Eczema (Atopic Dermatitis)

What is atopic dermatitis?

Atopic dermatitis, also called eczema, is a skin disorder that usually appears in babies or very young children, and 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, including environmental stress, allergies, and sweating. Of the children with eczema, 65 percent will show symptoms in the first year of life and 90 percent will show signs of eczema within the first 5 years.

What are the symptoms of eczema?

The locations where eczema occurs may change with age. In infants and young children, eczema is usually found on the face, outside the elbows, and on the knees. In older children and adults, eczema tends to appear on the hands and feet, the arms, and on the back of the knees.
Every each child may experience symptoms differently, but the main symptoms include the following:

  • 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)

Excessive rubbing and scratching can tear the skin, which can in turn cause an infection. Some children only have a few episodes or flare-ups, while other children will have eczema throughout adulthood.

The symptoms of eczema may resemble other skin conditions, so a physician should always diagnose eczema.

How is eczema diagnosed?

Eczema is very common. The National Institute of Arthritis and Musculoskeletal and Skin Diseases estimates that at least 10 percent of infants and children have atopic dermatitis. Diagnosis is usually based on a physical examination and medical history, but may also include the following:

  • Family history (children born to a mother who has allergic conditions are more prone to eczema)
  • Personal history of allergies or asthma
  • Blood tests

What is the treatment for eczema?

Specific treatment for eczema will be determined by the child's physician based on the following:
  • The child's age, overall health, and medical history
  • Extent of the disorder
  • The child's tolerance for specific medications, procedures, or therapies
  • Expectations for the course of the reaction
  • Child or parent’s opinion or preference

Note: There is no cure for eczema. The goals of treatment are to reduce itching and inflammation, moisturize the skin, and prevent infection. 

Developing Treatments

A new class of medications, called topical immunomodulators (TIMs), offers a steroid-free treatment option for treating atopic dermatitis. These medications can be used anywhere on the body to relieve the itching, redness, and pain caused by eczema. 

Tacrolimus is the first TIM approved by the US Food and Drug Administration (FDA). Another promising new TIM is called pimecrolimus. 

The FDA does not advise using TIMs on children under the age of two. Be sure to consult with the child's physician for more information.

How can eczema be managed?

The following list includes a variety of suggestions for managing eczema:

  • Avoid contact with irritants, as determined by the child's physician
  • Bathe the child regularly, use moisturizers, and practice good skin care techniques
  • Keep the child's room cool at night to prevent sweating that can irritate the skin
  • Avoid harsh soaps. Ask the child's physician to recommend a brand name
  • Make sure the child's fingernails are short, as scratching may contribute to an infection
  • Use lubricating lotions at least once a day. Ask the child's physician to recommend a brand name

What is the treatment for severe eczema?

In severe cases the child's physician may also prescribe medications. The following medications are most commonly used to treat eczema:

  • Antihistamines.

    These medications help to decrease the amount of itching. Examples include diphenhydramine (Benadryl®) or hydroxyzine (Atarax®). These medications may cause drowsiness, but several new antihistamines are available that do not cause sleepiness. Consult the child's physician for more information.

  • Steroid creams.

    These topical medications help decrease the inflammation in the skin, thereby decreasing itching and swelling. Many topical steroids in various strengths are available. Steroids, if overused, are potentially damaging to the skin, so follow the advice of the child's physician.

  • Oral antibiotics

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Dermatology

The Division of Dermatology at Children's National Health System continues to expand services as more families seek our expertise in the diagnosis and treatment of disorders of the skin, hair, and nails.

Allergy and Immunology

At Children’s National, children affected by allergies and complex immunologic disorders benefit from our specialists’ expertise, because our doctors treat children and only children with these conditions.

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