The Itch That Scratches and Scratches and Scratches....Eczema (Atopic Dermatitis)
For any of you that have children with eczema, you know what I am talking about. Kids can't help but scratch when they have an itch, and scratching ALWAYS leads to more itching! Eczema can range from dry, scaly skin to red, open, painful skin. It is sometimes associated with allergies and asthma (allergic triad). All forms of eczema have the same problem, there is a breakdown in the body's main protective organ - the skin. Babies tend to have eczema all over their bodies, which frequently spares the diaper area (sitting in a wet diaper does have some benefits!). Older children can have it all over their bodies, but classically they get it on the backs of their elbows and knees. You can find "magic" remedies for dry skin and eczema all in the drug stores and internet, but usually you can solve the problem with products you may already have around the house. The first step to treating eczema is to think of every product that touches your child's skin...I know, not an easy task. These products usually include (but are not limited to) detergents, fabric softeners, drier sheets, lotions, soaps, bubble bath, wet wipes, sanitizer wipes and gels, sun screen, saliva (drool) and foods. Got them?
- Remember all of those products that touches your child's skin...stop them. I know you can't stop food and drool from touching your child's skin, but you can put a protective barrier ointment on the skin before he/she eats.
- Use only dye free and fragrance free detergent, without fabric softener or drier sheets. They may smell and feel good, but those products stick to clothes and sheets, then your child's skin.
- Use only Sensitive Bar Soap. I prefer Dove or the generic alternative. Liquid soap is easier to use and feels nicer, but the chemicals that are used to make the soap into a liquid can irritate skin, even the sensitive versions.
- Apply an ointment moisturizer several times per day. I prefer Vaseline (petroleum jelly) because it is cheaper, but Aquaphor and several other companies make an ointment moisturizer that has petroleum as the main ingredient. Lotions feel and "absorb" into the skin better, but they do not form a barrier for the skin, which kids with eczema need. They can also burn when applied to irritated skin. One way that I have found to keep the petroleum jelly on your child's skin and off the furniture is to apply a thick layer and put a cotton one-piece pajama outfit on (dye-free if possible). For older kids, you can use cotton pajamas with cotton socks. If you or your child can not deal with the greasiness of petroleum jelly, then mineral oil can be used as an alternative (most formulations are petrolatum jelly in a liquid form).
These recommendations will help mild to moderate eczema, but if your child has very red, irritated skin, they may need a steroid ointment. If this is the case, you need to take your child into the pediatrician for further recommendations and a possible prescription. There are also prescription medications that help prevent flare-ups, to be used when your child's skin is clear. A newer treatment that has been used with success in children with moderate to severe eczema, to discuss with your pediatrician, is bleach baths (1/2 cup of bleach per tub), used 1-2 times per week. This is used to help decrease the bacteria living on the skin and prevent infection. It sounds weird, but it is actually similar to swimming in a public pool. This treatment needs to be used with caution in children with asthma, because the chlorine can cause wheezing. Of course, petroleum jelly needs to be applied after the bath, to prevent the skin from drying out. If itching is a major problem, then talk to your pediatrician about using an antihistamine (like Benadryl).
So, stop using the salve that Aunt Mary brought back from the "old country" and start using easy, everyday products to stop the itching!
-Heather Joyce, MD
Originally published on January 7, 2012 at http://pedsforparents.blogspot.com/