Eczema in children is a skin condition that has no cure that results in dry, itchy, red, and irritated skin. For many people eczema is an inherited condition, for some it is an allergic reaction, and for others there may not be a clear explanation for why they have it. Despite the cause, the management of eczema is similar for all types. Below are instructions for how to best care for your child's eczema.
Increasing the moisture content of the skin is the primary treatment of eczema and frequent bathing is a way to do this. We recommend the following:
When bathing, avoid soaps and use soapless cleansers like Cetaphil, Aquanil, Aquaphor, or CeraVe instead.
Give your child daily 10-20 minute soaking baths (until pruning occurs)
Immediately apply moisturizer to your child after the bath, this is the key to sealing in moisture from the bath. Do not towel dry the child, instead wipe off excess water with your hands and apply the moisturizer to the damp skin.
Bathing may be more effective if oil is added to the bathwater. Sunflower oil is a good choice as it is anti-inflammatory and inexpensive. If oil is added to the bathwater, do not rinse it off of the child prior to moisturizing.
If your child has an eczema flare requiring topical steroids, apply the medication to the skin prior to moisturizing. However, if you are not able to apply the steroid in less then 3 minutes after the bath, then wait to apply the steroid until after moisturizing has occured. In order for moisturizing after the bath to be effective, it must occur within 3 minutes of getting out of the bath.
For children with recurrent skin infections, adding household chlorine bleach to the bath (1/4 – ½ cup in a tub of water) will reduce the amount of bacteria on the skin and reduce the recurrance of infection as well as help the eczema heal. If you are not sure if your child would benefit from bleach baths, ask your doctor.
The best moisturizer is the one that works best for your child. In general, ointments are better than creams which are better than lotions. However, ointments leave the skin sticky and shiny and may not be suitable for use during the day. If you or your child can't tolerate using an ointment during the day, use a cream during the day and use the ointment before bed. The following are moisturizers that we like:
- Aquaphor Ointment
- Aveeno Baby Eczema Cream
- CeraVe Moisturizing Cream
- Cetaphil Restoraderm
- Curel Itch Defense Lotion
- Eucerin Eczema Relief Cream
- Triple Cream
- Vaseline Original Jelly (rated the best by the National Eczema Association)
Despite your best efforts, all children with eczema experience flares where their skin gets red, irritated, and itchy. Often it is necessary to use steroid treatments to calm the inflammation and improve the eczema. For most children, a low potency over-the- counter steroid like 1% Hydrocortisone is sufficient to treat the eczema. If a stronger steroid is needed, you will need to consult your doctor. When used appropriately, topical steroids are very safe. Be sure the follow these recommendations for safe, effective use:
- Apply steroids only to the rough affected skin and avoid normal skin unless directed otherwise by your doctor.
- Avoid use on eyelids
- Avoid applying steroids in the diaper area unless directed to by your doctor
- Do not apply steroids more than twice a day
- Do not use steroids for more than 2 weeks in a row unless directed by your doctor
It may sound strange, but putting your child to bed in wet pajamas is one of the best treatments for eczema. Despite the popular wives tale, putting your child to bed in wet clothes will not give him pneumonia, it will however provide continuous overnight moisturization for his dry skin.
- Leotard style pajamas work best. For the hands use gloves and for the feet use socks.
- Soak a pair of cotton pajamas in warm water then wring out the excess water so that the pajamas are still damp. After bath, moisturization, and topical steroid (if applicable), dress your child in the wet pajamas. Finally, dress them in dry pajamas of the same style so that the wet pajamas are covered by the dry.
- Do the same for socks and gloves if indicated.