Eczema in Kids

Eleven percent of children in the United States have eczema, a skin condition that causes skin to be irritated or inflamed. What can you as a parent do to help, if your child is affected by eczema? We asked Le Bonheur Hospitalist Cynthia Cross, MD, to weigh in.

How common is eczema?
It affects approximately 11 percent of U.S. children. The incidence seems to be increasing. It seems to be related to impairment of the skin's ability to act as a barrier, which can lead to problems with moisture control. Irritants may also enter the skin and cause inflammation.

What are some of the best ways to treat or control eczema in kids?
The skin of those with eczema is prone to drying, which leads to itching and increased irritation. If your child develops raised bumps that contain pus or multiple blisters seek medical attention immediately.

• Avoidance of triggers such as heat, perspiration and low humidity are important.
• Certain chemicals or cleaning solutions, including soaps, detergents, perfumes and cosmetics should be eliminated. Look for products that don't contain dyes and perfumes.
• Wool or synthetic fibers, dust, sand and cigarette smoke may also cause irritation.
• In infants, avoidance of certain foods may be helpful. Common food triggers include eggs, nuts, peanut butter, chocolate, milk, seafoods and soy.
• Most importantly, keep skin hydrated. Lotions or creams that have low water content are better because they lead to less drying. Examples of good agents are Eucerin, Nutraderm and Cetaphil. Vaseline, Aquaphor and petroleum jelly have zero water and offer protection against drying as well. Some users don't like these because they are greasy. Regardless of which product is chosen, they work best if applied immediately after bathing.
• When the skin is inflamed, steroid creams are useful. If the skin is only mildly inflamed, over the counter steroid creams applied twice daily may provide adequate relief. For moderate to severe eczema, prescription strength steroid creams or ointments may be needed. Topical steroids are used for 10 days at a time. Prolonged use may cause atrophy (thinning) of the skin. They should also be used with caution on the face and skin folds.
• Another class of medication, topical calcineurin inhibitors, may be prescribed, especially if steroids aren't effective. The advantage of these agents is they do not lead to skin atrophy. There has been concern raised about a link between these agents and cancer. These agents are also associated with burning or stinging of the skin. They are used under close supervision by a licensed medical provider.
• Wet dressings may also provide relief. After applying lotion or cream, dampened cotton garments covered with a dry garment may be helpful. These are usually best used at night.
• Antihistamines such as Benadryl and hydroxyzine may be used for itching but can cause drowsiness. Non-sedating antihistamines such as Zyrtec or Claritin may also be used.
• To decrease infection, bleach baths may be effective. Add 1/4 to 1/2 cup of bleach to a tub of lukewarm water. Soak for five to10 minutes, rinse well with plain water, pat skin dry, then immediately apply lotion or cream.
• Keeping finger nails trimmed helps limit trauma to the skin when children scratch. How likely are kids to outgrow eczema?

Can children outgrow this condition?
Eczema can occur at any age and usually improves as children get older. It is rarely outgrown, but flares may occur many years apart.