Eczema or atopic dermatitis is a very common skin condition that usually starts in infancy and childhood. It is estimated that 10 to 15% of all children in the United States have some form of eczema, and it is estimated to affect 1 to 2% of all adults in the United States. It occurs about equally between males and females. The vast majority of cases start during the first year of life and 95% of the cases start before the age of 5. 

The symptoms of eczema usually start with itching and skin dryness. This can then lead to areas of redness, flaking and thickening of the skin. Often the first areas of the body affected are the front portion of the elbows, behind the knees, around the ankles, and under the neck. It then may spread to other areas of the skin including the arms, legs, torso, and face. In more severe forms the itching and discomfort disrupts sleep and can cause behavior problems in children for parents. It can lead to loss of work and school days as people seek medical treatment and their quality of life is affected. Its frequency seems to be increasing. 

Atopic dermatitis is frequently seen with other atopic diseases like asthma and allergies. In atopic diseases we see an increase in a certain type of antibody called IgE. So we say it is an IgE mediated disease process. Approximately 30% of people with eczema will have asthma and approximately 35% of people with eczema will also have nasal allergies. It is common for all three of these diseases to occur in the same person. Oftentimes children affected by eczema will see their symptoms come and go. They may have periods of time where they do not have any skin symptoms but then suddenly have flare-ups. These may be triggered by things in their environment such as certain foods, contact with things they may be allergic to, irritants such as some soaps or detergents, some skin infections, or even changes in the weather. Food triggers are common in early infancy and typically show up before 3 months of age. In young infants, it is usually due to dairy ingestion by a nursing mom, or the infant is allergic to their milk based formula. Either the mother can eliminate the offending food from her diet if nursing, or she can change the infant’s formula, and often the infant’s eczema will improve. Most children will outgrow this skin reaction and allergy by 2 years of age. Atopic dermatitis often is worse in the winter due to the cold temperatures and the extremely dry weather. 

Many times individuals with atopic dermatitis will see their symptoms disappear when they travel to warm and humid climates. Although, for some sweating can make things worse. The treatment for atopic dermatitis starts with trying to stop the itching and eliminate dryness. The more frequent a person scratches, the worse the skin and eczema become. We describe this as the itch-scratch cycle of atopic dermatitis. 

The initial mainstay of therapy is to use a good skin moisturizer 2 to 3 times a day to help keep the skin barrier intact and to lesson dryness. Applying the moisturizer immediately after a bath or shower when the skin is still moist is helpful. We will often recommend to not wash your child too frequently with soap as this removes natural oils from the skin and may increase dryness. I generally recommend using soap in the bath twice a week for young children. In our dry climate, bathing with just water and then applying the moisturizer can suffice for many young children. Giving diphenhydramine by mouth at bedtime for itching so a child can sleep is often helpful. Applying steroid creams to the skin can also help if there is redness or itching. For mild cases 1% hydrocortisone 2 to 3 times per day is often helpful. 

For more moderate to severe symptoms, a stronger prescription strength steroid cream may be recommended. These medications are highly effective and safe when used appropriately. The major potential side effect of stronger topical steroid creams is the possibility of thinning of the skin with prolonged use. There are some newer medications available called calcineurin inhibitors that are often effective as well. They are currently approved for children over 2 years of age and adults. They are not considered to be a first line treatment due to cost and ongoing studies about long term safety. 

Probiotics are currently being studied to see if they are beneficial but current research doesn’t support their use. Oil of primrose has not been found to be helpful in scientific studies. Certain Chinese herbs contain prescription medications like prednisone and have been associated with dangerous side effects especially in children and are not recommended. Other non-medical therapies include wearing soft clothing, typically cotton, against the skin. Avoid wool and heavy polyesters against the skin. Clothing should only be washed in mild detergents and you should avoid fabric softeners and bleach. Use a cool mist humidifier in the bedrooms during the winter when it is very dry and in the summer when the air conditioner removes moisture from the air. Only use moisturizing soaps for bathing and limit baths in young children to 2 to 3 times a week if possible. The good news is there are many treatment options available, and as most children age, their eczema will resolve. If you have further questions, please talk with your child’s doctor.

Dr. Mark Schane is a board certified pediatrician at Longmont Clinic.  He can be reached at 720-494-3133.