Let's Talk About Eczema and Kids
Itchy skin can be irritation nation for young children. Understanding the ins and outs of this tricky condition can help you help them find comfort.by Jennifer Tzeses Health Writer
If the toddler population in the U.S. had a tagline, it would read “There’s a whole lot of itching going on.” Why? In a word, eczema. Among the under-five set, this chronic skin condition is everywhere. And while it’s not life-threatening, try telling that to any parent who has witnessed the shrieks and sobs of a child experiencing out-of-control itchiness. The good news is that there are some pretty effective ways to help your youngster get that uncomfortable skin under control. Here’s what experts say works best.
Our Pro Panel
We went to some of the nation's top experts in eczema to bring you the most up-to-date information possible. Look who's on your side:
Emma Guttman, M.D., Ph.D.
Director of the Center for Excellence in Eczema
Mount Sinai Hospital
New York, NY
John Anthony, M.D.
Dawn Marie R. Davis, M.D.
Professor of Dermatology and Pediatrics Division Chair, Clinical Dermatology
Potentially. There is no cure, but some people with childhood onset may see their symptoms improve as they get older. According to the American Academy of Dermatology, about 50% of kids with atopic dermatitis go on to have a milder form of the disease as an adult.
While it may be tempting to want to add a bath oil or hydrating soak to your baby’s bath water, additives (other than highly diluted bleach, which studies have found can soothe symptoms) have not been shown to have any benefit in easing eczema symptoms in children.
The injectable medication, made from proteins derived from living cells or tissues, is approved by the U.S. Food and Drug Administration for treating adolescents ages 12 years and older with moderate to severe atopic dermatitis that’s unresponsive to topical prescription therapies. It works by preventing two proteins that trigger eczema from binding to cell receptors, which stops the immune system from causing an inflammatory reaction. As of yet, dupilumab is not recommended for children under 12.
No, but it’s easy to confuse them. Cradle cap, or seborrheic dermatitis, causes patchy scaling or thick crusts most commonly on the scalp that look a lot like eczema. The difference is it’s much less red and scaly and won’t itch. (Obviously, your infant can’t tell you it’s not itchy, but you may observe them scratching less.) Unlike eczema, cradle cap usually clears up on its own in a few weeks or a few months. Washing your baby's scalp daily with a mild shampoo can help you loosen and remove the scales.
Remind Me, What’s Eczema Again?
Eczema is a non-contagious inflammatory skin condition that causes red, raw, and itchy skin. The desire to scratch is so great that many people with eczema have scabs or even scars from making their skin bleed.
While the disease can affect people of all ages, it’s most common in kids—in fact, nine million children in the U.S. are dealing with eczema right now.
There are seven types of eczema, the most common being atopic dermatitis, which first strikes in childhood. According to the American Academy of Pediatrics, it’s the most common skin problem treated by pediatric dermatologists: About 65% of kids with eczema develop symptoms of atopic dermatitis before age one and about 90% developing symptoms by age five. To plug that into the big picture, about 15% of all children have eczema compared with only 2% to 4% of adults. So, basically, kids are the OG eczema patients. Word.
Symptoms of Eczema in Kids
Keep in mind, eczema is a real head (and body) scratcher. It’s not a one-symptom-fits-all condition, and your child’s brand of eczema might look a little different from every other kid in the sandbox. The general symptoms include red, itchy skin and rashes, which can ooze or be very dry. As for where it pops up? That depends on your baby’s birthday.
Infants (up to 6 months)
Yup, it starts young. Eczema can occur in infants as little as two or three months old. Often making an appearance as a rash that causes dry, scaly, itchy skin, it can bubble, ooze, and weep fluid. It commonly appears on the scalp and face, particularly the cheeks, and potentially other areas of the body.
Babies (6 to 12 months)
For this age group, eczema usually shows up as a rash with itchy, scaly patches on the elbows and knees. Babies may rub against things like bedding or carpeting to try to scratch the itch. They also may have trouble sleeping thanks to the chronic itch. If the skin becomes infected (which it may, due to constant scratching), it may form a yellow crust or very small pus-filled bumps.
Toddlers/Young Children (2 to 5 years)
Common spots for eczema to crop up include the creases of the elbows and knees, or on the wrists, ankles, or hands. It may also appear on the skin around the mouth or on the eyelids. Skin may start to look dry and scaly or become thick with deeper lines.
Children (5 and up)
The folds of the elbows and/or knees are the most common areas for eczema. It can also pop up on a child’s hands, behind the ears, or on the feet or scalp.
Causes of Childhood Eczema
Like some of life’s greatest mysteries, the exact reason kids get eczema remains unknown. However, doctors believe genetics are a main suspect. Approximately 70% of people with eczema have a family history of atopic diseases (eczema, asthma, hay fever, and food allergies, also known as the allergic march).
Basically, if you or your partner have one of these conditions, your child’s chances of developing eczema just jumped two to three times higher. And if both of you have it, your tot’s risk increases three to five times (sorry, we’re just the messenger). But don’t panic, even if both parents have eczema, it’s still not a guarantee that your child will get it, too.
Research also shows that some people with eczema have a mutation in the gene responsible for creating filaggrin, a protein that keeps the top layer of skin strong. This mutation means the skin’s surface is weak, so moisture has easy access out and bacteria and viruses have easy access in. This is often the reason people with eczema tend to have very dry and infection-prone skin. Kids with this gene mutation may have earlier onset eczema, and their condition may be more severe and persistent.
What Triggers Eczema in Kids?
The causes of this chronic condition may still be up for grabs, but its triggers—the stuff that sets it off—are well-known. When your child comes in contact with one of these triggers, her over-reactive immune system (the hallmark of anyone with eczema), responds by causing inflammation in the body. Keep in mind, not every child who has eczema has the same triggers, and it can take some detective work on your part to figure out which ones set her off. But once you do, it makes it much easier to prevent flareups. These are some of the culprits to watch out for.
Dry skin: The drier your child’s skin, the more it will itch and make existing eczema worse—particularly your kid’s prone to scratching. You can tell if the skin is dry by touching it, or if it looks scaly or ashy, or has areas of cracked or bleeding skin.
Saliva: It’s a fact: Babies drool. Also a fact: That saliva can cause irritation, redness, or swelling on the areas it touches, like your baby’s cheeks, chin, or neck.
Sweat: Although kids don’t sweat as much as adults, it’s still worth noting that people with eczema tend to have higher glucose levels in their sweat, which promotes itching.
Clothing: Certain materials, like wool or polyester, can irritate your child’s skin and worsen eczema symptoms. Pay attention to whether your tot’s eczema flares occur after wearing specific items or if the itchiness occurs in places where seams or tags touch the skin.
Allergens: Substances that commonly trigger an allergic reaction (pollen, dust mites, pet dander, and mold) can also spark or worsen eczema symptoms.
Skin irritants: Common products like soap, body wash, shampoo, laundry detergents, fabric softeners, baby powder, or wipes can irritate your child’s skin and cause burning, itching, or redness. Other irritants include metals, especially nickel (commonly used for earring backings), fragrances, cigarette smoke, and formaldehyde, which is found in things like disinfectants, glues, and adhesives.
How to Fight Flares
By knowing your child’s triggers and making a few lifestyle tweaks, you can help reduce the odds of a flare (although sometimes flares occur for unknown reasons).
Moisturizing your baby’s skin is key to keeping eczema symptoms at bay. Ointment and cream formulas are best because they contain a higher concentration of oil and minimal water content. In addition, releasing moisture into the air by way of a humidifier can help prevent dry skin, especially during the winter.
Choose Clothes Wisely
Nix the wool onesies: Dress your child in loose-fitting clothes made from 100% cotton and be sure to remove all tags. Machine-wash clothing using fragrance-free, dye-free laundry detergent. If you add fabric softener, make sure it’s also fragrance-free.
Wipe Away Wetness
Gently pat saliva from your baby’s skin with a soft cloth (don’t rub, as this can trigger eczema). Talk to your pediatrician about applying a thin layer of petroleum jelly to skin that saliva often touches to keep it from drying out.
Control Dust Mites
You’d need magical powers to completely eliminate dust mites from your home, but you can help control them by cleaning your child's room regularly, placing dust mite covers on the pillow and mattress, washing bedding in hot water weekly, and removing carpets and rugs from her room.
Police Pollen Levels
If your child's eczema fires up when pollen or mold counts are high, keep doors and windows shut and use air-conditioning when possible. You’ll also want to limit time outside when the count is high and steer clear of the lawn for about two hours after it’s been mowed (mowing can kick up all kinds of irritants).
Monitor Pet Dander
If your family has a furry member, be mindful of pet dander: The tiny particles of skin that animals shed are a common allergen that can trigger or worsen eczema symptoms. Vacuum regularly, give your fuzzy buddy frequent baths, and try to make your child’s bedroom an animal-free zone.
On hot days, make sure your tot takes frequent shady breaks. Avoid too many covers at night and be sure to protect sensitive skin during the day by using the hoods on strollers and carriages.
How to Treat Childhood Eczema
There may be no cure, but there are effective ways to manage your baby’s eczema, ease itching, and prevent further flares. In fact, the approach is pretty similar to adults with the condition (with a few restrictions). From bathing to topicals, here’s what you need to know to for head-to-toe eczema treatment.
Soothe itchy skin with cleansing and care products that are soap-free, fragrance-free, dye-free, and formulated with gentle ingredients. There are many helpful products out there, and you’ll know you’ve found them with you see the National Eczema Association Seal of Acceptance on the packaging. These items have already been vetted by the NEA, which means they’re free of known irritants and formulated to ease eczema symptoms. Praise!
A daily bath helps remove dirt and other potential irritants from your baby’s skin. Use lukewarm water and a gentle, fragrance-free cleanser (not soap). Avoid rubbing or scrubbing, which can irritate delicate skin even more, using soft strokes instead. And keep it short—under 10 minutes—so you don’t end up drying out the skin instead. Adding ½ cup of household bleach to a full tub of bath water two-to-three times per week can help to decrease the number of bacteria on the skin, reducing the risk of skin infection and minimizing inflammation. However, take extra precaution to protect your child’s eyes and do not let your youngster drink the bath water. And talk to your pediatrician first just to be on the safe side.
Using a moisturizer twice a day can help keep your child’s skin hydrated, relieve itching, and control flares. Doctors recommend applying a fragrance-free moisturizer labeled “hypoallergenic” and “for sensitive skin” no more than three minutes after bathtime. As a general rule of thumb, the greasier the formula, the better it will be for your baby’s skin.
Ointments such as petroleum jelly and mineral oil, classified as occlusives or barrier creams, have the highest content of oil and help create a skin barrier, locking in water and keeping the skin moist. Skin creams (known as emollients) are the next-best choice, helping to enhance skin hydration, smoothness, softness, and flexibility.
Your child’s delicate skin may already be sensitive to the sun, but having eczema makes it that much more vulnerable to damaging rays and burns. That’s why it’s especially important to apply sunscreen on children 6 months of age and older.
Look for brands that contain mineral-based ingredients like titanium dioxide (TiO2) and/or zinc oxide (ZnO) rather than chemical ingredients like avobenzone or octyl salicylate, which are more drying and irritating. Other requirements: an SPF of 30 or greater, and broad-spectrum protection from both ultraviolet (UV) A and UVB rays.
Wet Wrap Therapy
It might feel like you’re mummifying your kid, but wet wraps are an effective way to ease symptoms like itching and irritation by helping keep the skin moist, which also allows topical medications to penetrate better. Wet wraps can also act as a barrier to keep your child from scratching, so she snoozes more soundly.
Here’s how to do it: Soak towels, gauze, or pieces of clean clothing in warm water. After a bath and application of topical medication or moisturizer, wrap the affected areas in these damp cloths. Place a dry layer over the wet one and leave for several hours. Wraps should be wet again or removed when they start to dry out. If you need to wrap your child’s hands or feet, try cotton gloves or socks for the wet layer and vinyl gloves or food-grade plastic wrap as the dry layer. These can be applied anywhere on the body where a flare strikes.
Medications for Childhood Eczema
If a daily routine of bath, moisturize, repeat just isn’t helping your child’s symptoms go away, your doctor may prescribe a stronger course of treatment. There are multiple options, depending on your youngster’s age and severity of the disease. Talk to your doctor about all of the following:
These OTC anti-inflammatory topical medications include Cortisone 10 (hydrocortisone) and Cort-Aid (hydrocortisone acetate). Found in cream and ointment forms, they can be very effective in relieving symptoms like the itching, swelling, and redness that accompany eczema. These are usually applied immediately after your baby’s bath before applying moisturizer. Babies tend to be more sensitive to corticosteroids, so be sure to follow your doctor’s recommendations for dosage and duration.
For kids whose symptoms are acute, doctors may prescribe topical steroid creams to relieve the itching and inflammation. Prescription steroid creams have a range of potencies so milder ones may be recommended to sensitive areas and (rarely) to the face for brief periods of time. In general, though, they aren’t recommended for use on the face since they can cause skin thinning, stretch marks, and skin darkening. More potent steroids may be required on other areas of the body such as the thick skin of the palms or soles of the feet.
Due to potentially serious side effects, kids shouldn’t use these creams for more than two weeks in a row, but your pediatrician may prescribe a “weekend treatment” regimen, where a steroid cream is applied one or two days a week along with a daily moisturizer.
Because babies and young children can be at an increased risk of side effects from topical steroids used in large quantities or over a long period of time, it’s crucial to talk with your doc about the best course of treatment for your child.
If your child’s eczema is not responding to steroid treatment, topical calcineurin inhibitors are the next step. Often used for sensitive areas such as the eyelids, face, underarms, or groin, these meds are applied twice daily to help reduce inflammation, improve itch, and combat dryness. They work by preventing the part of the immune system that causes eczema symptoms such as redness and itching from switching on.
There are two topical medications currently available for children over two:
Elidel (pimecrolimus), approved for the treatment of mild-to-moderate eczema
Protopic (tacrolimus), approved for moderate-to-severe eczema
Calcineurin inhibitors (TCIs) don’t carry the same risks for side effects as topical corticosteroids and so are considered safe for long-term use in children over 2. (The most common side effect is a temporary stinging sensation that usually improves after a few days.) For periods of over six weeks, however, current guidelines recommend intermittent use.
Topical PDE4 Inhibitors
For children two and older, another topical nonsteroidal medication, Eucrisa (crisaborole), is approved for mild to moderate eczema. It works by blocking an enzyme produced by the immune system know as phosphodiesterase 4 (PDE4). This enzyme controls proteins responsible for causing eczema-related inflammation. A study in the Journal of the American Academy of Dermatology found that almost one-third of people who used PDE4 inhibitors for a month had nearly twice as many improvements in symptoms as those who used a placebo. The twice-daily med comes as a 2% topical ointment and can be used anywhere on the body with only mild skin irritation reported.
If your child has moderate to severe eczema that hasn’t responded to topicals, try dupilumab (Dupixent). It was first approved for adults in 2017, followed by approval for teenagers in 2019. In May 2020, the FDA officially gave the green light for Dupixent to be prescribed to children ages 6 to 11. It comes in two doses, prescribed based on the child’s weight, and is administered either every two or every four weeks. It is recommended that you people taking Dupixent shots for the skin to remain clear.
This injectable drug is a biologic, which means it is a treatment developed from part of a living substance. Biologics block two proteins, interleukin-4 and interleukin-13, that are involved in eczema. More than half of people who used it for 16 weeks found that their eczema symptoms improved by 75%, according to a 2016 study published in the New England Journal of Medicine. There are two potential downsides to this medication: 1) the price, as it costs more than $30,000 a year without insurance; some insurances will pay, but not completely. And 2) you must give your child one to two shots in the belly or thigh every other week. If your child doesn't do good with needles, this isn’t the best option.
For children with severe eczema whose symptoms are unresponsive to topical treatments, oral immunosuppressant medications may be prescribed. These drugs work by blocking the body’s immune system from sending an inflammatory response signal to the skin, thereby lessening itching, redness, and rashes. They include:
Azasan, Imuran (azathioprine)
Gengraf, Neoral, or Sandimmune (cyclosporin)
Rasuvo, Trexall, or Rheumatrex (methotrexate)
These medications are considered “off-label,” meaning they’re not approved by the FDA to specifically treat eczema (even though clinical evidence suggests they work). They also carry potentially serious side effects like high blood pressure and kidney damage, and they make you more vulnerable to infection. As a result, most dermatologists won’t prescribe them for more than 6 to 12 weeks at a time. They are available in varying strengths and are typically taken once or twice daily.
For children over 6 with severe eczema that doesn’t respond to an intensive topical regimen with wet wraps, phototherapy may be recommended. This unique kind of light therapy utilizes narrowband ultraviolet B (UVB) light from special lamps to suppress the skin’s immune response, minimizing itching and inflammation and bolstering bacteria-fighting systems. It’s typically administered in a doctor’s office with the patient standing upright in a booth-like enclosure, for precisely selected intervals, over the course of weeks to months.
Ultraviolet light also has the advantage of being able to treat large areas of the body with minimal side effects. While generally safe in the short term, long-term use can cause premature aging of the skin and possibly a predisposition to certain skin cancers later in life.
Itch in eczema is complicated and involves a variety of inflammatory mediators. Histamine (a chemical your immune system produces to get rid of allergens) is likely not a large component of the itch mechanism in this condition and antihistamines may not improve the itching, according to the American Academy of Allergy, Asthma & Immunology. But don’t write them off just yet: In this case, the main benefit of certain antihistamines, such as Benadryl (diphenhydramine), is drowsiness. A sleepy child is more likely to snooze than scratch, thus ending the vicious cycle of itchiness that keeps your kid up all night.
Living With Childhood Eczema
No, it’s not cancer. Or MS. Or any number of challenging conditions that threaten a child’s quality of life—or, let’s face it, life itself. But the daily discomfort brought on by eczema is enough to drive even the saintliest youngster among us to borderline insanity.
Older children are able to verbalize what’s bothering them, but with babies and toddlers, you need to pay special attention to body language and other physical cues that they are in pain or uncomfortable. Take any actions of scratching or grabbing at their skin seriously and talk with your pediatrician if you see telltale signs of redness. There may not be a cure, but with so many effective ways to manage eczema, there is no reason it should slow your child down.
- Best Moisturizers for Kids: British Medical Journal. (2019). “Which Emollients Are Effective and Acceptable for Eczema in Children?” ncbi.nlm.nih.gov/pubmed/31649114?_ga=2.82803990.1272333931.1577462882-1099494363.1577462882
- Eczema & Steriods: Informed Health. (2017). “Eczema: Steriods and Other Topical Medications.” ncbi.nlm.nih.gov/books/NBK424899/
- Medication for Childhood Eczema: Medscape. (2020). “Pediatric Atopic Dermatitis Medication.” emedicine.medscape.com/article/911574-medication
- Dupilumab Use in Children: Journal of the American Academy of Dermatology. (2020). “Off-Label Use of Dupilumab for Pediatric Patients with Atopic Dermatitis: A Multicenter Retrospective Review.” ncbi.nlm.nih.gov/pubmed/31606479
- Treating Children With Eczema: UpToDate. (2019). “Management of Severe Atopic Dermatitis (Eczema) in Children.” uptodate.com/contents/management-of-severe-atopic-dermatitis-eczema-in-children
- Guidelines for Eczema: American Academy of Dermatology. (n.d.) “Atopic Dermatitis Clinical Guidelines.” aad.org/member/clinical-quality/guidelines/atopic-dermatitis
- Cradle Cap Vs. Eczema: Mayo Clinic. (n.d.) “Cradle Cap.” mayoclinic.org/diseases-conditions/cradle-cap/symptoms-causes/syc-20350396
- Managing Eczema: American Academy of Pediatrics. (2020). “Eczema in Babies and Children. healthychildren.org/English/health-issues/conditions/skin/pages/Eczema.aspx
- Wet Wrap Therapy: Seattle Children’ Hospital. (2017). “Wet Wrap Therapy.” seattlechildrens.org/pdf/PE1911.pdf