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
Table of Contents

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. In infants, the characteristic itchy, red, scaly 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 your child's eczema 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 intensely itchy rash that typically makes a debut in early infancy but can first show up in kids as old as 5. It's sometimes mistaken for other rashes, such as contact dermatitis, heat rashseborrheic dermatitis, and psoriasis, but it can have some 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 (vesicles)

Children, in particular, are prone to scratching eczema rash. Unfortunately, this only makes it worse.

Affected Areas

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

Babies older than this 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 of age 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-age children, eczema is common on the hands as well.

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

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, removed in this way.

Cradle cap generally goes away on its own by the time the infant is a year old.

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

Eczema makes skin more susceptible to infection. 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

Causes

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

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.

At least in part, eczema is believed to be caused by an overactive immune response to both internal and external stimuli, which triggers a rash.

Eczema has also been linked to mutations in filaggrin. 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:

  • Parents who 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 are 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.

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 that can do so. Instead, these help rule out other skin conditions that may be causing your child's rash.

Thankfully, 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 and avoiding triggers, 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.

Trigger Avoidance

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 ones 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

Moisturizing Creams

Creams and ointments are the cornerstone treatment for eczema. Keeping the skin well-moisturized protects the skin from future flare-ups 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 at bedtime if itching is keeping your child up at night.

This involves wrapping cool, damp cloths around the affected area and covering them 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. They range from over-the-counter hydrocortisone creams 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.

Never use a cream or ointment prescribed for someone else on your child.

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 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 ease discomfort and help them sleep.

Bleach Baths

If a case is not 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 be drawn carefully and 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 options, including oral steroids, ultraviolet light therapy, and immunosuppressive drugs, like cyclosporin.

In cases of skin infections associated with stubborn eczema, a child may also need an antibiotic.

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.

Aside from doing what you can to help your child avoid triggers, it's imperative that you make an effort to keep your child's skin moist and supple:

  • 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. Limit baths to about 10 minutes.
  • Lather on the moisturizer: Blot them with a towel so they aren't dripping wet, but don't rub them completely dry. Apply moisturizer while the skin is still damp (within two or three minutes). If you're also using a topical medication, apply that first.
  • Repeat several times a day: Keep creams handy and re-apply at least once or twice more during the day. (For prescription topicals, follow provided dosing instructions.)
  • Keep your child's skin products just for them: Store the special creams and ointments your child needs for their delicate skin in a place that others in the family aren't likely to grab and use them. (While most OTC options might be able to be used safely, you don't want to get caught short when a flare occurs.)

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 may be able to get the rash to clear up, it's likely to come back. Treatment can take trial and error. But with patience and guidance from your child's pediatrician, most cases of childhood eczema can be successfully managed.

Was this page helpful?

Article Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial policy to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  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