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Eczema in Your Child by BRIAN C. MACHLER, M.D.
Atopic dermatitis is the most common childhood rash affecting about 10 percent of infants and 20 percent of children. “Atopy” refers to a tendency toward inflammation of the skin, as well as the linings of the nose and lungs. There is often a familial tendency toward atopy in which siblings or parents suffer with sensitive skin, seasonal allergies, and/or asthma. About 20 percent of patients with atopic dermatitis do not have a family history. Atopy can affect patients at any age but is most common in infancy and early childhood. This tendency leads many to the idea that the patient will “grow out of it.”
In addition, the rash of seborrhea is a more pink-orange in color with a greasy appearing scale. Infants are quite itchy with atopy and often will scratch themselves or rub the affected skin. Many outgrow their condition to a large extent by age two. During childhood the rash can change in its appearance, becoming less red and oozing and developing dry, scaly, pink patches. Pruritus, or the sensation of itch, typically remains and leads some patients to scratching to the point of bleeding. Atopy tends to involve the bends at the elbows and behind the knees as well as the wrists, hand, feet and face. Although food allergy can play a role in atopy, affecting anywhere from 10 to 30 percent of patients, it is not the rule. Often parents recognize allergy because the infant or child has a tendency to worsen after certain food exposures. This of course becomes more difficult with those only on formula, yet the possibility of food sensitivity is often suggested in those patients who prove resistant to therapy. Sometimes formulas will be changed by your pediatrician or an allergist to alternate products known to be more tolerable. When the infant begins eating solid foods, vegetables and fruits can be added slowly so that if a food sensitivity issue arises, the culprit can be identified. In counseling my patients with atopy and their parents, education about the condition and its treatment is paramount. I often refer to the “atopic regimen;” this includes rules for caring for the skin in a manner that will calm the condition down. The avoidance of irritants is of utmost importance in the treatment of atopy. Unfortunately, the majority of products labeled for the treatment and prevention of sensitive skin are far from their claims. Treating the Condition As a general rule, keeping it simple is best. I recommend a daily tepid bath with a sensitive skin bar soap instead of liquid soaps, which have more ingredients that can act as potential irritants or allergens, and they are often filled with fragrance, which can worsen the condition. Bubble baths are strictly forbidden. I often see parents who were told to minimize the number of baths sometimes as infrequently as once a week to help eczema. Just think how you would feel with only a weekly bath. Infants generally love baths, but keep them short and warm, not hot. Soaps, which are detergents meant to remove oils, are often overused at bath time. One of the major problems in atopy is a lack of natural skin oils. The overuse of soaps in lathering up the entire body definitely worsens the condition even when using the gentlest soap. The use of emollients or moisturizers is critical in the treatment and maintenance of atopic dermatitis. In general terms, use of creams is far superior to use of lotion due to the increased oil content of the former. These should be applied daily, immediately after the bath. This technique traps the moisture into the skin gained at bathing and allows the treatments to penetrate better. These creams are often stopped after the child improves, which causes a recurrence or flare up of the eczema. Their use in maintaining the clearance of the rash cannot be stressed enough.
These preparations should be applied to the affected skin and not rubbed into the normal skin as a generalized moisturizer. I recommend the topical medication be applied first to the lesions with a non medicated moisturizing cream or ointment applied over it and the surrounding normal skin. When the redness subsides, the steroids can be stopped but not the moisturizers. Antihistamines are widely used to control itching, but their role is probably limited to sedative effects as histamine plays no role in the inflammation of atopy. As infections often arise in the lesions of eczema, oral antibiotics are quite helpful occasionally. Recently, a new class of anti-inflammatory agents, the topical calcineurin inhibitors, has been FDA approved for the treatment of eczema in children over age two. These agents are the first non-steroid treatment of eczema in over 40 years, and they do not cause the unwanted side effects of steroids. In all cases the “atopic regimen” is the mainstay of therapy. [ top ] |
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The word “eczema” comes from the Greek meaning, “to boil over.” It has come to be used to describe a wide variety of inflammatory conditions of the skin that are red, scaly, and almost always itchy. There are many different conditions that lead to such a response in the skin; allergic contact dermatitis (ex. poison ivy), irritant dermatitis (ex. dishwasher hands), seborrheic dermatitis (dandruff), nummular dermatitis, and atopic dermatitis. 
The rash of atopic dermatitis in infancy can be an oozing, crusting redness, typically involving the head and neck with random patches occurring anywhere on the body. It often spares the diaper region, most likely due to the humidifying or moisture–containing effects of the diaper itself. This distinguishes it from infantile seborrheic dermatitis, which also involves the head and neck but commonly involves the diaper region. 
The mainstay of therapy in atopic dermatitis for the past 40 years has been topical corticosteroids. There are many different steroids that are used and they vary widely in strength. The over-the-counter hydrocortisone 1 percent preparations are often not potent enough, particularly when the cream is used. Ointments, although more greasy, are always more potent. Prescription steroid creams are more potent but must be used judiciously. Overuse can lead to thinning of the skin, dilation of blood vessels in the skin, lightening of the skin’s color, and stretch marks. 
