Eczema is a skin condition where inflammation causes the skin to be dry, crust, crack, and ooze. Eczema can often get worse in the winter because the cold winter air can further dry out the skin. It is common, and can affect up to 1 in 5 children.

What causes eczema?

The cause of eczema is not completely understood.  Genetics likely play a role. People with a family history of eczema are at increased risk of developing eczema. In most people with eczema, the top layer of their skin (epidermis) is weaker and allows moisture to escape and bacteria to enter. This is why many people with eczema have dry skin that is more susceptible to infection.

What does it look like?

Eczema is a problem of dry skin that can lead to itchy, scaly red skin and usually presents at a young age.  The hallmark of eczema is dryness and itchiness. 

  • Lesions can look like little red bumps that itch, ooze, and have a scaly appearance.  
  • In infants and children less than 2 years of age, eczema is typically located on the back of elbows, front of knees, cheeks or scalp. In older children and adolescents, eczema is often found on the inside surfaces of elbows and knees, wrists, ankles and neck.
  • The lesions usually are NOT in the area where the diaper touches (this is important to differentiate from a diaper rash).

What are some triggers?

Eczema flares can be triggered by:

  • Skin getting dry (ie. cold weather)
  • Irritants (ie. metal, soaps, fragrances, certain fabrics)
  • Stress (ie. emotional stress)

How can I treat eczema?

  • Limit the use of soaps and detergents: Use a soap-free cleanser.  
  • Do not use any products that have fragrances:  Watch out for products that are “unscented” – these may actually HAVE fragrances in them that mask the smells of lotions to produce a neutral smell.  Instead, look for products that are “fragrance free.”
  • Avoid dry environments: In Canada this is hard – so try and bundle your little one up as much as possible in the cold and avoid skin exposure to the hard dry air.  
  • Use a humidifier: in the home as much as possible.
  • Avoid excessive heat in the shower and bath; this can speed up water loss from the skin. If possible, use lukewarm water.
  • Try a colloidal oatmeal bath: these baths have been shown to help soothe itchy, dry, irritated skin in eczema.
  • After bathing, pat their skin dry (do not rub) and slather them in a fragrance-free topical cream: (Vaseline or CeraVe are good options).   This will help form a barrier on the skin to slow down water loss and lock in moisture.
  • Apply the same “fragrance-free” moisturizers many times throughout the day. 

Eczema is a chronic disease of childhood therefore the symptoms will come back if proper moisturizing/bathing practices are not undertaken.  

If the symptoms of eczema are severe, or the bathing and cream routines above aren’t working well, your doctor may consider treatment with medications.  

  • Topical antibiotics: if the skin is infected due to a breakage in the skin barrier.
  • Topical steroid creams: to reduce the inflammation associated with eczema
  • Antihistamines: to help reduce itchiness, which in turn will reduce the eczema 
  • In severe cases, oral steroid mediations, ultraviolet light therapy, immunosuppressive drugs may be required to control eczema.  

If you’re at all concerned that your child’s dry skin might be eczema, don’t hesitate to make an appointment with your healthcare provider. 

The post was co-authored by Stephanie Liu, MD, MSc, CCFP, BHSc and Erin Manchuk, BScPharm, BCGP.

References:

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3.     Eczema. Canadian Dermatology Foundation (2017).https://dermatology.ca/public-patients/skin/eczema/

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Matiz C, Tom WL, Eichenfield LF, et al. Children with atopic dermatitis appear less likely to be infected with community acquired methicillin-resistant Staphylococcus aureus: the San Diego experience. Pediatr Dermatol 2011; 28:6.

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Huang JT, Abrams M, Tlougan B, et al. Treatment of Staphylococcus aureus colonization in atopic dermatitis decreases disease severity. Pediatrics 2009; 123:e808.

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