Eczema (atopic dermatitis)

By SickKids staff

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Learn what atopic dermatitis is and what you can do to help your child cope.

Key points

Atopic dermatitis (eczema) is a chronic skin condition that comes in many forms. Skin becomes dry and very itchy, and a rash may appear. There will be times when the skin is worse or better.
Eczema shows up as patches of dry, rough skin that can be red and is often itchy.
Sometimes the skin is itchy without any rash. Scratching the itchy skin can cause the rash to develop and sometimes cause breaks in the skin leading to wounds or sores, redness, swelling, damage and discomfort. Open wounds can develop weeping of clear fluid and crusting ("scabs").
There are many things you can do to control the itch and to protect your child's skin.

Introduction

Signs and symptoms

Treatment

How to manage eczema

Good skin care, including moisturizing, is a key part of managing your child's eczema.

It is sometimes possible to figure out what factors cause flare-ups in your child. If you know the triggers of your child's eczema, help your child stay away from them. However, many flare-ups happen without an obvious trigger.

Your child’s health-care provider may also prescribe one or more medicines to help your child. These medicines may be topical (applied to the skin) or oral (to be taken by mouth).

Skin care

Bathing

Gentle bathing techniques are recommended, such as:

Limiting baths to warm (not hot) water for about five to 10 minutes. Hot water can irritate the skin and trigger itching. If you need a reminder, try using a timer.
Some health-care providers may recommend bathing frequently to help with eczema, and some may recommend bathing infrequently. Neither of these methods has been shown to be better than the other.
If you use soap to cleanse the skin, avoid any product that irritates (stings or hurt) the skin or causes itching. Most children who bathe in warm water will have their skin look redder while in the bath and for a while after. This is from the warm water bringing more blood flow to the skin. If it is accompanied by increased itching, it could be a sign that the warmth of the water or the bath product aggravated the eczema.
Do not use wash cloths, sponges or loofahs to scrub or rub the skin as these can cause irritation when rubbed along the skin.
When you have finished bathing your child, pat their skin dry—do not rub.
After bath time, apply your child's medication, then apply a layer of the prescribed medicated ointments or creams to all the affected skin areas (the rough, red, bumpy and itchy spots).
After applying the prescribed active ointment or cream, use a product like petroleum jelly or moisturizer over the unaffected skin areas.
Use bath time as a chance to inspect your child's skin for irritation or flare-ups.
Children should never be left in a bath unattended.

Moisturizing

Dry skin is one of the most common features of eczema. When skin is dry, it can be itchy. It also starts to lose its function as a protective barrier. This means that more water is lost from the skin, and irritants can get into the skin. Both can trigger an eczema flare-up.

Moisturizers help decrease the itch and soothe the skin. They do this by creating a protective layer over the skin that acts as a barrier. This helps keep the water in the skin and the irritants out. Moisturizers are a mixture of fats, oils and water. There are three kinds of moisturizers that are used: ointments, creams and lotions.

Ointments are thicker, greasier products. Most of them do not contain water. They are the most effective method for hydrating very dry skin and large areas of skin. They are usually well tolerated.
Creams are a mixture of fats and water. They feel light and cool on the skin. Creams are used very often to prevent skin from drying out and when skin is cracked. These products often "burn" or sting the skin of patients with eczema.
Lotions contain the most water. They spread easily and can be cooling to the skin. They can be used on the scalp. They are not as effective for moisturizing dry skin as ointments or creams. Lotions can cause skin discomfort or stinging in very dry skin.

Avoid any product that irritates the skin. No particular brand of moisturizer is better than another. Find one that works well and that your child likes.

Medicines and other treatments

Depending on how severe your child's eczema is, your child's health-care provider may prescribe one or more medicines.

Topical corticosteroids

Topical corticosteroids are steroid ointments or creams ("cortisones") that are put on the skin. Steroids are an effective way to help reduce inflammation in the skin. Inflammation causes swelling, redness, bumpiness and skin irritation. Less inflammation leads to less itching and, therefore, less scratching.

These medicines are grouped by strength. Which corticosteroid you use depends on where the flare-up is on the body and how bad it is. For example, your child might need a milder corticosteroid for the face but a stronger one for the body. Your child's health-care provider will explain which type is best for your child. By carefully following your health-care provider’s instructions, you will use topical corticosteroids in the optimum way. This will allow for a better control of your child's flare-ups. When used correctly, topical steroids rarely have side effects. If you have concerns about these medications, talk to your health-care provider about them.

Topical calcineurin inhibitors

Topical calcineurin inhibitors are non-corticosteroid medications that help treat the inflammation in the skin. They are applied directly to the affected area of skin. Their brand names are Protopic and Elidel. These medicines are used in:

children who cannot tolerate topical steroids
children whose eczema does not improve as much as expected with proper use of topical steroids

Anti-infective agents

Having eczema increases a person's risk of skin infection. Scratching can disrupt the skin barrier, making it easier for bacteria on the skin to enter the body and cause infection. Viruses or fungi can also cross the skin barrier, although this is less common. Infection in the skin can make eczema worse.

Anti-infective agents are medicines used to fight infections caused by bacteria (antibiotics), viruses (antivirals) and fungi (antifungals). If your child needs an anti-infective, your child's health-care provider will prescribe one.

Coal tar preparations

Crude coal tar can be used to treat skin inflammation and soothe itch. This treatment has many ingredients that have not all been identified but seem to help. Many people avoid using this treatment because it can be messy, it has some odour, it can take a lot of time and it is not very convenient.

Herbal remedies and alternative therapy

Herbal remedies and alternative therapy may include the use of:

herbal and dietary supplements
vitamins
other over-the-counter products

These products have not been proven to help with eczema. Tell your health-care provider about any alternative therapies and supplements your child is using.

Helping your child

Managing the itch

Here are some tips that you and your child can use to help control the itching of eczema:

Tips for moisturizing

Moisturize, moisturize, moisturize!
Keep moisturizers and medicines cool by storing them in the fridge.
Avoid products that contain irritating ingredients such as alcohol and fragrances (perfumes).
Try applying a cool washcloth followed by moisturizing the skin.

Clothing tips

Have your child sleep with one layer of loose cotton pajamas because sweat can irritate the skin.
Avoid bedding and clothing with fabrics that irritate your child's skin. Some that might be irritating include nylon, wool or other rough fabrics. Cotton is often well tolerated.
Cut off the tags on clothing as these can sometimes irritate the skin.

Tips for reducing scratching

Scratching is a sign of a flare-up in children with eczema and indicates that your child's eczema could be better managed. Try the following suggestions. If the scratching goes on, ask your child's health-care provider for advice.

Ensure you are using your prescribed medications at the very first sign of a flare-up (or flare) and continue to use it until the flare is gone. "Under-treating" a flare (starting to treat the flare-up when it's already bad and stopping as soon as it's a little better but not gone) can lead to chronic itch. It can be frustrating as it seems the medicines are not working. The medicines work when the entire flare is treated, leaving the skin clear. Another flare may come, but there should be some "clear" time between flares. If a flare has not gone away within three weeks, your child should see their health-care provider.
Use a washing cloth cooled with cool water when your child feels itchy to help decrease scratching. Avoid using a washing cloth on large parts of the body because it may cause heat loss in babies and small children.
Keep your child’s fingernails short.
Ask your child to tell you when they are itching. Itching is the sign that your child's eczema is not under control. Itching leads to scratching. This leads to further irritation and inflammation and makes the condition worse.
If you notice that your child is often scratching at a particular time of day, assume it is the start of a flare-up and begin treating those areas even if there is no rash.
Antihistamine medications do not effectively reduce the itch in children with eczema and are not routinely recommended.

Tips for managing your child's environment

If heat or humidity is a trigger for your child, keep the environment cool but not cold. Young babies cannot control their temperature well and should be in environments between 20°C and 22°C. Fans may help but should be placed safely out of reach of children.
It is better for your child if they sleep alone. When a child is sleeping in the same bed as others, this can lead to flare-ups because the heat created by the other bodies increases and makes your child sweat more. Do not share a bed with your baby. It increases the risk of sudden infant death syndrome (SIDS).
Stress can sometimes cause increased scratching. Strategies such as deep breathing and mindfulness can be helpful for managing stress in children and teens. To learn more about mindfulness and find guided audio meditations, please see AboutKidsHealth's mental health video playlist.

Other considerations

Seasonal changes

You may find that your child's eczema is worse in the colder, drier months. During this time, the air becomes very dry and holds less moisture. This can cause drier skin. In the warmer months, the humidity can also worsen eczema for some people.

Laundry care

If a laundry product you are using seems irritating, consider trying a gentler product. Some families find gentle laundry products cause less irritation of the skin.

Coping with eczema

The daily care routine for eczema can be very stressful to you, your child and the rest of your family. It is very important to maintain the routine and be committed to it to manage your child's eczema. Your child's health-care team is a good resource if you need advice. Some children develop self-esteem problems or feel embarrassed by their eczema. That is one of the reasons why it is important to keep your child's eczema under control.

School and activities

If your child goes to daycare, talk to the daycare staff and to parents of other children that attend the daycare about eczema. Inform them about your child's condition and that it will not spread to other children.

If your child needs daytime moisturizing, have a doctor's note allowing your child or a nurse to apply it at school.

School can cause a great deal of stress in children with eczema. Parents, family members and teachers should understand the stress that these children experience and that they may need more emotional support and understanding.

It is important that your child is able to participate in their regular activities as much as they can. You may be able to make some changes to help enable this.

When to seek medical attention

Resources

Last updated: M10 9th 2023