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Atopic Dermatitis (Eczema) – Pediatric

Eczema refers to a number of skin conditions, all of which possess red itchy lesions. Seborrheic dermatitis, contact dermatitis, nummular eczema, and atopic dermatitis can all present with red itchy “eczema” patches. The most common cause of eczema in childhood is atopic dermatitis. The following discussion relates to this disorder.

Incidence:  15% of children.  Many children improve with age, and patients may clear completely before adolescence.

Genetics: This disease clearly runs in families, and if both parents have eczema, the risk of a child approaches 50%.

Cause: Although the exact cause is unknown, a clear relationship exists between atopic dermatitis and other types of hypersensitivity to the environment, such as asthma, and hay fever.  30 to 50% of children with atopic dermatitis will eventually develop either asthma or hay fever, and it is quite common to have other relatives with these conditions.  Your child did not “catch” atopic dermatitis.  It is NOT a contagious disease.  He/she was born with the tendency to have it.

Characteristics:  Atopic dermatitis usually begins in infancy, after 1-2 months of age, but it can start later.  The skin is dry and the rash is quite itchy, so infants may be restless and rub against the sheets, or scratch if able.  The rash may involve the face and it may cover a large part of the body.  As the child gets older, the rash may become more localized.  In early childhood, the rash is commonly on the legs, feet, hands and arms.  As a person becomes older, the rash may be limited to the bend of the elbows and knees, on the back of the hands, feet, and on the neck and face.  As the rash becomes more established, the dry itchy skin may become thickened, leathery and sometimes darker in color.  The more the person scratches, the worse the rash is and the thicker the skin gets. The skin is easily irritated by sweating, environmental changes, wool clothing, playing on the grass, too much soap, excessive swimming, etc..  Scratching may then lead to secondary bacterial infection at the sites where the skin is damaged.  Most children with atopic dermatitis outgrow the condition before school age; some continue to have problems as an adolescent or even as an adult.

Food Allergies:  The majority of children with atopic dermatitis do not have significant allergies to foods, and the ones who do often show little improvement when that food is avoided. Thus for the majority of patients with atopic dermatitis, extensive evaluations for such allergies are unproductive.  In a small group of atopics, however, significant food sensitivities can be documented. The foods most likely to aggravate atopic dermatitis include milk, eggs, nuts, soy, wheat, and seafood.  In patients with severe or refractory eczema, evaluations for such allergies may be appropriate.


There is no magic cure for atopic dermatitis. In fact, there is no cure at all.  As an inherited condition, the best we can do is manage it.  In most cases we can have considerable success, if treatments are maintained.

  1. Moisturize the skin with a greasy product and avoid irritation!  Some good moisturizers are:  Vanicream, Cetaphil, Aquaphor, Eucerin, and plain petroleum jelly. Moisturizers help protect the skin thus making it better able to act as a barrier against things that irritate it.  Although topical steroids may improve a child’s condition, the patient will not remain clear once the steroids are discontinued unless moisturizers are routinely used. Determining the best moisturizer for any one patient is frequently a trial and error process, as some patients may be sensitive to a product that works fine for the majority of patients.  Moisturizers should be used EVERY day.  Try to keep as much natural skin oil as possible by minimizing the use of soap. If done correctly, bathing can be very beneficial.  Use a mild soap such as Vanicream gentle cleanser and a laundry detergent marked “Free and Clear”. Do not use fabric softener. Rinse clothes well.
  2. Minimize scratching and rubbing! Scratching leads to breaks in the skin barrier, risking possible infection, and makes the rash worse.  Keep nails trimmed and smooth.
  3. Do not be afraid to use topical steroids, but do not over-use them either! Over-use can lead to damage of the skin (thinning, easy bruising, and development of small blood vessels), or over-absorption into the body and interference with growth.  These side effects are exceedingly unlikely if steroid ointments are used as directed.  There are many strengths and types of topical steroid creams and ointments, and the lowest strength necessary to control the eczema should be used.  Topical steroid are important and quite useful treatments; they must be used as directed by the physician.  Ointments should be used instead of creams whenever possible because creams tend to contain more preservatives.
  4. Notify your doctor if your child fails to improve despite appropriate treatment! Occasionally bacterial infections or allergies to topical creams can occur, and you doctor will be able to address these possibilities.


Skin Care Instructions:

  • Bathing needs to be done correctly. Use Dove, Vanicream, Aquaphor baby wash, or Cetaphil soap, only if needed, and then only wash the mouth areas, hands, feet and private areas. Do not use a wash cloth.  Use warm water, because hot water is irritating.  Do not use bubble bath.  Limit soaking in the tub to clean water, not soapy water. Soak first, use the soap last, and then quickly remove the child from the tub).  Pat skin dry with a towel.  Follow IMMEDIATELY with an application of the moisturizer ointment.  The use of too much soap, soaking in soapy water, and not immediately applying moisturizer will make your child’s skin worse, not better. Vanicream gentle cleanser or Aquaphore baby wash and shampoo can be used for the scalp 2-3 times a week.
  • The topical steroids are used to control inflammation. A film of ointment should be applied to the affected areas two times a day.  Massage it in well.  Flaky scalp areas can be treated as well.  The treatment for the face may be different than the one for the body.
  • Apply a moisturizer to the normal skin not treated by the steroid on the entire face and body. The moisturizer may need to be used more than twice a day if the skin seems dry between uses.

Call Teton Dermatology at 307-734-1800 to schedule an appointment to evaluate your warts and develop a personalized treatment plan.

Call Teton Dermatology at 307-734-1800 to schedule an appointment to evaluate your warts and develop a personalized treatment plan.