Eczema: The Itch that Rashes

One of the more common problems pediatricians treat is rashes. Many different things cause rashes but one very common cause is Eczema. 

What is Eczema? Eczema is a difference in the skin that causes it to lose moisture more quickly and easily than normal.  It also makes skin sensitive to chemical irritants.  Eczema may run in families but can be seen in children where there is no other affected family member.  An infant’s skin may look normal but feel dry and rough to the touch. Over time the skin becomes red and irritated in patchy areas and may even become scaly in appearance.  The dry skin is very itchy so older children often scratch constantly. This scratching further irritates the skin and children may scratch so much they bleed or develop skin infections.

The condition waxes and wanes, sometimes becoming hardly noticeable to very severe at different times. It tends to be worst in the colder drier months improving in the more humid summertime. Eczema also improves in the teenage years because hormones that are high in teens tend to make skin more oily (hence acne). While the dryness is all over, the really irritated patches tend to be in skin folds or creases and on the cheeks.

What can you do to treat eczema? It is first important to see a pediatrician to confirm this is indeed eczema and not a “look-a-like” such as ringworm, or contact dermatitis. Severe eczema flares often need treatment with prescription medications but, once under control ,there are many ways to minimize flare ups and control the dryness.

Skin prone to eczema loses moisture easily, so the key to controlling eczema is to moisturize the skin.  Moisturize, moisturize, moisturize and then moisturize some more. Choosing the right moisturizer however can be tricky. Eczema skin is also easily irritated by common chemicals such as fragrances and dyes. Many moisturizers and soaps marketed for “babies” are full of perfumes and dyes. They look and smell nice but on this sensitive skin they can do more harm than good. Find a lotion that is fragrance free, dye free, for sensitive skin. Use it head to toe at least twice a day and within 3 minutes of bathing to “lock in” moisture.  On really irritated skin or skin exposed to the elements (like the cheeks), an ointment will penetrate better and provide a better barrier to the elements.  Soaps and in fact anything that touches the child’s skin should be fragrance and dye free including laundry detergents, shampoos, and bath products. Fabric softener and scented dryer sheets are full of chemicals and should be considered off limits too. 

Other ways to help skin prone to eczema are to bathe less frequently especially in winter when the air is dryer, perhaps twice a week instead of daily. Bathe your child gently in warm (but never hot) water. Think more of soaking than bathing since bathing implies rubbing and scrubbing; a big no-no for sensitive skin.  When drying your child off don’t rub them with a towel, instead gently blot them dry with one.  When a child swims in a chlorinated pool or hot tub make sure to rinse them with clear water immediately afterward and moisturize from head to toe. 

If your child is over 2 years of age keeping them well hydrated will help the skin.  Encourage but never force a child to drink several cups of water a day. Children under 2 should not have free water so consult your pediatrician regarding ways to keep them well hydrated.  A cool mist humidifier in the home will help keep moisture in the air minimizing skin’s water loss.

Even if you faithfully use these strategies your child may still have some breakthrough rashes. Therefore, it is important to follow up with your pediatrician periodically to decide how best to deal with breakthrough events.  Still these simple steps can minimize the frequency and severity of this condition.

By Dr. Patricia Callahan, pediatrician, ThedaCare Physicians-Pediatrics in Appleton.