Is this your child's symptom?
- An itchy rash that your doctor told you was eczema
- Eczema is a chronic skin disease
- Recurrent flare-ups of severe itching occur
- The medical name for eczema is atopic dermatitis
Symptoms of Eczema
- The main symptom is itching. If it doesn't itch, it's not eczema.
- With flare-ups (itching attacks), the rash becomes red or even raw and weepy.
- Onset: Average onset at 3 months old. Range: 1-6 months old. Usually begins by 2 years old.
- Location: Classic eczema starts on the cheeks at 1 to 6 months of age. It can spread to the rest of the face. In infants, the outer surfaces of the arms and legs also become involved.
- In older children, eczema is found in the joint creases. The elbows, wrists, and knees are the most common places.
- The rash is usually the same on both sides of the body.
Cause of Eczema
- A type of dry, sensitive skin that children inherit.
- Flare-ups are from skin contact with soap, shampoo, pollen or other irritating substances.
- About 30% of babies with severe eczema also have food allergies. The most common is cow's milk.
- Over 10% of children have eczema. It's the most common skin condition of the first 10 years.
Triggers of Eczema Flare-Ups
- Soaps. Never use bubble bath. It can cause a major flare-up.
- Pollens. Keep your child from lying on the grass during grass pollen season.
- Animals. Avoid any animals that make the rash worse.
- Foods. If certain foods cause severe itching (flares), avoid them.
- Wool. Avoid wool fibers and clothes made of other scratchy, rough materials.
- Dry Air. Use a humidifier if the air in your home is dry.
- Herpes Virus Infection (Serious). Keep your child away from anyone with fever blisters (cold sores). The herpes virus can cause a serious skin infection in children with eczema.
- Eczema is not caused by laundry soap you use to wash clothing.
- Mild: doesn't interfere with normal activities
- Moderate: interferes with child care or school, sleep, or other normal activities
- Severe: constant itching that can't be controlled
Food Allergy and Eczema Flare-Ups
- Food allergies are a factor in 30% of young children with severe eczema. This factor is mainly seen in babies.
- The main allergic foods are cow's milk and eggs.
- The main symptoms are increased skin redness and itching. Some parents report these symptoms start during or soon after the feeding.
- The eczema becomes easier to control if you avoid the allergic food.
Diagnosing Food Allergy and Eczema Flare-Ups
- Your child's doctor may suggest the steps listed below:
- Remove the suspected food or foods from your child's diet for 2 weeks. The eczema should greatly improve.
- Then give your child that food when the eczema is under good control. This is called a "challenge."
- If the food is causing flare-ups, the eczema should become itchy and red. The flare-up should occur quickly within 2 hours of eating the food.
- If this occurs, avoid giving this food to your child. Talk to your child's doctor about the need for any food substitutes.
- If the eczema does not flare-up, your child isn't allergic to that food.
When to Call for Eczema
Call 911 Now
- You think your child has a life-threatening emergency
Call Doctor or Seek Care Now
- Fever in baby less than 12 weeks old. Caution: do NOT give your baby any fever medicine before being seen.
- Looks infected (spreading redness, pus, soft oozing scabs) and fever
- Many small blisters or punched-out sores occur
- Your child looks or acts very sick
- You think your child needs to be seen, and the problem is urgent
Contact Doctor Within 24 Hours
- Eczema is very painful to touch
- Looks infected but no fever
- Itching is severe after using steroid cream for more than 48 hours
- You think your child needs to be seen, but the problem is not urgent
Contact Doctor During Office Hours
- Itching flare-ups occur often
- Eczema diagnosis was never confirmed by a doctor
- You have other questions or concerns
Self Care at Home
- Eczema with no other problems
- Questions about prevention of eczema flare-ups
Treatment for Eczema
- What You Should Know About Eczema:
- Eczema is a chronic skin disease. So, you need to learn how to control it.
- Itching attacks (flare-ups) are to be expected.
- The goal is to treat all flare-ups quickly. Reason: To prevent skin damage.
- Here is some care advice that should help.
- Treatment is Based on Severity of Eczema:
- Mild Eczema. Just need to use a moisturizing cream and to avoid flare-up triggers.
- Moderate Eczema. Also need to use a steroid cream and bedtime allergy medicine.
- Severe Eczema. Also may need antibiotics for a skin infection caused by Staph bacteria. This infection starts in open skin from severe itching.
- Moisturizing Cream or Ointment for Dry Skin:
- All children with eczema have dry sensitive skin.
- The skin needs a moisturizing cream (such as Eucerin) Apply once or twice daily.
- Apply the cream after a 5 or 10-minute bath. To trap moisture in the skin, apply the cream while skin is still damp. Do this within 3 minutes of leaving the bath or shower.
- The steroid cream should be applied to any itchy spots first. Then use the moisturizing cream as the top layer.
- While most parents prefer creams, moisturizing ointments are sometimes needed in the winter. An example is Vaseline.
- Caution: Never stop the moisturizing cream. Reason: The rash will come back.
- Steroid Cream or Ointment for Itching:
- Itchy skin is the main symptom of eczema.
- Steroid creams or ointments are essential for controlling red, itchy skin.
- Apply steroid creams only to itchy or red spots (not to the normal skin).
- Most children have 2 types of steroid creams. (1) A mild steroid cream is used to treat any pink spots or mild itching. This is often 1% hydrocortisone cream (such as Cortaid). No prescription is needed. (2) Another stronger steroid cream is needed to treat any spots with severe itching. This is a prescription steroid cream such as Synalar. Never apply this stronger cream to the face.
- Apply these creams as directed or 2 times per day.
- After the rash quiets down, apply it once per day. After 1 good week just use moisturizing cream.
- Bathing - Avoid Soaps:
- Give one bath a day for 10 minutes in lukewarm water. Reason: Water-soaked skin feels less itchy. Follow the bath with a moisturizing cream (such as Eucerin) to all the skin.
- Avoid all soaps. Reason: Eczema is very sensitive to soaps, especially bubble bath. There is no safe soap for young children with eczema. They can be cleaned using warm water.
- Allergy Medicine for Itching at Bedtime:
- Some children with eczema need an allergy medicine by mouth at bedtime.
- Reason: Scratching in bed can cause severe skin breakdown. It may also interfere with falling sleep.
- Give the med your child's doctor wanted you to use for itching.
- If none was suggested, you can try Benadryl at bedtime until you talk with your doctor. No prescription is needed. Age limit: 1 and older.
- Caution: do not use Benadryl for more than a few days.
- Itching Attack - Shower to Remove Irritants:
- Playing in the grass, being around animals, or swimming can cause increased itching.
- For itching from these causes, give your child a quick shampoo and shower.
- Itching Attack - Treatment:
- At the first sign of any itching, use the steroid cream. Put it on the areas that itch. If unsure, apply 1% hydrocortisone cream (such as Cortaid). No prescription is needed.
- Keep your child's fingernails cut short and smooth.
- Ask older children to try not to itch, but never punish for itching.
- For constant itching in young children, cover the hands with socks or gloves. Use for a day or until the itching is brought under control. Provide extra cuddling during this time.
- Return to School:
- Eczema cannot be spread to others.
- Children with eczema do not need to miss any child care or school.
- What to Expect:
- Eczema is a chronic condition. Around the teen years, about half get over their eczema.
- Many children who have severe eczema as babies develop asthma and nasal allergies.
- Call Your Doctor If:
- Itching is not under control after 2 days of steroid cream
- Rash looks infected (spreading redness, yellow scabs or pus)
- You think your child needs to be seen
- Your child becomes worse
Prevention of Eczema Flare-Ups
- Tips to Help Prevent Flare-Ups:
- Some flare-ups of eczema cannot be explained. But others are triggered by things that can be avoided.
- Avoid chlorine in swimming pools and spas, harsh chemicals, and soaps.
- Never use bubble bath. It can cause a major flare.
- Keep your child off the grass during grass pollen season.
- Avoid any animals that make the rash worse.
- If certain foods cause severe itching (flares), avoid them.
- Wear clothes made of cotton or cotton blends as much as possible. Avoid wool fibers and clothes made of other scratchy, rough materials. They make eczema worse.
- Try to avoid excess heat, excess cold and dry air (use a humidifier). Avoid over-dressing. Heat can make the rash worse.
- Caution: Keep your child away from anyone with fever blisters (cold sores). The herpes virus can cause a serious skin infection in children with eczema.
- Call Your Doctor If:
- You have other questions or concerns
And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.
Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.
Last Reviewed: 10/07/2022
Last Revised: 01/13/2022
Copyright 2000-2022. Schmitt Pediatric Guidelines LLC.