Amy Nelson, MMSC, PA-C
As parents, we all want to do our best for our children. We want them to be safe, healthy, and happy. When our children have a health issue, we will go out of our way to try to help them. Dermatology issues such as eczema are prevalent in children. At Advanced Dermatology & Skin Surgery, we aim to help parents obtain the tools necessary to help their children deal with any dermatology issue.
As a quick overview, eczema is an inflammatory skin condition that causes itchiness, rashes, scaly patches, blisters, and skin infections that can manifest as early as infancy and progress into adulthood. There are several types of eczema – atopic dermatitis, contact dermatitis, seborrheic dermatitis (also known as “cradle cap” in infants), and dyshidrotic eczema, with the most common being atopic dermatitis. According to the National Eczema Association, 13% of all children under 18 in the United States are affected by eczema. This type of dermatitis can appear as early as in the first six months in children. It is not a contagious skin disease but can be extremely itchy and uncomfortable for your child and lead to skin infections and other issues.
Why Does My Child Have Eczema?
Eczema is believed to be caused by a problem with the skin barrier. Many children with eczema do not have enough of a particular protein called filaggrin which helps the skin form a strong barrier between the body and the outside environment. Skin with too little of this protein struggles with retaining water and keeping out bacteria and environmental irritants. Both a person’s genes and environment play a role in eczema. It often runs in families and tends to occur with other allergic conditions such as asthma and seasonal allergies.
Eczema symptoms can come and go. When the symptoms flare up, it is usually the child’s immune system reacting to something. These are called triggers. Triggers for eczema can be either extrinsic (from outside the body) or intrinsic (from inside the body.) Evidence suggests that people with infantile eczema have a gene mutation responsible for helping our bodies maintain a healthy protective barrier. External triggers include, but are not limited to:
- Dry skin
- Stress
- Airborne allergens such as pollen, mold, dust mites, and pet dander
- Skin care products, including certain moisturizers and soaps with fragrances
- Cleaning products such as detergents
- Food allergies
- Abrasive fabrics, especially rough wool fabrics
- Extreme temperatures (hot or cold)
- Sweat
If you suspect your child has eczema, it is best to consult with a Board-Certified Dermatologist. Dermatologists specialize in skin conditions and have experience diagnosing and treating eczema. They can look at your child’s rashes, ask about symptoms, family history, and the child’s past medical history to rule out other conditions and recommend a course of action.
It is important to note that eczema has a strong association with other allergic diseases such as hay fever, asthma, food allergies, alopecia, chronic urticaria, and skin infections. There is also emerging data linking eczema to mental health disorders such as depression, substance abuse disorder, and ADHD.
How Does Eczema Present in Children of Different Ages?
In babies, eczema usually manifests on the scalp and face. Red patches may often occur on the cheeks, forehead, and around the mouth. It can also appear on their torso or body but usually spares the diaper area. If your child has a rash in that area, it can generally be attributed to a diaper rash.
In young and school-age children, the rash often moves to the creases of the elbows, on the backs of the knees, on the neck, and around the eyes.
Treatments Available
Eczema is not a curable skin condition, but treatments are available that help with the symptoms and keep flare-ups to a minimum. Treating eczema includes maintaining a healthy skin barrier through the use of gentle products such as soap-free cleansers and applying thick moisturizing creams, particularly after bathing.
Your Board-Certified Dermatologist will recommend a treatment based on the child’s age, the severity of the symptoms, and the location of the rashes. Prescription treatments include topical treatments applied to the skin or some type of oral medication.
Topical steroid – commonly used as a cream or ointment to ease skin inflammation, suppressing the immune response. This also allows relief from the itchiness. Make sure to follow the directions from your Provider since these prescriptions come in different strengths and, when misused, can cause more problems than solutions.
Topical nonsteroidal anti-inflammatories include medicines that change how the skin’s immune system reacts, relieving pain and inflammation.
Phototherapy – this treatment exposes the child’s skin to ultraviolet (UV) light and safely and effectively treats eczema, even in children. Your Provider might prescribe a certain number of treatments per week, depending on the individual needs.
Injectable monoclonal antibodies – this treatment is sometimes used on patients where eczema has not been controlled with topical prescription therapies or where such therapies are not advisable.
Janus kinase inhibitors (JAKs) – the Food and Drug Administration (FDA) has approved a handful of JAK inhibitors for treating moderate to severe eczema. These topical or oral treatments have been shown to significantly reduce the severity of skin lesions and rapidly reduce itchiness.
What can I do to Help my Child?
The following are some helpful suggestions for parents dealing with a child’s eczema:
- Bathe your child in warm, not hot water, and limit your child’s time in the bath to 5 to 10 minutes.
- Use cleanser only when needed and always a soap-free, fragrance-free cleanser.
- Gently pat your child’s skin dry and immediately apply moisturizer or medication to damp skin.
- Attempt to apply moisturizer twice daily to the affected areas.
- Keep your child’s fingernails short and smooth to prevent them from damaging their skin from scratching. If your child is scratching at night, you may want to consider some comfortable gloves for them to wear.
- Keep temperature and humidity levels comfortable in your home and bedroom.
- Use a laundry detergent made for sensitive skin.
- Purchase clothes without tags or any abrasive materials. Clothes should be loose-fitting and be made from soft, breathable fabrics such as silk, cotton, or bamboo.
- Get rid of known allergens in your household, and help your child avoid allergens such as pollen and tobacco smoke.
The top tips for relieving itchy skin related to eczema that we give our patient’s parents are to apply a cool compress to itchy skin using a damp towel or washcloth. You can add colloidal oatmeal to a bathtub and let your child soak for 10 to 15 minutes, making sure to apply moisturizer within three minutes of bathing. It is vital to apply a thick moisturizer such as petroleum jelly to damp skin upon exiting the bathtub.
Should I get my Child Tested for Allergies?
Allergy testing is indicated if and when you have been following the eczema management plan created by your child’s dermatologist. Despite sticking to the plan, your child’s eczema remains the same or only improves slightly.
Another reason for obtaining allergy testing would be if your child’s eczema flares every time you feed them certain foods.
A third reason would be if your child is not meeting their height or weight benchmarks determined by their well-child exams.
Advanced Dermatology & Skin Surgery’s Providers, including our Board-Certified Dermatologists, Certified Physician Assistants, and Nurse Practitioners, are highly qualified and motivated to help your child with any skin condition. We can diagnose their condition and work with you to find a treatment plan that works specifically for them. Please book an appointment with us at any of our four locations in the Greater Spokane and Inland Northwest area.
About the Author:
Amy Nelson, MMSC, PA-C, is board-certified by the National Commission on the Certification of Physician Assistants. Her specialties include medical dermatology, skin cancer treatments, and cosmetic dermatology. She is passionate about working with her patients to help them achieve their skin health goals.