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Commentary: Explaining Eczema—Answering Parents’ Most Common Questions

08/10/19 Mercedes E. Gonzalez, MD, University of Miami Miller School of Medicine |Florida International University Herbert Wertheim College of Medicine|Pediatric Dermatology of Miami;

That old cliché “soft as a baby’s bottom” doesn’t always ring true. One in five children suffer from atopic dermatitis, a type of eczema, that causes itchy, red, scaly, and dry patches of skin. It’s most often seen in infants and young children, but it can affect people of any age.

And while it is common, it’s uncomfortable and can be embarrassing for older kids and adults. It’s sometimes a warning sign of other conditions worth keeping an eye on. Many parents have questions about what causes it and how to best treat it. Here’s a rundown of some of the most common questions parents have about eczema and what they need to know to keep the condition in check.

How can I tell if my child’s rash is eczema?

There are three tell-tale signs of eczema.

  • The location: In children under two, eczema tends to show up on the face and extensor surfaces of the extremities. For older kids and adults, it’s more commonly found in the folds of elbows and knees and on the hands.
  • The itch: Eczema tends to be itchier than other skin conditions such as psoriasis.
  • The flare-ups: Eczema is chronic, which means flare ups come and go over time.

Is eczema an allergy?

Eczema is not an allergic reaction to a specific food or substance. For example, in most cases, simply removing baby formula or other food like dairy from the diet will not eliminate the eczema.

But there is a close connection between the skin condition and allergies. Children with atopic dermatitis are more likely to have food allergies later in life. They’re also more likely to develop asthma in childhood and seasonal allergies in adolescence. More severe eczema makes this connection even stronger. Parents and pediatricians should pay close attention to this progression, often called the “atopic march.” It’s an opportunity to identify these issues earlier, and parents should talk to their child’s pediatrician about what to watch out for.

Is eczema genetic?

Eczema itself is not strictly genetic in the same way as purely genetic disorders such as sickle cell disease or cystic fibrosis. However, there is a genetic component to eczema. Children are much more likely to have eczema if a parent or sibling has it. Also, a family history of allergic conditions such as asthma or hay fever (also called allergic rhinitis with runny nose, sneezing, stuffiness) is a major risk factor for eczema.

What causes eczema flare ups?

The most common environmental triggers are sweat and heat. Other factors vary by individual, but can include:

  • Contact with rough fabrics like wool and carpet
  • Dust mites
  • Animal dander
  • Strong fragrances
  • Stress

Frequent extended baths can dry out the skin. Often, cutting down on play time in the tub and keeping baths to 10 minutes with slightly cooler water can help reduce eczema symptoms.

How should I treat my child’s eczema?

Because eczema is chronic, flare-ups will happen. Parents should focus on prolonging the amount of time between these flare-ups. In addition to avoiding triggers, here are three things parents can do:

  • Take good care of the skin: Bathe only once a day with a gentle cleanser (not strong soap) and warm (not hot) water.
  • Apply skin treatments: After bathing, apply a moisturizer. Pediatricians typically also prescribe a corticosteroid ointment or cream to be used once or twice a day. Use the treatments until the signs of eczema are completely gone. Too often parents stop treatment when there are signs of improvement and it’s not itching. However, stopping the treatment too early can cause recurring flare-ups.  
  • Watch for early signs of a flare-up: Often skin becomes itchy before spots develop. Watch for areas where children are scratching or complaining about. Treating those flare-ups early can minimize the amount of medication needed.

Are corticosteroids dangerous?

Corticosteroids are an important component of many eczema treatment strategies. Using a lot of corticosteroids on the skin for a long time can cause adverse effects, particularly in infants. However, when used in the appropriate dosage for the right amount of time, the potential for side effects is minimal. Parents should also know that there are also a number of new eczema treatment options currently being researched and developed. It’s important to have regular conversations with your child’s pediatrician or specialist. Talk to the doctor about emerging treatment options and how your child’s eczema is changing as they get older.

Refer to the Manuals page on eczema to learn more and prepare for a visit with your child’s doctor