The ABCs of Treating Your Kid’s Eczema

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By Katharina Bishop

Eczema is a common, recurring skin condition characterized by a dry, flaky, itchy rash, which can affect different parts of the body. Its appearance may vary depending on its severity and topical location. Another commonly used term for this condition is atopic dermatitis.

Childhood eczema is very common, affecting approximately 10 percent of infants and children in industrialized countries. It can start as early as two months of age.

Eczema has two distinct components: dry, easily irritated skin (there is a genetic tendency toward dry skin) and allergies (underlying allergies are manifested in the skin). When a child with eczema is exposed to allergens, the skin overreacts and breaks out in a rash. Since it is already dry and slightly irritated, the skin is less able to handle this allergic rash and less able to heal itself quickly.

Treatment of eczema needs to tackle both components, aiming to retain moisture in the skin and thereby prevent irritation and itching as well as to limit exposure to allergens and skin irritants.

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The most important step towards minimizing your child’s eczema is to avoid dry skin by moisturizing. Give your baby lukewarm baths, and avoid adding soap. Whereas hot and soapy water make eczema worse, lukewarm baths allow water to soak into the skin, moisturizing it in the process. If you need to use soap, a soap free cleanser such as Cetaphil is recommended.

Do not rub your baby dry, as this strains sensitive skin. Instead, pat her dry gently with a soft towel. Now, apply a moisturizing lotion. Straight after the bath is the best time, as it locks in the moisture. Apply moisturizing lotion or cream all over your child’s body two to four times a day, paying extra attention to affected areas. There are many brands on the market that are specifically formulated for the treatment of eczema. Try a few of these to see which one works best for your child.

Avoid skin irritants. Cotton (preferably organic) clothing and bedding are best. Wool and synthetic materials are more abrasive and often irritate sensitive skin. Avoid artificial perfumes and fragrances in body care products. Wash your child’s laundry with a mild, dye-free detergent and rinse thoroughly.

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Watch your child and take note of the environmental factors that seem to trigger flare-ups. Environmental allergy triggers include dust, mold, pets and seasonal outdoor allergies such as pollens. Although these environmental allergies are more likely to cause nasal allergies and asthma rather than eczema, they can contribute to the condition.

Food allergies, if present, play a major role in triggering eczema. It is not always easy to establish whether your child has food allergies and even more difficult to pinpoint the exact triggers. There are, however, eight common foods that make up nearly 90 percent of possible allergic foods. These are milk, egg, soy, peanuts, tree nuts, fish, shellfish and wheat.

By eliminating all of these foods for two to three weeks and then gradually reintroducing them one by one, you will be able to detect which foods, if any, your child is allergic to. If you are breastfeeding, you may wish to experiment with this elimination diet yourself to see if any of the foods you eat affect your baby via your milk.

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To control the vicious cycle of itching, scratching, skin irritation and more itching, make sure your child’s skin is moisturized and choose clothes (climate permitting) that cover as much as possible of his body. If the skin is covered, he won’t be able to scratch as much.

Make sure that your child’s fingernails are cut short and that her hands are kept as clean as possible. Every time she scratches, the bacteria underneath the nails and on the skin come in contact with the open wound of the rash. Skin infections may ensue.

To control itching through medication, your health care provider may recommend oral antihistamines or topical treatment with cortisone creams. You can buy over-the-counter antihistamines such as Benadryl (diphenhydramine) and Claritin (loratadine). Prescription antihistamines such as Zyrtec and Allegra are available, but of these two, only Zyrtec is currently approved for children less than 6 years of age. Claritin, Zyrtec and Allegra are long-acting and non-sedating, which makes them very convenient for use during the day. Often parents prefer to give an antihistamine such as Benadryl at night and a non-sedating antihistamine during the day.

Antihistamines are best used during flare-ups and periods of moderate to severe itching. They help to break the itching and scratching cycle before the rash worsens and may be safely used every day for several weeks.

Topical steroid cortisone creams are a highly popular and very effective treatment for eczema. They vary in strength from the very mild over-the-counter hydrocortisone cream, to mild, medium, strong and very strong prescription creams. Cortisone creams may be used as a preventive treatment if your child has moderate to severe eczema and a rash and itching that do not respond adequately to any other type of treatment.

In this case, your health care provider may instruct you to use cortisone cream (in the mildest effective strength) on a daily basis to improve the condition. Cortisone creams are also the treatment of choice during flare-ups.

Virtually all children with eczema will experience flare-ups from time to time. These can range from a mild topical rash to a severe flare-up covering the whole body. Mild rashes with only a few areas of reddish, raised rash respond well to treatment with over-the-counter hydrocortisone cream, applied as directed by your physician, until the rash subsides.

Moderate rashes require a mild or medium-strength prescription cortisone cream. Severe rashes with very red and irritated skin areas that ooze and bleed are usually treated with medium-strength prescription cortisone cream.

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In the case of severe areas that do not respond to treatment with a medium-strength cream, your doctor may prescribe a strong cream to be used very sparingly on the affected skin areas. Stop using the prescription cream once the rash subsides, and step down to a weaker cream in the course of treatment every time you notice improvement in the rash.

Cortisone is a highly effective medication, but to minimize side effects and habituation, it should be used sparingly and wisely. Side effects of steroid creams include local side effects related to the skin such as thinning, stretch marks and infections, as well as internal side effects such as a reduced growth rate. The latter is extremely rare and occurs with overuse of strong steroid creams; for this reason, the very strongest creams should not be used in children.

Living with eczema

Living with eczema is difficult for all involved. With the help of dietary changes and supplements, lifestyle adjustments and medical prescriptions and advice, the condition can be brought under control.

For most children, eczema improves during childhood. As they get older, they may experience slight problems with dry skin and occasional mild rashes. The vast majority of children, however, grow up with hardly any inconvenience from this condition.

New Treatments on the Horizon

Dermatologists at UT Southwestern Medical Center at Dallas have begun offering a new light therapy that works by resetting the immune system. “We are harnessing a very small part of the sun and filtering out aspects that we don’t want, like the burning,” says Dr. Heidi Jacobe. Each session takes about 12 minutes and can be repeated several times a week.

A new prescription medication, Elidel, is a non-steroidal cream for short-term or intermittent long-term use. Though the way it works is not completely understood, it reduces eczema flare-ups by preventing the activation of certain immune cells and inflammatory chemicals in the skin. Elidel is not for use in children under 2 years of age. — Christine Climer

© Katharina Bishop

Katharina Bishop studied medicine for three years in Germany and is now in the process of completing a psychology degree. She is a certified reiki and seichim master in the Usui tradition and is in the final year of a degree in alternative medicine/naturopathy, specializing in homeopathy, yoga, acupressure, medicinal herbalism and gemstone therapy. To learn more about Katharina or holistic healthcare visit Tushita Holistic Therapies.