Clinical Reference Systems: Pediatric Advisor 10.0
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DESCRIPTION

• red, extremely itchy rash
• often starts on the cheeks at 2 to 6 months of age
• most common on flexor surfaces (creases) of elbows, wrists, and knees
• occasionally on neck, ankles, and feet
• if scratched, rash becomes raw and weepy
• constant dry skin.

Previous confirmation of this diagnosis by a physician is helpful.

CAUSE

Eczema is an inherited type of sensitive, dry skin. A personal history of asthma or hay fever or a family history of eczema makes it more likely that your child has eczema. Flareups occur when there is contact with irritating substances (for example, soap or chlorine).

In 30% of infants with eczema, certain foods cause the eczema to flare up. If you suspect a particular food item (for example, cow's milk, eggs, or peanut butter) is causing your child's flareups, feed that food to your child one time (a "challenge") after avoiding it for 2 weeks. If the food does cause flareups, the eczema should become itchy or develop hives within 2 hours of eating the food. If this occurs, avoid ever giving this food to your child and talk to your physician about food substitutes.

EXPECTED COURSE

This is a chronic condition and will usually not go away before adolescence. Therefore, early treatment of any itching is the key to preventing a severe rash.

HOME TREATMENT

1. Steroid creams

   Steroid cream is the main treatment for the itch of eczema. Use the steroid cream prescribed by your child's physician. The physician will tell you how often you should apply the cream when the eczema flares up. When the rash quiets down, use it at least once a day for an additional 2 weeks. After that, use it immediately on any spot that itches. When you travel with your child, always take the steroid cream with you. If your supply starts to run out, get the prescription renewed.

2. Bathing and hydrating the skin

   Hydration of the skin followed by lubricating cream is the main way to prevent flare-ups of eczema. Your child should have one bath a day for 10 minutes. Water-soaked skin is far less itchy. Eczema is very sensitive to soaps, especially bubble bath. Young children can usually be cleaned without any soaps. Teenagers need a soap to wash under the arms, the genital area, and the feet. They can use a nondrying soap such as Dove for these areas. Keep shampoo off the eczema.

3. Lubricating cream

   Children with eczema always have dry skin. After a 10-minute bath, the skin is hydrated and feels good. Help trap the moisture in the skin by applying an outer layer lubricating cream to the entire skin surface while it is damp. Apply it after steroid cream has been applied to any itchy areas. Apply the lubricating cream once daily (twice a day during the winter). Some lubricating creams are Keri, Lubriderm, Nivea, and Nutraderm. Avoid applying any ointments, petroleum jelly, or vegetable shortening because they can block the sweat glands, increase the itching, and worsen the rash (especially in warm weather). Also, soap is needed to wash them off. For severe eczema, ointments may be needed temporarily to heal the skin.

4. Itching

   At the first sign of any itching, apply the steroid cream to the area that itches. Keep your child's fingernails cut short. Also, wash your child's hands with water frequently to avoid infecting the eczema.

PREVENTION

Wool fibers and clothes made of other scratchy, rough materials make eczema worse. Cotton clothes should be worn as much as possible. Avoid triggers that cause eczema to flare up, such as: excessive heat, sweating, excessive cold, dry air (use a humidifier), chlorine, harsh chemicals, and soaps. Never use bubble bath. Also, keep your child off the grass during grass pollen season (May and June). Keep your child away from anyone with fever blisters since the herpesvirus can cause a serious skin infection in children with eczema.

Try to breast-feed all high-risk infants. Otherwise, use a soy formula. Also try to avoid cow's milk products, soy, eggs, peanut butter, wheat, and fish during your infant's first year.

CALL YOUR CHILD'S PHYSICIAN IMMEDIATELY IF:

• The rash looks infected and your child has a fever.
• The rash flares up after contact with fever blisters.

CALL YOUR CHILD'S PHYSICIAN WITHIN 24 HOURS IF:

• The rash becomes raw and open in several places.
• The rash looks infected (red streaks, pus, yellow scabs)
• The rash hasn't greatly improved in 7 days of this treatment.
• You have other concerns or questions.