Atopic Dermatitis (Eczema)

What is atopic dermatitis?

Atopic dermatitis, also called eczema, is a skin disorder that usually appears in babies or very young children, and may last until the child reaches adolescence or adulthood. Eczema causes the skin to itch, turn red, and flake.

Parents with eczema are more likely to have children with eczema. Different triggers can make eczema worse, including environmental stress, allergies, sweating, and cigarette smoke. Of children who have eczema, most will show signs of eczema in the first year of life and 85 percent will show signs of eczema within the first five years. Atopic dermatitis is not contagious.

Eczema occurs in approximately 10 to 20 percent of all infants. Of these children, nearly half will improve as they grow and develop between ages five to 15. Roughly 60 percent of children may have some form of eczema throughout their lifetime.

What are the symptoms of eczema?

The distribution of eczema may change with age. In infants and young children, eczema is usually located on the face, outside of the elbows, and on the knees. In older children and adults, eczema tends to be on the hands and feet, the arms, and on the back of the knees. The following are the most common symptoms of eczema in children. However, each child may experience symptoms differently. Symptoms may include:

  • Dry, scaly skin

  • Small bumps that open and weep when scratched

  • Redness and swelling of the skin

  • A thickening of the skin (with chronic eczema)

Excessive rubbing and scratching can tear the skin and result in an infection. Some children only have a few episodes of flare-ups, while other children will have atopic dermatitis throughout adulthood.

The symptoms of eczema may resemble other skin conditions. Always consult your child's primary care provider for a diagnosis.

How is eczema diagnosed?

Atopic dermatitis is very common. In addition to a complete medical history and physical examination, diagnostic procedures for eczema may include the following:

  • Family history (children born to a mother who has allergic conditions are more prone to eczema)

  • Personal history of allergies or asthma

  • Blood tests

Treatment for eczema in children

Specific treatment for eczema will be determined by your child's primary care provider based on:

  • Your child's age, overall health, and medical history

  • Extent of the disorder

  • Your child's tolerance for specific medications, procedures, or therapies

  • Expectations for the course of the reaction

  • Your opinion or preference

There is no cure for eczema. The goals of treatment are to reduce itching and inflammation of the skin, moisturize the skin, and prevent infection.

Management of eczema symptoms

The following are suggestions for the management of eczema:

  • Avoid contact with irritants, as determined by your child's primary care provider.

  • Bathe your child regularly, use moisturizers, and practice good skin care techniques.

  • Do not use harsh soaps. Ask your child's primary care provider to recommend a brand.

  • Make sure your child's fingernails are short, as scratching may contribute to an infection.

  • Use lubricating lotions at least once a day. Ask your child's primary care provider to recommend a brand.

Your child's primary care provider may also prescribe medications in severe cases. The following medications are most commonly used to treat eczema:

  • Antihistamines. These medications help to decrease the amount of itching. Some examples include diphenhydramine (Benadryl) or hydroxyzine (Atarax). These medications may cause drowsiness. Some new antihistamines are also available that do not cause drowsiness. Consult your child's primary care provider for more information.

  • Steroid creams. These topical medications help to decrease the inflammation in the skin, thus decreasing the itching and swelling. Many topical steroids in various strengths are available. Steroids, if overused, are potentially damaging to the skin. Follow the advice of your child's primary care provider.

  • Oral antibiotics. These medications are derived from mold or bacteria and slow the growth of specific microorganisms. A sample from the body part thought to be infected may be taken and cultured in a lab to determine what type of antibiotic to use for the most effective treatment. Follow the instructions for dosing and administration carefully and consult with your child's primary care provider as needed.

Less frequently, your child's primary care provider may recommend:

  • Oral cyclosporine. This medication is used primarily to prevent rejection after organ transplantation. It suppresses the immune system and has other side effects that should be considered. Consult with your child's primary care provider as needed.

  • Phototherapy (light therapy). It is safest to have this treatment under medical supervision, but light therapy is not offered at all dermatology clinics. Home light therapy devices are available, but may not be covered by insurance. Narrow band UVB (ultraviolet B) light units are the most effective. Be sure to follow the manufacturer's instructions carefully to avoid injury.

  • Topical immunomodulator (TIMs or TCIs). Topical immunomodulators are a new class of drugs for the treatment of eczema. These drugs are applied directly to the skin to alter the immune response.

Reviewed by Venita Kaul, MD, FAAP