Eczema in Three Steps

Eczema in Three Steps

Itching, scratching, weeping skin. Interrupted sleep, daytime annoyance (or worse). Bad picture days. If your child has eczema, you probably recognize problems that occur commonly in your day-to-day life.

Eczema is an immune condition. In the spectrum of immune disease, it’s relatively small. Other immune conditions often produce more disability, side effects from medications, sometimes organ transplant. But if eczema is in your home, it’s bad enough.

For many, there are also triggers in the environment, including hot weather, humidity, sweating, stress, and some allergens such as pets and dust mites.

You may also have heard eczema referred to by its other name, atopic dermatitis. Technically, atopic dermatitis is just one of several types of eczema, but it’s the most common type among children and teens. It’s a close “cousin” of asthma and seasonal allergies, as these often occur as well in people with atopic dermatitis.

The most common complication of eczema is skin infection, which is most likely to occur when the skin is broken, and common skin bacteria breech the protective barrier of the skin, get underneath and develop into infections.

What to do? Here’s an overview of the three step management plan. As always, implement in consultation with your doctor or nurse practitioner.

1. Moisturize

a. 5 minute bath time will reduce dehydration of the skin which occurs with longer time in the tub. Be alert about soap and usually skip it, it may irritate the skin.

b. Pat skin dry after bath time, don’t rub it, which may trigger more itching.

c. Ointment, Ointment, Ointment. Better than creams, lotions and vaseline because ointment is thicker and coats the skin more effectively, reducing water loss through the skin.

2. Stop the Itch

a. Figure out, if you can, what triggers your child’s eczema, and avoid.

b. Double rinse all laundry – clothes, sheets, blankets, towels – to minimize irritation from laundry detergent residue

c. Use cotton clothing, pajamas and sheets, and remove clothing tags if present.

d. When your child’s skin is itchy, teach him or her to squeeze the itchy area, don’t scratch. Squeezing may help soothe the itch better than scratching.

e. Soaking a cloth in cold water and putting it on itchy skin will often help soothe itch as well.

f. Keep your child’s fingernails short and clean.

3. Prevent the skin from breaking open

a. Antihistamines (by mouth), particularly at bedtime, may help reduce scratching in bed (until your child learns to squeeze, see above)

b. Steroid creams (on the skin) are often needed when eczema is getting more severe and your efforts to moisturize and stop the itch aren’t keeping up. Generally, we tell our patients to limit use of topical steroids to 10 days per month to minimize side effects. When and how to use steroids is definitely something to discuss with your doctor or nurse practitioner.

c. Despite your best efforts, eczematous skin will get infected from time to time. If your child’s skin starts to bleed, even a little, the risk of infection climbs significantly. Bleeding skin is a good time to see your doctor or nurse practitioner.

There is much more that can be done for eczema if these steps don’t help significantly. Although eczema is a chronic condition, with treatment you can expect sleep to become restful again, skin to be much less irritated, and infections rare.


– Dr. G. Paul Dempsey

[Featured image: Shawn (Urijamjari)]


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