Eczema is an itchy, noncontagious inflammation of the skin that usually begins in childhood. In most cases, eczema begins as intense itching, followed by a patchy skin rash that is red, inflamed, dry and scaly. The rash most often affects the face, arms and legs as well as the creases of the hands and feet. Patients who scratch incessantly may break the skin, opening wounds that are vulnerable to infection.

Eczema is especially prevalent among children. Around 10 percent of all infants and children have eczema at some point, according to the National Eczema Association for Science and Education. It typically begins within the first year of a child’s life. Many children begin to see improvement in the condition by the age of 5 or 6, and more than half who have eczema will grow out of the problem by the teen years. However, some children may see conditions improve, only to get worse again during puberty.

The terms “eczema” and dermatitis are usually used interchangeably. There are several types of eczema, but most people use the term to refer to atopic dermatitis, the most common variety. Atopic dermatitis is a disorder of the upper layers of the skin (epidermis) that usually begins in childhood. It typically affects children in families with a history of atopic dermatitis, allergic conditions or asthma. Scaly, itchy skin rashes are typical symptoms of the disorder, which is the most severe and longest-lasting form of dermatitis.

Other forms of eczema include contact dermatitis (results from direct skin contact with various irritants or allergens), neurodermatitis (occurs when a tight garment or insect bite irritates the skin) and seborrheic dermatitis (involves an overproduction of skin cells and the skin’s natural oil).

The exact cause of eczema is unknown. However, scientists believe that the disease has a genetic component, because it tends to run in families. Flare-ups often result when a child is exposed to certain allergens or irritants. However, many other factors can trigger symptoms, including stress, exposure to temperature extremes and infections.

In diagnosing eczema, a physician will perform a complete physical examination and compile a thorough medical history. A family history of eczema, allergies or asthma may be an important clue in diagnosing eczema in a child. Other evaluations such as an allergy skin test also may be performed.

Eczema is an inflammation of the skin. It is not life-threatening or contagious. However, it typically causes itchiness, discomfort and a dry, scaly skin rash. Because the disease is intensely itchy, patients often have the urge to rub or scratch the affected area. This only makes the condition worse.

Eczema is a common condition that affects people of all ages and races. It is especially prevalent among children and usually begins within the first year of a child’s life. Around 10 percent of all infants and children have eczema at some point, according to the National Eczema Association for Science and Education.

Some patients’ eczema remains chronic (ongoing) or appears periodically over the course of a lifetime. Some patients may go through years of remission before symptoms resurface.

There are several types of eczema, but most people use the term to refer to atopic dermatitis, the most common variety.

Atopic dermatitis is a condition that may occur in association with allergies and frequently runs in families with a history of asthma or hay fever. It typically begins in infancy, where it is often related to food allergies. It is rarely present when a child is born, but often develops over the first six weeks of a baby’s life. Almost all cases occur by the time a child is 5.

There are two main forms of atopic dermatitis:

• Chronic, with symptoms lasting for long periods of time
  
  
• Episodic, with symptoms more likely to come and go in periodic flare-ups

Atopic dermatitis does not usually occur in the diaper area, as the moisture in this region helps in prevention. However, it can affect all other areas of the body. It tends to vary in severity during childhood and adolescence. Certain conditions (e.g., colds, infections) and seasons (either dry winter weather or hot, humid summer weather) tend to cause flare-ups. Atopic dermatitis may become less troublesome in adulthood. However, exposures to certain allergens (e.g., pollen, molds, dust) or irritants (e.g., tobacco smoke, certain fabrics) can trigger an outbreak later in life. Stress can also exacerbate atopic dermatitis. Although some children outgrow the condition, individuals who have had eczema during childhood may continue to have dry, sensitive skin. 

Other types of eczema include:

• Contact dermatitis. Results from direct skin contact with various irritants (irritant contact dermatitis) or allergens (allergic contact dermatitis). Irritants include laundry soap, skin soaps or detergents, and cleaning products. Allergens include rubber, metals such as nickel, jewelry, perfume, cosmetics, hair dye, weeds such as poison ivy, and neomycin, an ingredient often found in topical antibiotic creams. A brief exposure to a small amount of allergen can cause contact dermatitis. However, it takes a more significant amount of an irritant – and a longer period of exposure – to trigger irritant contact dermatitis.
  
  
• Neurodermatitis. Occurs when a tight garment or insect bite irritates the skin, leading to chronic scratching or rubbing and a subsequent rash that is dull red to brown, thickened and slightly scaly. Common locations include ankles, wrists, outer forearms or arms, and the back of the neck.
  
  
• Seborrheic dermatitis. Common in people with oily skin or hair, it involves an overproduction of skin cells and the skin’s natural oil (sebum). Also known as cradle cap, it is most likely to appear during infancy before disappearing between the ages of 8 months to 12 months. Cradle cap usually affects the scalp but may occasionally affect the infant’s entire body. It may reoccur depending on the season of the year or whether the patient is under stress. Adults who have neurologic conditions (e.g., Parkinson's disease) or who are immunocompromised (e.g., HIV patients) also are at risk for this form of eczema. Seborrheic dermatitis is often an inherited condition. It is readily treated with mineral oil.
  
  
• Perioral dermatitis. Often associated with conditions such as rosacea, acne or seborrheic dermatitis of the skin around the mouth or nose. The precise cause is unknown, but exposure to makeup, moisturizers and dental products may be involved. This type of eczema rarely occurs in children.
  
  
• Latex dermatitis. Occurs when the skin comes into contact with latex, a fluid produced by rubber trees and found in gloves, balloons, condoms and other products.
  
  
• Dyshidrotic dermatitis. An intensely itchy, chronic form of eczema that typically appears on the palms, fingers and soles of the feet. The cause of dyshidrotic dermatitis is unknown but may include allergies, exposure to irritants and stress. It often progresses to small, fluid-filled bumps, which peel off after one or two weeks. This leaves cracks in the skin that resolve slowly over time. This type of eczema occasionally occurs in teenagers.

The exact cause of eczema is unknown. However, scientists believe that the disease has a genetic component, because it often runs in families. For example, children who have relatives with atopic dermatitis, asthma or hay fever are at a 50 percent risk of developing one or more of these conditions, according to the National Eczema Association for Science and Education. The odds are even higher if both of a child’s parents have one or more of these conditions.

Genetics is not the only factor to cause eczema. Some of the environmental factors known to trigger eczema include exposure to various skin irritants (e.g., solvents such as gasoline) in the environment, perspiration, and various allergens (e.g., pollen, pet dander, foods). Food allergies that trigger eczema are more likely in children than in adults.

Other eczema triggers include:

• Bacteria
• Clothing
• Illness (e.g., colds, infection)
• Jewelry
• Physical or mental stress
• Rubbing the skin
• Soaps, detergents, lotions, bubble bath 
• Weather (hot, cold, humid or dry)
• Hot baths or showers
• Chlorine
• Acidic foods (e.g., tomatoes, citrus fruits)
• Tobacco smoke

In most cases, eczema begins as intense itchiness, followed by a patchy skin rash that is red, inflamed, dry and scaly. The rash most often appears on the face, arms, and legs, and particularly affects the creases of the hands and feet. The rash often itches or burns and may ooze or become crusty when scratched.

Rashes in children under age 2 tend to begin on the cheeks, elbows and knees because these areas are easy to scratch and rub. Eczema rarely occurs in the area covered by a diaper. In older children and adults, rashes are more likely to begin on the inside surfaces of knees and elbows. These age groups are also more likely than younger children to have patches that appear brownish, scaly and thickened. Some people with eczema develop red or clear, fluid-filled bumps that look bubbly. Painful cracking also may occur. Scarring may develop due to patients scratching the intensely itchy rash.

In some cases, eczema may cause other associated skin conditions. These may include:

• Infection. Eczema is often so itchy that children will scratch themselves until they break the skin and bleed. Open sores and cracks associated with eczema frequently are the source of secondary infections of the skin. For instance, a form of infection called impetigo may be caused by Staphylococci bacteria. It is often associated with atopic dermatitis.
  
  
• Cellulitis. Bacterial infection of tissues beneath the skin. Cellulitis manifests as red streaks of skin that are swollen, tender and warm to the touch. It often spreads and has indistinct margins. Cellulitis occurs when a patient’s immune system has been compromised, making it a potentially life-threatening condition that demands prompt medical attention.
  
  
• Lichen simplex chronicus. A toughening of the skin that appears as small skin patches that become thickened and leathery with a dull red to brown color. It is caused by repeated scratching of the skin.

Parents should consult a physician if their child experiences any of the following in relation to their eczema:

• Discomfort that causes the child to lose sleep or become distracted from daily routines
  
  
• Extremely painful skin
  
  
• Indications that the skin may be infected (e.g., fever, redness or warmth of skin, pus-filled bumps, areas that look like cold sores or fever blisters)
  
  
• Failure to see improvement in eczema despite self-care measures

Diagnosis of a child’s eczema can be difficult because children tend to experience many different skin conditions that can be mistaken for eczema (e.g., psoriasis).

To diagnose eczema, a physician will perform a complete physical examination and compile a thorough medical history. A family history of eczema, allergies or asthma may be an important clue to the presence of eczema in a child. The physician may also inquire about environmental factors potentially at the root of a child’s skin rash. For example, a parent may be asked whether the child’s clothes are being washed with a new brand of laundry detergent, which could cause skin irritation. Recent stresses in the child’s life also may be a source of irritation.

Eczema is usually diagnosed if three conditions are present:

• Characteristic scaly rash
• Intense itching
• Personal or family history of asthma, hay fever or other allergies

However, other tests may also be performed. For example, a physician may refer a child to an allergist for testing that exposes a patient’s skin to various substances to determine if any of the substances inflame the skin, which would be characteristic of contact dermatitis. Allergy testing may occasionally be necessary to identify allergens that may trigger atopic dermatitis.

In addition, parents may be asked to make certain lifestyle changes for a specific period of time. These may include eliminating certain foods from the child's diet and changing brands of detergent or soap. This often enables parents and physicians to determine whether a child is reacting to a certain substance.

Treatment options for eczema may vary depending on the type of eczema being treated, and whether it appears as dry and scaly lesions, dry and thickened lesions or “weeping” lesions. Some patients with severe or chronic eczema may wish to consult a dermatologist for treatment. In general, the goal is to reduce skin inflammation, dryness and itchiness.

Medications such as over-the-counter or prescription corticosteroids (to control inflammation), antihistamines (to control itching), and antibiotics and antifungal topical creams or ointments (to control secondary infection from scratching) may be used. These should be used only as directed by a physician to prevent accidental injury to a child. For example, corticosteroid creams are prescribed in dosage levels appropriate for an individual child. Applying one child’s prescribed corticosteroid cream to another child’s skin may result in damage to the skin of the second child.

Recently, the medications known as topical immunomodulators have been used to treat eczema. While these drugs do not work as rapidly as corticosteroids, they may pose fewer risks to a child’s sensitive skin, particularly when it occurs in delicate areas such as the face and groin. Immunomodulators are not recommended for children under age 2, and are used as a second choice for eczema treatment.

If an allergen is the source of a child’s eczema, a physician may suggest ways to avoid the offending substance. For example, children with food allergies may be asked to modify their diet. However, diet should not be restricted to the point that children do not receive the proper nutrients.

Older children with severe skin damage from eczema may benefit from ultraviolet light treatment (phototherapy). These treatments can clear a child’s skin, making it more cosmetically appealing.

Mothers of newborn children may be able to help prevent eczema by breastfeeding their children. Some studies have shown that children who are breastfed are less likely to develop eczema. Women who are breastfeeding may want to discuss with a physician whether or not to give up certain dietary items that may trigger allergies in their child. These include cow’s milk, eggs, fish, peanuts and soy.

While eczema cannot always be prevented, certain steps can be taken to reduce the risk of flare-ups. Children with the form of eczema known as contact dermatitis are encouraged to avoid coming into contact with irritating substances – such as poison ivy or harsh soaps – that may trigger the condition.

Many other forms of eczema can be partially or fully prevented by avoiding dry skin. Tips for helping to achieve this goal include:

• Bathe less frequently. When possible, children should bathe just two or three times a week, limiting themselves to 15 minutes of bathing in warm – rather than hot – water.  Adding oatmeal to the bath may help reduce itchiness in some patients.
  
  
• Use mild soaps or synthetic detergents. Mild soaps clean without excessively removing natural oils. Soap substitutes (synthetic detergents) in bar, gel and liquid forms dry the skin less than deodorant and antibacterial soaps. Soap should be used on the face, underarms, genital areas, hands and feet. Clear water can be used elsewhere. Scented soaps should be avoided.
  
  
• Dry skin carefully. Brush the skin rapidly with the palms of the hands, or gently pat skin dry with a towel after bathing.
  
  
• Moisturize skin. While skin is still damp, seal in moisture with an oil or cream, especially on the legs, arms, back and the sides of the body. More frequent moisturizing may be necessary during the winter, when the skin tends to be drier. Lotions, which often contain water or alcohol, are not usually helpful for eczema because they do not moisturize dry skin as effectively.
  
  
• Wear gloves in the winter. Exposing skin to cold air with little humidity can dry out skin.
  
  
• Encourage the child to drink plenty of water. Consuming fluids can help add moisture to the skin.

Other tips for preventing eczema or for reducing symptoms associated with the disease include avoiding:

• Substances that provoke allergies (allergens), which may trigger atopic dermatitis. This may include pollen, molds, dust and certain types of foods (e.g., cow’s milk, eggs, fish, peanuts, soy).
  
  
• Tight-fitting, rough or scratchy clothing. Wool and some synthetics are especially likely to irritate the skin. Cotton and cotton blends are better choices. Loose-fitting clothing can help prevent overheating.
  
  
• Scratching the skin rash. For children who find it difficult to control this urge, parents should cover the area with a dressing or have the child wear gloves at night to minimize damage to the skin caused by scratching. Parents should also keep their children's nails short. Shorter nails make it less likely that a child will damage the skin when scratching. This can reduce the odds of a secondary infection. Frequent washing of the child’s hands can also help prevent infection.
  
  
• Strenuous exercise during a flare-up. Sweating can irritate the rash.
  
  
• Mental and physical stress. Stress can trigger flare-ups.
  
  
• Contact with solvents and soaking in water. People who use solvents or who use water to clean should wear gloves to protect the skin on their hands.

As children grow older, they may become increasingly self-conscious about the cosmetic damage that eczema can cause to the skin. There are several steps these youths can take to minimize such damage. For example, taking short showers in lukewarm water helps reduce the risk of eczema flare-ups. Using hypoallergenic moisturizers (which are designed to reduce the likelihood of allergic reaction) also can help protect the skin. Youths who use makeup and sunscreens are urged to make sure these are also hypoallergenic.

Preparing questions in advance can help parents to have more meaningful discussions with their child’s physicians. Parents may wish to ask their child’s doctor the following questions related to eczema and children:

1. What signs and symptoms might indicate that my child has eczema?
   
   
2. How will you diagnose my child?
   
   
3. What type of eczema does my child have?
   
   
4. Is my child's eczema contagious?
   
   
5. What is the likely source of my child’s eczema?
   
   
6. What are the potential complications associated with my child’s eczema?
   
   
7. Is my child likely to develop scars? If so, what steps can we take to minimize scarring?
   
   
8. What are my child’s treatment options?
   
   
9. What are the potential side effects of treatments?
   
   
10. What are the pros and cons of various treatments?
    
    
11. How can I help my child prevent eczema outbreaks?
    
    
12. Is my child likely to outgrow the condition?  
    
    
13. How can I help improve the appearance of my child’s skin?
    
    
14. Are my children less likely to develop eczema because I breastfed them?