Is dry, cracking, itchy skin causing your child (and you) to be downright miserable this winter season? Is the condition made worse by sub-zero arctic blasts of cold air that seem to greet you every time you walk outside? Are over-the-counter remedies no longer helping? Is the dermatologist booked out for weeks (or even months)?
Atopic dermatitis, or eczema, is a common inflammatory skin condition for children of all ages. Learning how to prevent and manage flare-ups is critical. Eczema’s hallmark feature is dry skin. Your biggest task is to keep the natural moisture within the skin from evaporating. The best treatment is prevention, but recognizing a flare-up and starting aggressive treatment is crucial.
1. Avoid the fresh aromas. Scented lotions and soaps, fragrances, perfumes, or anything that makes your child smell terrific can be irritating to the skin. Check the ingredients of your product. Any type of sweet-smelling compound could make your child’s skin inflamed.
2. Consider limiting baths. Taking a hot bath really dries the skin out. After bathing, “pat” the skin dry with a towel but don’t soak up every single water drop. Keep the skin slightly damp.
3. Moisturize the entire face and body. Apply a cream or ointment over the entire face and body. The key is frequent reapplication. Try an emollient such as Aveeno®, CeraVe®, Cetaphil®, or even Vaseline® 100% Pure Petroleum Jelly. Moisturizers actually help in repairing the skin barrier. Apply as soon as possible after bathing so that the skin does not dry out. Reapply constantly.
4. Control the itch. Trim your child’s nails. The skin itches, so your child is destined to scratch. With every scratch, the skin will have more inflammation and will itch more. Ask your child’s pediatrician about starting an antihistamine, such as cetirizine or loratidine, which are both long-acting, to help manage the itch of atopic dermatitis. Sometimes sleeping with socks or mittens on can help avoid involuntary nighttime scratching.
5. Use topical steroids wisely. Steroids are ranked by class based on strength. Class VII is low-potency and Class I is super potent. Low-potency, over-the-counter topical steroids like hydrocortisone 1% should be used for minor flare-ups. They should be used for the shortest amount of time possible and usually no more than twice a day. Continual and repetitive use of topical steroids thins the skin too much. If the low-potency topical steroid is not working well, your child’s doctor may recommend a prescription strength topical steroid for the more severe flare-ups. Avoid applying topical steroids on the face because the natural skin pigments may be lost.
6. Keep the skin free from infection. Many people have eczema flare-ups and have a coexisting skin infection such as Staphylococcus aureus. If you see oozing, yellow crusts, drainage, or pus bumps near the areas you typically notice eczema flares, call your child’s doctor.
7. Wet wrap it. Studies have shown that severe eczema can be treated well with wet wrap therapy (also called wet dressings). The wet dressings increase penetration of topical steroids into the skin, decrease itch, and can effectively deter a child from continuously scratching. After a bath, topical steroid is applied to the affected areas followed by application of a moisturizer to the rest of the skin. Moist gauze or cotton clothing that has been dampened with warm water is then applied. The wet layer is then covered with dry cotton clothing. Blankets and a warm room (since the child is essentially wearing wet clothes to bed) will help provide comfort. The dressings can be left in place for 3-8 hours before being changed. Wet dressings can be used continuously for 24-72 hours or overnight for up to a week at a time. Your child may briefly look like a mummy but at least one with better skin!
Reviewed by Dr. Sara Connolly, January 2020
- Moisturizing is essential for prevention and treatment of eczema. Use topical steroids wisely.
- Make sure a secondary bacterial infection is not complicating eczema.
- For severe eczema flare-ups, consider wet wrap therapy.