Eczema – More Than Just Dry Skin
What is eczema?
Eczema is also called atopic dermatitis, and it is a skin lesion characterized by dry, flaky, itchy, reddened patches of skin. It is the most common inflammatory skin disorder in childhood, affecting 10% of children. The exact cause of eczema is not fully understood, but it is thought to be a combination of disruption of the natural skin barrier, dysfunction of the immune system, and abnormalities of typical skin bacteria. There does seem to be a genetic component to the disease, and it tends to occur more often in children who also have allergies and asthma.
In babies, eczema most often occurs on the cheeks and the scalp but may also be present on the rest of the body. In older children, eczema is usually found in the creases of the elbows and knees, on the neck, and around the eyes.
Eczema is more than just “dry skin.” In dry, arid climates (such as in Colorado, where I practice) there is little to no moisture naturally in the air, which causes the skin to often be dry and sensitive, even to the point of cracking. This is NOT eczema, though certainly children with dry skin can also have patches of eczema.
How is eczema treated?
There is no “cure” for eczema. The majority of children with eczema are treated symptomatically and topically.
Emollients: applying good-quality moisturizers to the skin immediately after bathing and patting the skin dry can help trap water in the skin. Ointments and creams are usually the best options. Using creams specifically designed for eczema care are better choices than regular lotions.
Itch relief: in addition to emollients, symptoms of itching can be controlled with antihistamines, use of wet wraps (the process of placing a wet cloth directly onto the skin for 30-60min), wearing gloves to protect the skin from scratching, and frequent moisturizing.
Avoidance of allergens: this is particularly important in children who also have environmental allergies. Use of natural fiber clothing, fragrance-free detergents and soaps are much more gentle on the skin. Avoid chemicals where possible. Keeping houses clean of pet dander and dust is also helpful. In some children with milk protein intolerance, avoidance of dairy products can help eczema symptoms as well.
Topical steroids: these are applied to more significant eczema flare ups that are not responding to emollients. These prescription medications are only applied for a short period of time – usually 3-7 days. They come in different strengths depending on the severity of the flare up. They also come in different forms, including lotions, creams, ointments, and oils.
Additional therapies: In more severely affected patients, phototherapy and immunotherapy is used (though it should be noted that no immunosuppressive agents are FDA-approved for use in children). More recently, research has shown effectiveness of a new type of medication, called “biologics” in treatment of eczema. These medications use antibodies to block the auto-immune response of eczema. Positive response has lead to FDA approval of biologics in children and adolescents who fail traditional topical therapy.
Are there complications?
At the minimum, eczema can cause disruptions in daily life to due pain and itching. It can cause sleep disturbances as well.
More significantly, children with eczema lesions are at risk for secondary skin infections. Any time there is a break in the integrity of the skin, there is a chance for the bacteria that naturally live on the skin to get in and cause infection. This can present as impetigo, cellulitis, folliculitis, or abscesses. These infections will need to be treated with an antibiotic. If you think your child may have developed a secondary bacterial skin infection, please take him or her to your Pediatrician for evaluation.
Final thoughts
Eczema is a common issue among young children. The good news is that many outgrow it by four years of age. Still, for the parents of an infant who has significant skin breakdown on a regular basis, four years old can be far into the future.
It is important to remember that your child’s eczema may still flare up despite all that you do to prevent it. It is a chronic medical issue that ebbs and flows depending on weather, exposures, allergens, illness, happenstance. Continue to apply emollients and treatments as recommended by your child’s Pediatrician, and follow up if you are concerned it is getting worse.
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