Eczema in Children (Atopic Dermatitis)

Key points about atopic dermatitis in children:

• It is a long-lasting, chronic skin disease. It is usually seen in babies and children, and most often appears in babies between 3 and 6 months of age.
• It is more common in allergic children or in those with a family history of atopic dermatitis.
• Itching, dryness and redness of the skin are the most common symptoms.
• The aim of treatment is to reduce itching and inflammation of the skin, increase the skin's moisture level and prevent infections.
• The key to controlling the disease is avoiding triggers.
• As the child grows older, the disease either goes away completely or gradually improves.

What causes atopic dermatitis in children?

Although the exact cause is still unknown, some factors are associated with it:

• Genetics
• The immune system
• External factors: winter, bathing in very hot water, using soap, or dry, hot air.

Which children have an increased risk of atopic dermatitis?

• If someone in the family has atopic dermatitis
• If the child is allergic, the risk is high.

What are the symptoms of atopic dermatitis in children?

Symptoms sometimes come and go and sometimes persist. Any area of skin on the body can be affected. In babies, the face, neck, scalp, elbows and knees are usually affected. In children, the inner elbows, backs of the knees, neck area, area around the mouth, wrists, ankles and hands are usually affected.

Although they vary from child to child, the symptoms are as follows:

• Dry, scaly skin
• Severe itching
• Redness and swelling
• Thinning of the skin
• Paleness of the face
• Darkening of the skin around the eyes
• Skin changes around the mouth, eyes and ears
• Red, raised skin lesions

How can we prevent atopic dermatitis?

Since the skin lesions are usually a condition that runs in families, prevention is not really possible.

When should I see a doctor?

• If the symptoms are getting worse
• If the lesions show signs of infection such as increased redness, warmth, oozing or swelling
• If new symptoms appear

How is atopic dermatitis diagnosed?

The doctor asks whether the child and family have allergic symptoms or other allergic diseases (such as asthma, allergic rhinitis or atopic dermatitis). The diagnosis is confirmed by the physical examination findings.

There is no specific diagnostic test for atopic dermatitis. However, additional tests may sometimes be requested. These include:

• Blood test: IgE levels are checked. They are usually high in children with atopic dermatitis. Other routine blood tests are also requested.
• Skin test

How is atopic dermatitis treated?

Treatment may vary depending on your child's symptoms, age, general health and the severity of the disease. There is no cure. Treatment is supportive and soothing. The aim of treatment is to reduce itching and inflammation, increase the skin's moisture level and prevent infections. Treatment includes:

• Avoiding irritants as recommended by your doctor
• Gentle baths that do not irritate the skin, as recommended by your doctor
• Keeping your child's nails short (to reduce scratching and thus protect against infections that scratching may cause)
• Using moisturizing lotions recommended by your doctor

Your doctor may also recommend some medications:

• Corticosteroid creams or ointments
• Antibiotics: to treat an infection, if present
• Antihistamines
• Calcineurin inhibitor creams or ointments
• Ointments that modify the immune system
• Phototherapy (light therapy)
• Immunomodulatory therapy
• Biologic agents: dupilumab

What are the complications of atopic dermatitis?

It can cause thinning of the skin, bacterial infections and allergic dermatitis. Severe itching disrupts sleep. Severe itching can lead to depression. Overuse of steroid creams can cause thinning of the skin and subcutaneous tissue.

How can I help my child with atopic dermatitis?

There is no cure. However, it usually improves and disappears as your child grows older. There will be times when the symptoms disappear for a while and times when they get worse. This is called a flare-up. To prevent flare-ups, pay attention to the following:

• Avoid triggers: wool, soaps and chemicals, eggs, house dust mites, animal dander and stress.
• Prevent your child from scratching the skin: it can worsen the symptoms and lead to infections.
• Always keep the nails cut short.
• Always bathe or shower your child in lukewarm water; never use very hot water. Gently pat the skin dry after a shower or bath.
• Always apply moisturizer after a shower or bath.
• Dress your child in soft clothing. Avoid wool or thick fabrics.
• Keep the room temperature as low as possible, because excessive heat and sweating will increase the itching.