Eczema

What is eczema? 

Eczema, or atopic dermatitis (AD), is a noncontagious skin condition that causes itchy, red, and dry skin.  Children with atopic dermatitis go through periods of flare-ups followed by periods of remission from infancy through childhood.  Some kids outgrow it, though some still have eczema as adults. Adults with eczema may also have flare-ups, though they are typically less severe. 

For kids with more severe cases of eczema, your pediatric healthcare provider can help refer you to a dermatologist. The most common skin issue treated by pediatric dermatology specialists is eczema. 

Scratching may seem like it offers some relief, but it will generally make things worse. Common places for eczema are in elbow creases, behind knees, cheeks, hands and feet, and the buttocks.  

Eczema Signs & Symptoms

• Itchiness
• Dry skin
• Red patches/rashes 
• Scaly skin with crusty patches
• Oozing skin
• Swollen/sore skin
• Sensitive skin

Eczema Prevention

• Moisturize. Prevent eczema flare-ups by keeping the skin moisturized with a good lotion. We like CeraVe Moisturizing Lotion. Moisturize 3-4 times daily, including immediately after the bath. Apply moisturizer to the entire surface of the skin and use it for flare-ups sites throughout the day. It’s a good idea to keep a small tube of cream on you at all times. For severe spots, use a thicker moisturizer, like Aquaphor.
• Be picky about your clothes.  Choose fabrics like 100% cotton that are less irritating on the skin.  Switch up your laundry detergent to something gentle on the skin and do not use any fabric softeners. Avoid wool and synthetic fabrics. 
• Take a short bath in lukewarm water.  Too-hot water and staying in the tub too long can dry out the skin.  Keep the soaking to under 15 minutes and keep the water around room temperature. 
• Cleanse. We like Cetaphil Gentle Skin Cleanser or a similar product. Only use your skin cleanser every second or third day.  For cleansing in between washing, use only plain water on the skin. Immediately after a shower, bath, or washing hands, apply a thick layer of moisturizer. 
• Only wash hands when necessary.  Use mild, unscented soap. Dry hands thoroughly after washing. 
• Don’t scratch. It can make the itching worse and introduce infections.  Keep nails short and smooth with a file. Produce distractions for kids who are chronic scratchers. 
• Find triggers.  Keep a journal of foods, pet interactions, or pollen exposure that may be increasing flare-ups.  If you find that your child often has flare-ups when they eat a particular food, you can try taking that food out of their diet and see how they do. Stress can also be a trigger, so try to help your child develop coping mechanisms during times of stress. 

Common triggers include anxiety, stress, temperature changes, humidity, irritants, scratchy materials (wool), allergens, and infections.  

Eczema Treatment Options

Treatment of eczema typically involves finding a way to decrease the amount and severity of flare-ups.  If inflammation becomes so bad that you need to medicate, you can use certain ointments or creams.  However, do not use medicated ointments long-term.  For kids less than two years of age, we start with 1% hydrocortisone cream.  If that doesn’t work, we can advance to a prescription medication like triamcinolone creams. Use Protopic (tacrolimus) Ointment 0.03% or Elidel (pimecrolimus) Cream 1% for kids who don’t do well with anti-inflammatory cream.   These are only for flare-ups or severe problem areas. Use medication two times daily at most. 

Alternative Methods for Treating Eczema

Bleach Baths

According to the American Academy of Dermatology, bleach baths can help to decrease inflammation and infections associated with eczema. Bleach has antibacterial properties that can reduce the presence of harmful bacteria and viruses on the skin surface. Bleach can be drying for the skin, so it is essential to only use this therapy 2-3 times a week at most. 

How to Prepare a Bleach Bath 

Use regular 6% bleach without additives or higher concentrations.  As a general rule, do not use more than one teaspoon of bleach per gallon of water. For a full bathtub of water, this ends up being roughly 1/2 cup of bleach. 

1. Pour the bleach into running bath water and wait until the bath is full to get in. Hot water can also dry out skin, so it is important to use lukewarm water. Never submerge the head in a bleach bath.
2. Soak from the neck down for 5-10 minutes.
3. Drain the bathwater and gently rinse off skin in a lukewarm shower. Never apply bleach directly to the skin surface. 
4. Gently pat skin dry with a white towel to avoid staining good bath towels. 
5. If you have eczema medication, you can apply it after drying, followed by a moisturizer. 

Wet Wrap Therapy (WWT) for Eczema

Dr. Boguniewicz from National Jewish Health has developed a therapy called “wet wrap therapy” or WWT. After using this therapy, applied 2-3 times daily for four days, there were dramatic improvements in patients with eczema.  Using WWT, children soak in a tub of clear water (no soap or additives) for 15 minutes. While still damp, apply topical steroid medication to the affected area. Then, cover the child in a layer of damp clothing or cloth, followed by a layer of wet clothing. Do not remove the garment until it begins to dry out. Some may also re-wet the first layer of clothing for an extended period of soaking. 

This therapy appears to be more effective for children than medication alone.  Studies show that it keeps skin moist and improves the effectiveness of the topical medication. It also has a cooling, anti-itch effect on kids. Some studies found WWT to be effective. However, it can be time-consuming. You can purchase wet wrap garments online and in some drug stores for use, as well.

Ginger Compress 

A ginger compress can help to boost your kidneys and adrenal glands.  Ginger can be an excellent tool for your overall health. You can add ginger to your tea or in your foods, you can diffuse ginger essential oils, and you can apply a ginger compress to your skin.  

A ginger compress is created by applying ginger and heat to specific areas with a cup of hot ginger tea in the evening.

1. Make a pot of ginger tea, preferably with real, chopped ginger. 
2. While you allow the tea to cool to a comfortable temperature for skin application, do a self-massage with an unscented moisturizer or oil.  Focus on the kidney area, the back, and any flare-up areas.  
3. Dip a towel into the hot tea and squeeze out excess.  Test the tea first to be sure it isn’t too hot for the skin. 
4. Laying belly down, place the towel across the lower back, over the kidneys.  
5. As the towel cools, redip it.  You can place it back over the kidneys or on another problem area. 
6. Rest and relax. 

Dietary Changes

Avoid food that causes flare-ups, like dairy, wheat, citrus, spices, nuts, or soy.  Take Omega-3 fish oils with DHA and EPA to emoliate the skin from the inside out.  Eat anti-inflammatory foods like fish, apples, broccoli, cherries, spinach, or kale. Eat probiotic foods like yogurt, kombucha, sauerkraut, miso, tempeh, or kefir.  Try an allergy test to find food irritants. 

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