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
- very hot, cold, dry, or humid air
- dry skin
- skin irritants (chemicals, soaps, perfumes, and clothes that “rub” the skin too much)
- 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
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.
Infant to age 2
Childhood 2 – 12
What is the treatment for AD?
The goals of treatment are to stay away from triggers and break the itch-scratch cycle. Because AD is a chronic problem, it may be necessary to do “work” to keep it under control, even when there is no rash. Treatment includes:
• bathing in warm water daily
• the use of creams and ointments to keep the skin moist
• the use of medicated creams to calm the skin down
• avoidance of factors or “triggers” that make AD worse
• sedating antihistamines (such as diphenhydramine or Benadryl®) may reduce itching to some degree due to the drowsiness they can cause in the child
Treatment tips include the following:
• Wear loose fitting clothing. Cotton or other light fabrics are best, as they let the skin breathe and prevent sweat build-up. Avoid tight elastic waistbands and wool, nylon or other stiff, scratchy fabrics.
• Apply moisturizer when your child feels itchy, instead of letting him/her scratch or rub the skin.
• Take a bath! Baths are good for the skin especially if you do the right things after the bath. Stay away from 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. Do not rub the skin with a washcloth – gently clean skin areas.
• After taking a bath, pat dry the skin gently (avoiding rubbing or brisk drying). Within 3 minutes, moisturize the skin while still damp.. This helps lock in moisture. 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 Aveeno®, Cetaphil® or Vanicream®. Ointments may also be used such as Aquaphor®, Vaniply®, Vaseline® petroleum jelly or Crisco®.
• Keep fingernails short. This prevents damage to the skin from scratching, which also helps prevent infection. Cotton gloves worn on the hands at night will also prevent scratching.
• Use mild laundry soaps free of perfumes, such as All Free® or Cheer Free®. Avoid using fabric softeners.
• If your child has either environmental or food allergies, avoid what they are allergic to.
• Use sunscreen (SPF 15 or greater) when outdoors. Avoid getting sunburned.
• Swimming in chlorinated pools can cause much drying of the skin. After swimming in a pool with chlorine, rinse off under a warm shower and apply a moisturizer.
Additional treatment suggestions for severe AD:
For children who have more severe eczema, additional treatment recommendations may be made including:
• Bleach baths 1-2 times daily. ½ cup of bleach is placed in a full tub of water or a ¼ cup in a half tub of water. The child then soaks in the tub for 15 minutes. The bleach water is rinsed off followed by applying the creams/ointments to the skin.
• Wet wraps 1-2 times daily. After bathing and applying creams, the skin is covered with wet cotton pajamas or wet wraps (such as kerlix) which are left on for 15-30 minutes or may be kept on overnight if tolerated by the child. Wet cotton gloves may be used on the hands. It is helpful to cover the wet wraps with dry clothing. Wet wraps are soothing.
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, in the skin folds or in the genital area.
• Elidel® cream and Protopic® ointment may also be used to treat AD. They are steroid free. They may be safely used on the face.
Atopic dermatitis and quality of life:
AD affects the entire family – not just the child with the disease. When the child’s AD is flared, s/he may be fussy, whiney and demanding. Doing the skin cares can be a battle.
The itch of AD is said to be worse than the itch of poison ivy. The child will dig at their skin – often when sleeping. At times, a parent will sleep with the child due to the fear of extreme night scratching causing skin breakdown. AD children are often tired during the day due to poor quality sleep – as are their parents Keeping the child busy and distracted during the day to avoid scratching is an additional challenge for the tired parent or caregiver.
The child with AD may also face emotional and social difficulties due to changes in appearance especially when in childcare or school.
It is important to talk with your doctor or nurse if your child and family are feeling stressed.
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:
• National Eczema Association
• National Institute of Arthritis and Musculoskeletal and Skin Diseases
• American Academy of Allergy Asthma and Immunology
• National Jewish Health
• The Food Allergy and Anaphylaxis Network
o www.foodallergy.org (food recipes)
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
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
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.
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: 08/20/2012
Copyright © 08/14/2012 University of Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#5386
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