Eczema can be simply described as skin allergy. It is called atopic dermatitis in medical lingo, and it is actually a part of a large spectrum of allergic conditions that affect children. Two other conditions — nasal allergy and asthma — are discussed in Chapters 14 and 15. Together, these three conditions are known as the “atopic triad” because they are so closely related.

Itchy and Scratchy

Even though eczema is an allergic condition, most children with eczema do not have specific food allergies that trigger the skin outbreaks. Instead, the most common trigger for eczema is dryness. The trouble almost always starts when the skin gets dry.

The best way to understand this skin condition is to learn how a skin rash progresses. The initial trigger for the rash occurs when the skin becomes too dry. For someone without eczema, this would not be a big deal, but eczema sufferers experience an intense itch when the skin dries up. Children with eczema tend to have drier skin to begin with, so they are more prone to itchiness.

Once the itching starts, it's just a matter of time before the child starts to scratch the skin incessantly. This scratching causes damage to the surface of the skin, which leads to redness and rawness. This is the appearance of a typical eczema rash. The presence of this intense itch is mandatory for the development of eczema.

If the scratching continues unabated, the skin surface can become raw and damaged. Once the skin surface is disrupted, bacteria on the surface of the skin can penetrate the damaged skin and cause a skin infection. Skin infection is the most serious problem facing children with severe eczema. Sometimes an untreated skin infection can evolve into a system-wide infection in the body.

Eczema can affect any part of the body, but depending on the patient's age, it is more likely to appear in different areas. For most infants, the face, ears, and neck are the areas most likely to be targeted by eczema. As your child grows older, the distribution of eczema tends to shift. School-age children are most likely going to have eczema in their elbows, behind the knees, in the armpits, and on the wrists. The skin around the eyes remains a popular spot for eczema. Adolescents and adults tend to have eczema on their hands.

Other factors, such as emotional stress, changes in humidity, and excessive sweating can also trigger eczema. Eczema tends to worsen during certain seasons. For most people suffering from eczema, skin condition frequently worsens during the winter and improves during the summer (assuming the weather is not too hot).

Breaking the Cycle

Since dryness is the first step of the itch-scratch cycle, it is most effective to stop the cycle at this early stage. Keeping the skin moist is essential. If you can successfully prevent your child's skin from getting too dry, you can avoid most eczema flare-ups.

There are many skin-care strategies that can be used to maintain skin moisture. Avoiding prolonged exposure to water and harsh soaps is a key step. Even though it is not absolutely necessary for children with eczema to avoid taking a bath, taking a shower is generally a better idea. In addition, keep the time spent in the shower as short as possible — ideally under ten minutes. Prolonged soaking of the skin with water washes away the natural skin oil and in the process dries out the skin.

If the weather is cool and your child does not get too dirty during the day, you might want to consider making bath or shower time less frequent — every other day, for instance, instead of daily. Even if your child becomes sweaty or dirty, try to consolidate all the washing to just once daily. Multiple showers in one day can excessively dry the skin and worsen eczema.

Using a harsh soap (such as Lever 2000) has the same effect as frequent washing; it deprives the skin of its natural moisture content. The best types of soap to use for children with eczema are those that include a moisturizer (such as Dove). In fact, if you can manage to get your child clean without using any soap at all, that's even better.

Since avoiding skin dryness is the foundation of controlling eczema, skin moisturizers have a critical role in keeping eczema attacks at bay. Cheap over-the-counter moisturizers are just as effective as the expensive ones sold at cosmetic counters. In fact, petroleum jelly works well for many children. The best time to apply a moisturizer is immediately after a shower. Moisturizing right after a shower helps to trap the water from the wash into the skin. Waiting too long allows that water to evaporate.

Even though the brand name of the skin moisturizer is not important, you should only use a cream or a thick ointment for the job of moisturizing the skin. Lotions contain mostly water, and once the water content evaporates, the skin is left unprotected. In fact, some eczema may even get worse with repeated application of lotion.

Topical Medications

The powerful ability of steroids to subdue inflammation makes these medications the most effective treatment for eczema by far. Just a few days after using these medications, you will notice a drastic improvement in your child's eczema. These steroid medications are directly applied on the skin, and they come in either creams or ointments. Most topical steroids are prescribed by doctors, but some extremely weak ones can be purchased over the counter.

However, you cannot apply topical steroids indiscriminately, which is the reason they must be used under the supervision of doctors. If these medicated creams and ointments are used too long or too often, they can cause the skin to become abnormally thin or to lose its natural pigmentation. Despite their efficacy, they must not be abused.

A new class of prescription creams for eczema came onto the market approximately ten years ago. These creams do not contain steroids, so they don't come with the same possible side effects. Examples in this class of medication include Pro-topic and Elidel.

These medications do not work nearly as well as steroids, and they tend to work a lot more slowly than topical steroids. Even though these medications do not thin out or bleach the skin like steroids, recent research suggests that they might increase the risk of skin cancer. This is obviously a worrisome finding, and more studies are needed to confirm this initial suspicion.

Anti-Itch Campaign

This is the aspect of eczema management that tends to be underutilized by physicians. Given that the itch-scratch cycle is the foundation for the formation of the eczema, it makes intuitive sense that if the itching can be prevented, the rash will also be a lot better. This is indeed the case.

The most effective medication to relieve itching is the oral antihistamine. Medications such as Claritin, Benadryl, and Atarax belong to this category. While using these medications, keep in mind that some of them can be sedating.

Long-Term Outlook

Fortunately, you can almost always count on the fact that your child's eczema will improve with age. Most children suffer significantly less from their eczema by the time they reach adolescence. Exactly when your child might start experiencing relief is difficult to predict. Some children start getting better by school age, and many others carry their eczema into adulthood.

Furthermore, eczema is a genetic condition. This means that if your child has eczema, the chance of your grandchildren suffering from eczema, asthma, and nasal allergy is significantly increased. Since you can't choose your parents, the only thing you can do is be vigilant and bring your child to the doctor at the earliest sign of a problem.