Many topical steroids in various strengths are available. Steroids, if overused, are potentially damaging to the skin. Follow the advice of your child's health care provider.
Oral antibiotics. These medicines are derived from mold or bacteria and slow the growth of specific microorganisms. A sample from the body part thought to be infected may be taken and cultured in a lab to determine what type of antibiotic to use for the most effective treatment. Follow the instructions for dosing and administration carefully. Talk with your child's health care provider as needed.
Oral cyclosporine. This medicine is used primarily to prevent rejection after organ transplantation. It suppresses the immune system and has other side effects that should be considered. Talk with your child's health care provider as needed.
Phototherapy (light therapy).It is safest to have this treatment under medical supervision, but light therapy is not offered at all dermatology clinics. Home light therapy devices are available, but may not be covered by insurance. Narrow band UVB (ultraviolet B) light units are the most effective. Be sure to follow the manufacturer's instructions carefully to avoid injury.
Topical immunomodulator (TIMs or TCIs). Topical immunomodulators are a new class of drugs for the treatment of eczema. These drugs are applied directly to the skin to alter the immune response.
Emollients. Moisturizers that help repair the barrier of the skin should be used often to decrease the incidence of flares.
Systemic steroids. Oral steroids or steroid injections can be used for flares.
Other immunosuppressive therapies. Methotrexate and mycophenolate are nonsteroid agents that can help control severe atopic dermatitis.
Gentle cleansing techniques. Use cleansers that do not have dyes or allergens for body wash as well as to wash clothing.