Eczema

When To Call

Call 911 Now

• You think your child has a life-threatening emergency

Call Doctor or Seek Care Now

• Fever in baby less than 12 weeks old. Caution: do NOT give your baby any fever medicine before being seen.
• Looks infected (spreading redness, pus, soft oozing scabs) and fever
• Many small blisters or punched-out sores occur
• Your child looks or acts very sick
• You think your child needs to be seen, and the problem is urgent

Contact Doctor Within 24 Hours

• Eczema is very painful to touch
• Looks infected and no fever
• Itching is severe after using steroid cream for more than 48 hours
• You think your child needs to be seen, but the problem is not urgent

Contact Doctor During Office Hours

• Itching flare-ups occur often
• Eczema diagnosis was never confirmed by a doctor
• You have other questions or concerns

Self Care at Home

• Eczema with no other problems
• Questions about prevention of eczema flare-ups

Care Advice

Treatment for Eczema

What You Should Know About Eczema:

• Eczema is a chronic skin disease. So, you need to learn how to control it.
• Itching attacks (flare-ups) are to be expected.
• The goal is to treat all flare-ups quickly. Reason: to prevent skin damage.
• Here is some care advice that should help.

Treatment is Based on Severity of Eczema:

• Mild eczema. Just need to use a moisturizing cream and to avoid flare-up triggers.
• Moderate eczema. Also need to use a steroid cream and bedtime allergy medicine.
• Severe eczema. Also may need antibiotics for a skin infection caused by Staph bacteria. This infection starts in open skin from severe itching.

Moisturizing Cream or Ointment for Dry Skin:

• All children with eczema have dry sensitive skin.
• The skin needs a moisturizing cream (such as Eucerin) Apply once or twice daily.
• Apply the cream after a 5 or 10-minute bath. To trap moisture in the skin, apply the cream while skin is still damp. Do this within 3 minutes of leaving the bath or shower.
• The steroid cream should be applied to any itchy spots first. Then use the moisturizing cream as the top layer.
• While most parents prefer creams, moisturizing ointments are sometimes needed in the winter. An example is Vaseline.
• Caution: never stop the moisturizing cream. Reason: the rash will come back.

Steroid Cream or Ointment for Itching:

• Itchy skin is the main symptom of eczema.
• Steroid creams or ointments are essential for controlling red, itchy skin.
• Apply steroid creams only to itchy or red spots (not to the normal skin).
• Most children have 2 types of steroid creams. (1) A mild steroid cream is used to treat any pink spots or mild itching. This is often 1% hydrocortisone cream (such as Cortaid). No prescription is needed. (2) Another stronger steroid cream is needed to treat any spots with severe itching. This is a prescription steroid cream such as Synalar. Never apply this stronger cream to the face.
• Apply these creams as directed or 2 times per day.
• After the rash quiets down, apply it once per day. After 1 good week just use moisturizing cream.

Bathing - Avoid Soaps:

• Give one bath a day for 10 minutes in lukewarm water. Reason: water-soaked skin feels less itchy. Follow the bath with a moisturizing cream (such as Eucerin) to all the skin.
• Avoid all soaps. Reason: eczema is very sensitive to soaps, especially bubble bath. There is no safe soap for young children with eczema. They can be cleaned using warm water.

Allergy Medicine for Itching at Bedtime:

• Some children with eczema need an allergy medicine by mouth at bedtime.
• Reason: scratching in bed can cause severe skin breakdown. It may also interfere with falling sleep.
• Give the med your child's doctor wanted you to use for itching.
• If none was suggested, you can try Benadryl at bedtime until you talk with your doctor. No prescription is needed. Age limit: 1 and older.
• Caution: do not use Benadryl for more than a few days.
• If needed longer than a few days, switch to a long-acting antihistamine, such as Zyrtec. Age limit: 6 months and older.
• Zyrtec dosing for 6 months to 2 years: 2.5 mL (2.5 mg) every 24 hours.
• Zyrtec dosing for 2 years and older: follow package directions.

Itching Attack - Shower to Remove Irritants:

• Playing in the grass, being around animals, or swimming can cause increased itching.
• For itching from these causes, give your child a quick shampoo and shower.

Itching Attack - Treatment:

• At the first sign of any itching, use the steroid cream. Put it on the areas that itch. If unsure, apply 1% hydrocortisone cream (such as Cortaid). No prescription is needed.
• Keep your child's fingernails cut short and smooth.
• Ask older children to try not to itch, but never punish for itching.
• For constant itching in young children, cover the hands with socks or gloves. Use for a day or until the itching is brought under control. Provide extra cuddling during this time.

Return to School:

• Eczema cannot be spread to others.
• Children with eczema do not need to miss any child care or school.

What to Expect:

• Eczema is a chronic condition. Around the teen years, about half get over their eczema.
• Many children who have severe eczema as babies develop asthma and nasal allergies.

Call Your Doctor If:

• Itching is not under control after 2 days of steroid cream
• Rash looks infected (spreading redness, yellow scabs or pus)
• You think your child needs to be seen
• Your child becomes worse

Prevention of Eczema Flare-Ups

Tips to Help Prevent Flare-Ups:

• Some flare-ups of eczema cannot be explained. But others are triggered by things that can be avoided.
• Avoid chlorine in swimming pools and spas, harsh chemicals, and soaps.
• Never use bubble bath. It can cause a major flare.
• Keep your child off the grass during grass pollen season.
• Avoid any animals that make the rash worse.
• If certain foods cause severe itching (flares), avoid them.
• Wear clothes made of cotton or cotton blends as much as possible. Avoid wool fibers and clothes made of other scratchy, rough materials. They make eczema worse.
• Try to avoid excess heat, excess cold and dry air (use a humidifier). Avoid over-dressing. Heat can make the rash worse.
• Caution: keep your child away from anyone with fever blisters (cold sores). The herpes virus can cause a serious skin infection in children with eczema.

Call Your Doctor If:

• You have other questions or concerns

Remember! Contact your doctor if you or your child develop any "Contact Your Doctor" symptoms.

Photos

Eczema - Child

This is how eczema can appear on the cheeks of a child. The skin is red, dry, cracked and swollen. Your child may find it itchy.

Source: Self Care Decisions, LLC
From the Dr. William Weston Collection of Pediatric Dermatology. Used with permission.

Eczema-Teen

This shows eczema in the elbow crease of a teen. The skin is dry, cracked and swollen. It may be itchy.

Source: Self Care Decisions, LLC
From the Dr. James Fitzpatrick Collection of Pediatric Dermatology. Used with permission.

Eczema - Teen

This shows eczema in the elbow crease of a teen. The skin is dry and may be itchy. It also shows loss of skin pigment (color), which may happen in people with dark skin. Eczema can cause the skin color to be darker or lighter.

Source: Self Care Decisions, LLC
From the Dr. James Fitzpatrick Collection of Pediatric Dermatology. Used with permission.