Atopic Dermatitis In Children

What is atopic dermatitis and what increases my child's risk for it?

• Atopic dermatitis is an itchy, red skin rash. It is also called eczema. It is common in children between the ages of 2 months and 5 years. Your child is more likely to have atopic dermatitis if he also has asthma or allergies. He is also more likely to have it if family members have allergies, atopic dermatitis, asthma, or hay fever.
  
  
• It is a condition that may go away on its own or may last for years. Your child could have flare-ups for the rest of his life. A flare-up means his symptoms get worse sometimes.

What are the signs and symptoms of atopic dermatitis in children?

Flare-ups can happen anytime of year, but they are more common in winter. Your child may have any of the following:

• Infants up to 2 years old:
  
  
  • Dry, red, scaly skin that begins on his cheeks and may spread to his chin
    
    
  • A red ring around his mouth or blisters near his lips that are crusty or oozing fluid
    
    
  • A rash on top of his head
    
    
  • A rash on his arm or another area where he can reach and scratch
    
    
  • Irritability or restless sleep
  
  
• Children 2 to 18 years old:
  
  
  • An itchy, red rash that begins around his neck and may spread to his wrists, ankles, knees, or elbows
    
    
  • A rash that is covered with white or brown scales
    
    
  • Skin that is bumpy, blistered, crusty, or oozes clear fluid.
    
    
  • Skin that feels thick and hard, like leather

What triggers atopic dermatitis in children?

Triggers are things that cause atopic dermatitis to flare-up. Anything that increases dryness or makes your child want to scratch is a trigger. The following are common triggers to avoid:

• Some kinds of soaps, shampoos, and detergents: These may bother your child's skin. Ask your caregiver what kinds of mild cleaning products and detergents to use.
  
  
• Pet dander and other allergens: Pet dander (tiny dead skin flakes) and dust mites (tiny bugs that live in house dust) can worsen your child's symptoms. Pollen, mold, and cigarette smoke may irritate his skin.
  
  
• Too many baths or showers: This can lead to dry, itchy skin.

How is atopic dermatitis in children diagnosed?

A caregiver will examine your child. He will ask if he has a history of dry skin. He will ask how old your child was when his itchy rash began. Tell him if you, your child, or other family members have asthma, hay fever, or other allergies. He may ask how often you bathe your child. He may ask if you notice things that trigger your child's rash. There are no tests to diagnose atopic dermatitis. Your caregiver may test your child for allergies to find out if they trigger your child's atopic dermatitis.

How is atopic dermatitis in children treated?

There is no cure for atopic dermatitis. The goal of treatment is to reduce your child's pain and itching and to add moisture to his skin. His symptoms should improve after 3 weeks of treatment. Your child may need the following:

• Skin cream: Rub emollients (thick creams) into your child's skin often. Examples of emollients are unscented skin cream and petroleum jelly. Ask your caregiver which creams to use and how often to apply them. Do not use lotion that contains alcohol because it can dry your child's skin.
  
  
• Medicines:
  
  
  • Steroid cream: You need a doctor's order for this medicine. Apply this cream to your child's skin to reduce redness, pain, and swelling.
    
    
  • Antihistamines: This medicine is used to reduce itching.
    
    
  • Antibiotics: This treats or prevents an infection caused by bacteria. Your child may need this if he has a skin infection.
    
    
  • Oral steroids: This may be given to reduce your child's redness, pain, and swelling if his atopic dermatitis is very bad.
  
  
• Phototherapy: This treatment uses ultraviolet light to heal your child's skin. It is also called light therapy.

How can I manage my child's atopic dermatitis?

• Reduce scratching: Your child's symptoms get worse when he scratches. Trim his fingernails short so he does not tear his skin when he scratches. Put cotton gloves or mittens on his hands while he sleeps.
  
  
• Keep his skin moist: Rub thick cream or petroleum jelly into your child's skin. Do this right after a bath or shower when his skin is still damp. Apply cream as many times as needed each day to keep his skin moist and soft.
  
  
• Use bandages: You may be told to cover your child's rash with dry bandages. This helps the cream sink into his skin. It may also prevent your child from scratching.
  
  
• Give him fewer baths: Let your child take a bath or shower in warm (not hot) water for 20 minutes or less. Use mild bar soap. Teach him how to gently pat his skin dry. Help him rub in skin cream within 3 minutes after his bath or shower.
  
  
• Choose cotton clothes: Dress him in loose-fitting clothes made from 100% cotton. Avoid wool.
  
  
• Humidify your home: Use a humidifier to add moisture to the air in your home.
  
  
• Reduce allergens at home: Do not keep cats, dogs, birds, or other pets. Choose artificial plants instead of live plants.
  
  
• Use mild soap and detergent: Ask your caregiver which mild soaps, detergents, and shampoos are best for your child. Do not use fabric softener.

What are the risks of atopic dermatitis in children?

• Your child is at risk for skin infections caused by bacteria. He also has a higher risk for eczema herpeticum. This can happen if his rash becomes infected with the herpes virus. He could develop a painful condition called erythroderma. This occurs if redness and swelling develop over most of the skin on his body. It can be life-threatening without treatment.
  
  
• Pain and itching may often wake him up at night. Lack of sleep could change his behavior or slow his growth. The steroid creams used to treat your child's condition can weaken his skin. This means his skin could easily tear, bruise, or scrape. Patches of his skin could be lighter or darker after the rash goes away.

When should I contact my child's caregiver?

Contact your child's caregiver if:

• Most of your child's skin is red, swollen, painful, and covered with scales.
  
  
• Your child's rash develops bloody, painful crusts.
  
  
• Your child's skin blisters and oozes white or yellow pus.
  
  
• Your child often wakes up at night because his skin is itchy.
  
  
• You have questions or concerns about your child's condition or care.

When should I seek immediate help?

Seek immediate help if:

• Your child develops a fever, red streaks going up his arm or leg, or his rash gets more swollen, red or hot.
  
  

Care Agreement

You have the right to help plan your child's care. Learn about your child's health condition and how it may be treated. Discuss treatment options with your child's caregivers to decide what care you want for your child.

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