Atopic Dermatitis in Children - Asthma and Allergy Clinic
What is atopic dermatitis (AD)?
Atopic dermatitis (AD), also known as eczema (EK-zema), is a common skin disease. It affects children more than adults. The main symptoms are red, dry, and itchy skin. AD can happen in cycles (episodes) that last weeks to months. AD often responds well to treatment and is not contagious. People with AD cannot “give” it to someone else. It is a chronic (long-lasting) condition. Treatments are helpful.
What causes atopic dermatitis?
The exact cause of AD is not known, although triggers in the environment and family history (genes) seem to be important and may affect the immune system, the skin, or both. Children with AD often have a parent with either allergies or asthma. The skin becomes inflamed (swollen) and itchy because of triggers.
The triggers of AD include
- sweat
- very hot, cold, dry, or humid air
- dry skin
- skin irritants (chemicals, soaps, perfumes, and clothes that “rub” the skin too much)
- emotions
- allergies to certain things (such as foods or environmental allergens like cats, dogs, or dust mites) about 1/3 of children with eczema have a food allergy
- infection
What are the symptoms of AD?
The main symptoms are severe itching and scratching. Scratching the skin then leads to a rash and further itching, an “itch-scratch” cycle that is hard to break. The skin will look normal at the start of an outbreak, but as the child scratches, it becomes bumpy and red. The more the child scratches, the more the skin itches. Intense scratching and rubbing can cause the skin to thicken, flake, crust, scab or even become infected. AD is described as the “itch that rashes”. Different parts of the body are affected at each age.
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Infant to age 2 |
Childhood 2 – 12 |
Puberty |
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What is the treatment for AD?
Treatment often works well. The goals of treatment are to avoid triggers and break the itch-scratch cycle. Because AD is a chronic problem, it may be necessary to do a little bit of “work” to keep it under control, even when there is no rash. Treatment includes
- using creams and ointments to keep the skin moist.
- avoiding factors or “triggers” that make AD worse.
- using of medicines to calm the skin down.
Treatment tips include the ones listed below.
- Wear loose fitting clothing. Cotton or other light fabrics are best, as they allow the skin to breathe and prevent sweat build-up. Avoid tight elastic waistbands and wool, nylon or other stiff, scratchy fabrics.
- Take a bath! Baths are good for the skin especially if you do the right things after the bath. Avoid hot showers and baths. Instead take warm baths and use very little soap. Bathing should be fun with playtime and toys. When using soap, only use mild, unscented bar soap at the end of the bath, such as Unscented Dove® or Cetaphil®. Do not let your child soak in soapy water.
- Moisturize the skin while still damp after bathing. This helps lock in moisture and prevents dry skin. Do not use lotions since they often contain alcohol and water that evaporate from the skin soon after applied. Thick creams are best, such as Cetaphil® or Vanicream®. Ointments may also be used such as Aquaphor®, Vaseline® petroleum jelly or Crisco®.
- Wet wraps may be used for more severe eczema. After bathing and applying creams, the skin is covered with wet cotton pajamas or wraps (such as kerlix). This will help keep moisture in the skin.
- Keep fingernails short. This prevents damage to the skin from scratching, which also helps prevent infection.
- Harsh soaps can cause dry skin and make your child itch. Use mild laundry soaps free of perfumes, such as All Free® or Cheer Free®. Avoid using fabric softeners.
- If your child has allergies, avoid what they are allergic to. This can include foods.
Medicines used to treat AD
- Steroid creams or ointments remain the most common treatment for AD. Milder steroid creams, such as hydrocortisone, can be bought without a prescription. For more severe rashes, stronger steroid creams may be prescribed. The stronger creams should not be used on the face or in the skin folds.
- Elidel® and Protopic® are other creams used to treat AD. They target the disease in the skin and are steroid free. They may be safely used on the face.
Call your doctor if
- The child cannot sleep due to the itching.
- The rash is getting worse or not getting better even with treatment.
- The rash appears to be infected (painful, very red and warm to the touch, “pimples”, or pus)
- The child gets a fever.
For more information, contact
- The Inflammatory Skin Disease Institute, PO Box 1074, Newport News, VA 23601
Web Sites
http://www.niams.nih.gov/hi/topics/dermatitis/
http://www.aaaai.org/patients/advocate/2001/summer/atopicdermatitis.stm
Atopic Dermatitis Treatment Plan
For MILD ECZEMA do the following
Bath for 15 minutes once daily
Moisturizing cream for skin with no rash or itching
Apply: __________________________________________________
to skin one to two times daily.
Topical medicine for skin with rash and/or itching Face, underarms: _____________________________________________________
one time a day.
Trunk, arms, legs: _____________________________________________
one time a day.
For MORE SEVERE ECZEMA do the following
Bath for 15 minutes twice daily
Moisturizing ointment for skin with no rash or itching
Apply: __________________________________________________
to skin one to two times daily.
Topical medicine for skin with rash and/or itching Face, underarms: ______________________________________________________
two times a day.
Trunk, arms, legs: ______________________________________________
two times a day.
Foods to avoid
_______________________________________________________
_______________________________________________________
Foods to try
_______________________________________________________
Other
_______________________________________________________________
The Spanish version of this Health Facts for You is #6584.
The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Any duplication or distribution of the information contained herein is strictly prohibited.
Last Updated: 09/04/2008
Copyright © 09/04/2008 University of Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Department of Nursing. UWH #5386
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