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Eczema 101: The Basics Of Managing Your Child's Itchy Rashy Skin
Has your child been diagnosed with "eczema"? "Eczema" is a general term used to refer to a group of skin conditions characterized by itchy red rashes. Frequently, the term "eczema" is used when referring to the skin condition known as atopic dermatitis. Atopic dermatitis is a red, itchy rash that may be seen in association with allergies and/or asthma. It is extremely common and tends to wax and wane. Some common triggers include illness, stress, and changes in the weather or temperature, although there are many others. The cause of atopic dermatitis is not well-understood. At its most basic level, it appears to be a problem of abnormal barrier function of the skin. Studies have shown that the skin of people with atopic dermatitis has abnormalities that decrease its ability to provide an adequate barrier between the internal and external environments. This abnormal skin is comparable to a brick wall with holes that allow moisture to escape and environmental irritants to get in. Therefore, the skin of people with atopic dermatitis tends to be extremely dry and sensitive. Atopic dermatitis cannot be cured, but it can be controlled. Most children with atopic dermatitis tend to gradually improve and many will outgrow it, usually over a period of years. In order to optimize control over the condition, a proper daily skin care regimen is of paramount importance. A daily bath or shower is recommended. It is a common myth that daily bathing worsens atopic dermatitis. This is not true. This step puts moisture in and rinses irritants and germs off of the skin. However, the bath or shower should be short (preferably less than 10 minutes) and not too hot. The skin should be washed with a small amount of a gentle, fragrance-free, dye-free cleanser. For example, Dove™ for Sensitive Skin or Aveeno™ fragrance-free cleanser are good choices. After bathing, the skin should be patted dry with a soft cotton towel and a heavy bland moisturizer should be applied to all skin to seal in the moisture.
The type of moisturizer you select is very important. It is best to use an ointment (like plain unscented Vaseline™ or Aquaphor™) or a heavy cream (like Vanicream™, CeraVe™ cream, or Aveeno™ Baby Ezcema Therapy Moisturizing cream, to name a few). Lotions are undesirable because they contain more water and tend to contain more preservatives and ingredients that can sting on open skin or cause irritation. In general, moisturizer should be applied to the skin at least twice daily, but more often if your child's skin seems unusually dry or if their eczema is more severe. If you have been given prescription topical medications for your child's eczema, those products should be applied sparingly to the affected areas prior to the application of moisturizer. I typically recommend application of topical medications twice daily, but you should follow the instructions given by your child's doctor.
It is very important that medications are applied only to areas of active eczema and never to areas of normal skin. However, moisturizer should be applied to all skin, including over the areas where you have applied medication. This time of year, I am frequently asked if swimming is OK for children with atopic dermatitis. Generally speaking, swimming should not be a problem for children with atopic dermatitis. In fact, some children seem to improve dramatically with regular swimming. This may be because chlorinated water decreases germs on the skin that can play a role in eczema flares. However, chlorinated water can be very drying to the skin, so it is important to rinse the skin thoroughly and apply a generous layer of a heavy moisturizer as soon as possible after swimming. For most children, taking these steps will prevent significant flares of atopic dermatitis related to swimming. In my practice, I see many children with atopic dermatitis on a daily basis. I understand that dealing with this chronic skin condition can be very challenging and frustrating for parents. If your child has eczema, you may feel like you have tried "everything", but nothing works. The recommendations I have outlined here are very helpful for many patients I see. I sincerely hope they will help your child and I welcome your questions.