Childhood & Infant Eczema

Eczema is an itchy, scaly, irritating rash that can affect babies, children and adults. Ten percent to 15 percent of children in the United States have childhood eczema, including 1.5 million children under the age of 2. Eczema affects children of all ethnicities.

Although 90 percent of childhood eczema appears before the age of 5, the first symptoms typically begin appearing during infancy. While eczema treatment helps heal the initial occurrence, additional flare-ups are likely even with diligent attention. The good news is that 40 percent to 50 percent of children outgrow childhood eczema.

Types of Eczema

The most common form of eczema is atopic dermatitis, which literally translates as "inflammation of the skin." Atopic dermatitis accounts for about 50 percent of all cases of infant and childhood eczema.

Two other types of eczema seen in children are:

• Exogenous eczema (allergic contact dermatitis) arises from an allergic reaction, manifested as a rash.
• Irritant contact dermatitis results from skin contact with chemical agents.

A common type of infant eczema is infantile seborrhoeic eczema, better known as cradle cap. Although cradle cap neither itches nor causes discomfort, dandruff is generally the main symptom. Symptoms of infant eczema usually arise at the age of six months. If an infant is afflicted with cradle cap he will be afflicted with rashes in the arm pit and genital area.

Eczema Skin Symptoms

The characteristic symptom of eczema is a rash that is red, itchy and scaly. The affected skin becomes extremely dry, enhancing the itchiness. In some cases, the itch is so bad that chronic scratching causes the skin to look leathery. If the skin becomes infected, the skin may crack and the rash may develop a wet appearance.

While eczema can affect any part of the body, it occurs in some areas more often than others. Infant eczema typically occurs on the:

• arms
• face
• legs.

More visibly, eczema in older children typically occurs on the neck and upper chest. Sometimes, however, it appears on the:

• ankles
• insides of the elbows
• knees
• wrists.

Causes of Eczema

While researchers have not uncovered the exact causes eczema, they do recognize certain risk factors and triggers:

• After the initial outbreak, a number of factors can trigger an eczema flare-up. These factors include:
  • exposure to extreme temperatures
  • over-drying of the skin
  • skin irritation
  • stress.
• Infant eczema can be triggered or exacerbated by moisture from prolonged skin exposure to saliva or milk.

• The most prominent risk factor for childhood eczema is a family history of atopic dermatitis, allergies or asthma.

The Asthma and Allergy Connection

Not only is a family history of asthma and/or hay fever a risk factor for eczema, the two often affect an eczema sufferer as well. In fact, about two-thirds of eczema patients also have hay fever and approximately one-half have asthma.

Eczema Treatment

The symptoms of an eczema flare-up can be controlled and minimized with appropriate treatment. The goal of treatment is to minimize itching to prevent scratching.

Several medications can be used to treat eczema:

• Oral antihistamines may be recommended to help control itchiness, particularly at night.
• Topical immunosuppressant creams,applied directly to the rash until symptoms subside, are used only when flare-ups occur. They are considered second-line treatments and should be used only when other treatments fail to control symptoms.Primecrolimus cream (Elidel^®) and tacrolimus cream (Protopic^®) may be prescribed for children over 2years of age with moderate to severe eczema. On Jan. 20, 2006, the FDA approved updated labeling for both of these drugs. The new labels include a "black box" warning about an increased risk of cancer (skin cancer and lymphoma) with use. While a definite connection has not been established, neither has assured long-term safety.
• Topical steroids help reduce inflammation and itching. An over-the-counter topical steroid, such as 1-percent hydrocortisone cream, is the first line of treatment for an eczema flare-up. Stronger creams are available by prescription and are prescribed only when eczema causes severe symptoms.

Managing Childhood Eczema

While steroids control skin symptoms, they do nothing to improve the skin's health. Moisturizing your child's skin with eczema creams is one of the most important aspects of eczema management. Follow these steps to keep your child's skin well-moisturized and to minimize eczema skin symptoms:

• Alter Diet: If your child has food sensitivities, eliminate these foods from his diet. Common offending foods include milk, eggs, citrus fruits (oranges, tomatoes, etc.), mangos, nuts and chocolate.
• Keep Well-Ventilated: Avoid overheating and sweating, both common causes of eczema flare-up. Eliminate wool, polyester and synthetic fabrics from your child's wardrobe. Stick with cotton clothing and undergarments.
• Limit Sugary Drinks: Minimize sodas and sugary juices. These should not take the place of water consumption.
• Maintain a Regimen: Apply moisturizer throughout the day to eczema-prone areas.
• Minimize Allergens: Reduce the level of dust and pollen in the home. Control hay fever symptoms and asthma, if present. Use only fragrance-free, dye-free laundry detergent. Do not use fabric softeners or scented dryer sheets.
• Moisturize: Apply a cream moisturizer immediately after the bath. If your child has been prescribed a topical steroid or antihistamine as part of the treatment regimen, apply this first and then the moisturizer. You may have to experiment with creams to find the one that works best for your child. Recommended eczema creams include Eucerin^®, Cetaphil^® and Aquaphor^®.
• Stay Clean: Have your child take a 10-minute to 15-minute bath in lukewarm (not hot) water each day. Avoid harsh soaps and bubble baths. Use a mild moisturizing soap or soap substitute and a gentle shampoo and always rinse well. Pat the skin dry after bathing.
• Stay Hydrated: Ensure your child drinks enough water, about 1/2 ounce per pound of body weight or 2/3 ounce per pound if the child is very active. For instance, a child who weighs 50 pounds should drink 25 ounces of water, or about three cups. If the child is very active, he needs 33 ounces, or about four cups. A well-hydrated infant will have six to eight wet diapers per day.

Special Tips for Older Children

Here are some tips to help older children minimize their risk of getting eczema:

• Don't over-schedule your child's life, as stress can trigger or exacerbate eczema flare-ups. Encourage stress reduction techniques, such as meditation or yoga.

• Encourage participation in physical activities that will allow the skin to remain cool, including walking, biking, swimming, etc.

• If your child is old enough to help with household chores, such as cleaning the bathroom or washing the dishes, encourage him to wear gloves, then to wash his hands and apply a moisturizer.

• If your teen wears makeup, have her use only fragrance-free, non-comedogenic, hypoallergenic products.

• Teach acne-prone children and teens with eczema how to care for their skin without over-drying it.

Resources

Adams, S. (2002). Water consumption recommendations for kids. Retrieved Sept. 6, 2007, from the Healthforums.com Web site: https://www.healthforums.com/library/1,1258,article~9602,00.html.

Iannelli, V. (n.d.). Eczema treatments for kids. Retrieved Sept. 6, 2007, from the Pediatrics/About.com Web site: http://pediatrics.about.com/cs/conditions/a/eczema_kids.htm.

Kelly, R.B. ed (updated 2005).Eczema: Tips on how to care for your skin. Retrieved Sept. 6, 2007, from the American Academy of Family Physicians Web site: http://familydoctor.org/176.xml.

Quekett, J. ed. (2005). Eczema (atopic). Retrieved Sept. 6, 2007, from the BUPA.co.uk Web site: http://hcd2.bupa.co.uk/fact_sheets/Mosby_factsheets/eczema.html.

Reuters Health (2006). Pimecrolimus cream safe for infants with eczema. Retrieved Sept. 6, 2007, from the National Library of Medicine Web site: http://www.nlm.nih.gov/medlineplus/news/fullstory_29185.html.

U.S. Food and Drug Administration (2006). FDA approves updated labeling with boxed warning and medication guide for two eczema drugs, Elidel and Protopic. Retrieved Sept. 6, 2007, from the FDA Web site: http://www.fda.gov/bbs/topics/news/2006/NEW01299.html.