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The Informed Parent

Eczema: The Itch That Rashes

by Laura Murphy, M.D.
Published on Apr. 28, 2003

The infant with the red scaly rash on his cheeks; the child with the scratch marks behind his knees; the adolescent with the dry patches to her hands...all these patients suffer from eczema, which can be an extremely frustrating problem for both our patients and their parents. Those affected are plagued by recurrent bouts of itchy patches of skin, sometimes lying awake at night, scratching and miserable. The parents are tormented by frustration over a problem that just won’t go away. What causes this stubborn rash, and what can be done?

Eczema, or atopic dermatitis, involves recurrent inflammation of the skin, resulting in the characteristic itchy patches of skin. These areas can appear red, scaly, thickened or simply very dry. While appearance may vary, the itchiness does not and is, rather, a constant in this condition. Eczema is sometimes referred to as “the itch that rashes”.

Eczema can affect patients of any age, but is most common in infants and children. The condition tends to improve with time, though about 50% of patients will remain affected to some degree throughout their lives. For babies, the rash can involve any part of the body, but most commonly is found on the face and scalp. In children and adolescents, the rash is usually localized to the area behind the knees, in the bend of the elbow, or on the hands and feet. That being said, eczema can affect any part of the skin at any time.

What causes eczema? Usually there is no identifiable trigger that if removed can bring about a cure. Rather, patients with eczema simply have very sensitive skin and are prone to recurrent itching and dryness. Food allergy can rarely, in about 10% of cases, be associated with eczema. However, elimination of the particular food from the diet usually does not solve the problem. Eczema does occur more frequently in patients with allergies, but a single trigger is usually not found.

Caring for children with eczema involves an ongoing effort to avoid skin irritants, keeping the skin moisturized and controlling the inevitable flare-ups. The following are some general tips:

  • Keep the skin well moisturized by daily use of hypoallergenic creams. The goal is to seal in moisture, so often a thicker or greasier product will best serve this purpose.
  • After bathing, do not fully dry the skin. It is better to apply moisturizers to damp skin that has been only patted dry.
  • Use non-drying soaps.
  • Oral antihistamines can be used to control the itching.
  • Avoid irritating skin care products, perfumes, chemicals; and also try to avoid tight clothes or rough fabrics like wool.
  • The pediatrician may recommend cortisone (steroid) creams to help control flare-ups.

Until now, steroid creams have been the cornerstone of therapy for eczema. Today, we have a new family of medications called topical immunomodulators. These are also applied directly to the skin and work to modify the immune response that leads to the inflammation of eczema. They look to be an effective new weapon in the fight against this stubborn problem.

So, if your child is affected by eczema, be comforted by the fact that it will likely get better with time, if not resolved completely. But, in the meantime, know that it is a persistent, recurring condition that requires daily attention to prevent exacerbations. There is no miracle cure, but help certainly is found in persistence with good skin care, patience and the passage of time.

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