An Overview of Eczema (Atopic Dermatitis) in Children

Prevent Flares and Ease Itchy Rashes

Child with eczema

Paul Whitehill / Science Photo Library / Getty Images

In This Article

Eczema, also known as atopic dermatitis, is a common childhood skin condition. Around 10% of kids in the U.S. have this skin disease, according to the National Institutes of Health. Eczema causes an itchy, red, scaly rash. In infants, the rash appears most often on the cheeks, chin, and forehead. In children, the rash commonly develops on the insides of the elbows and behind the knees. Although it's possible to get the rash under control, it's likely to come back periodically in what is called an eczema flare.

Symptoms

The telltale symptom of eczema is an itchy rash that typically makes a debut in early infancy but can first show up as kids as old as 5. It's sometimes mistaken for other rashes, such as contact dermatitis, heat rashseborrheic dermatitis, and psoriasis, but it does have unique characteristics.

A rash caused by eczema usually looks like:

  • Patches of rough, red, itchy skin
  • Small bumps
  • Scaly, dry patches
  • Small, fluid-filled blisters called vesicles

The rash can develop in infants at just a few weeks old. It most often begins on the cheeks, between the ages of 1 month to 6 months old. Eczema can progress to the chin, forehead (and sometimes scalp).

Older babies, those older than 6 months, may also develop the rash on their outer arms, elbows, knees, and legs. Eczema does not generally appear in the diaper area.

In children 2 years old and older, the rash happens less often on the face and instead develops in the creases of the elbows, behind the knees, and on the ankles and wrists. In school-aged children, eczema is common on the hands as well.

It's important to note that eczema can develop anywhere on the body, but those are considered the "classic" locations.

No matter where eczema develops, it itches, often quite intensely. Children, in particular, are prone to scratching. Unfortunately, scratching at this rash makes it worse.

Eczema is not contagious. Your child did not catch the condition from somebody else, nor can they pass it along to another person.

Call your child's pediatrician right away if you notice signs of infection, including:

  • Increased redness, swelling, or pain
  • Crusting, especially yellow or honey-colored
  • Drainage of pus, or pus-filled blisters
  • Fever, or flu-like symptoms

You can also call your doctor if you're concerned for any reason.

Eczema vs. Cradle Cap

Cradle cap is another type of dermatitis, called seborrheic dermatitis. Like eczema, it is an incredibly common childhood rash. It looks very similar to eczema and can appear in some of the same areas.

Cradle cap causes yellowish flakes or crust on the scalp, eyebrows, or on and around the ears. Eczema can also cause flaking in these areas, but eczema rashes cause the skin to be red and inflamed, as well as dry and scaly. Eczema scales are not likely to be yellow.

The scales of cradle cap can be softened with the application of mineral oil and gently brushed away. In contrast eczema flakes can't be, nor should they be, brushed or scrubbed away.

Cradle cap generally goes away on its own by the time the infant is 12 months old.

Infants can have both cradle cap and atopic dermatitis at the same time.

Causes

There isn't one factor alone that has been specifically implicated in causing eczema. Instead, there seems to be a host of components that influence eczema development.

It's believed that eczema is, at least in part, caused in part by an overactive immune response.

The immune system overreacts to both internal and external stimuli, triggering a rash.

Eczema has also been linked to mutations in filaggrin. Filaggrin is a protein that is responsible, in part, for creating a strong skin barrier.

When this protein is deficient, the skin barrier is compromised. It can't hold onto moisture as it should, causing the skin to dry out. It also allows substances to pass through the skin barrier more easily, leading to allergies and irritation.

Risk Factors

There are several factors that influence a child's risk of developing eczema. They include:

  • Children whose parents have (or have had) eczema: There does seem to be a genetic component as eczema does run in families.
  • Personal or family history of asthma, or allergies (including food allergies): Eczema is linked to these conditions, which is why asthma, allergies, and eczema is sometimes referred to as the triad.
  • Urban living: Some studies have suggested that air pollution and other environmental factors children living in urban areas are exposed to may raise the risk of eczema.

Triggering Factors

Once a child has eczema, the skin must be treated carefully. There are many things that the child may come in contact with that can trigger a flare.

Triggers don't cause eczema, but they do make existing cases worse. Avoiding trigger factors as much as possible is a key component of treatment.

Every child has there own unique triggers, but some of the most common include:

  • Allergens such as pollen, dust, and dander
  • Harsh or highly-fragranced soaps, lotions, and skin care products
  • Laundry detergents
  • Stress
  • Cold, dry weather
  • Sweat
  • Rough fabrics, like wool or nubby knits
  • Certain foods, especially eggs, dairy, and nuts
  • Dry skin

Diagnosis

Diagnosing your child's eczema is usually fairly straightforward. The pediatrician can typically diagnose eczema based on the appearance of the rash and your child's medical history.

If there is any doubt, or if there is a concern of allergies, the physician may recommend:

  • Blood tests to check for allergies
  • KOH prep test to check for fungal infections
  • Skin prick tests or patch tests to check for allergies

These tests do not diagnose eczema itself, as there is no specific diagnostic test for eczema. Instead, these help to rule out other skin conditions that may be causing your child's rash.

On the bright side, if your child is diagnosed with eczema now in all likelihood they won't have to deal with it forever.

For most kids, eczema eases up or even disappears entirely as they get older.

In the meantime, there are plenty of treatment options as well as strategies for preventing rashes from flaring up.

Treatment

How you deal with your child's eczema will depend in part on how old your child is. For very young infants, pediatricians often take the watch-and-wait approach. Besides keeping the skin well-moisturized, infants may not need any treatment at all as eczema can go away over time.

If your child does need treatment, your pediatrician will steer you toward the best medication for your child.

Moisturizing Creams

Creams and ointments are the cornerstone treatment for eczema. Keeping the skin well-moisturized protects the skin from future flareups and helps existing rashes heal.

Choose a mild, fragrance-free product like Eucerin, Aquafor, or Aveeno. Apply at every diaper change, or several times a day for older children, and immediately after a bath.

If you need help choosing a product, ask your pediatrician or pharmacist for recommendations.

Wet Wraps

Wet wraps can help ease eczema flares and relieve itching. This is especially helpful for bedtime if itching is keeping your child up at night.

Cool, damp cloths are used to wrap around the affected area, and covered with dry strips of cloth. Your pediatrician will give you precise instructions on how to do so, if wet wraps are recommended for your child.

Topical Steroids

If simple moisturizing treatments just aren't enough, topical steroids are the next step. These are a go-to for eczema flares. They range from over-the-counter hydrocortisone creams, which are so mild you can use them on your child's chubby little cheeks, to stronger mid- and super-potent ones that require a prescription.

If used for too long, though, these can cause thinning of the skin and stretch marks. Prescription topical steroids should never be applied to the face or be covered by a bandage or diaper.

Immunomodulators

Immunomodulators, also called topical calcineurin inhibitors, are non-steroid medications. These are also applied directly to the skin (twice a day) and can be used anywhere on a child's body, including on the face.

They have another advantage too: They sometimes can snuff out a pending flare if used at the first sign of itching or a rash. The most common of these steroid-free medications are Elidel (pimecrolimus cream) and Protopic (tacrolimus ointment).

Antihistamines

If itching is keeping your child awake at night, a sedating antihistamine such as Benadryl (diphenhydramine), may help them sleep. (An angry itch also can be tamed with cold compresses or wet dressings.)

Bleach Baths

In some cases that aren't responding well to traditional treatment, your physician may recommend giving your child a dilute bleach bath. This can help reduce the number of bacteria on the skin, allowing the skin to heal.

Bleach baths should only be given under a doctor's recommendation.

Treatments for Recalcitrant Eczema

For stubborn eczema that doesn't respond to any of the standard treatments, there are more aggressive ones, including oral steroids, ultraviolet light therapy, and immunosuppressive drugs, like cyclosporin. Sometimes kids get skin infections along with stubborn eczema, in which an antibiotic may be needed.

Caring for Your Child's Skin

Eczema flares are especially likely to happen in winter when the air is dry, and in summer if a child spends a lot of time swimming or gets overheated. During the periods of time when your little one's eczema is most likely show up, the first step you can take to prevent that from happening is to avoid anything you know is likely to prompt a flare.

The second strategy for preventing eczema flares is to keep your child's skin moist and supple. Overly dry skin is like an open invitation for eczema to settle in, so do all you can to prevent it.

  1. Give your child a daily bath. Use lukewarm water and a mild, moisturizing soap or soap substitute. Hot water and harsh soaps can exacerbate dry skin. Keep them, in the water for 10 minutes or so. 
  2. Lather on the moisturizer. Do this as soon as you lift your little one out of the tub. Blot them with a towel so they aren't dripping wet, but don't rub them completely dry. Apply moisturizer while their skin is still damp—within two or three minutes. If you're also using a topical medication, apply that first. 
  3. Choose the right product. A greasy ointment, such as petroleum jelly, will work best. Some creams can do the trick, but steer clear of lotions and oils. You may have to try a variety of products to find the one that works best for your child. If you can't find an over-the-counter product you like, your pediatrician may prescribe a non-steroidal cream.
  4. Moisturize multiple times. Besides after a bath, grease up your kid at least once or twice more during the day.

A Word From Verywell

Eczema can be exasperating because there's no cure and it can be tricky to treat. It's a little like a boomerang: while you can get the rash to clear up it's likely to come back.

Treatment can take trial and error, from discovering your child's triggers to learning which treatments they respond to best. With patience and guidance from your child's pediatrician, most cases of childhood eczema can be successfully managed.

Was this page helpful?

Article Sources

  1. Silverberg JI, Simpson EL. Associations of childhood eczema severity: A US population based study. Dermatitis. 2014 May-Jun; 25(3): 107–114.

    doi:10.1097/DER.0000000000000034


Additional Reading