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Eczema (Atopic Dermatitis)

Eczema (Atopic Dermatitis)

What is Eczema?

Eczema, medically know as Atopic Dermatitis, is an intensely itchy, chronic or chronically relapsing (comes and goes) rash with a mixture of redness, scaling, bumps (papule), and extreme dryness.

While eczema itches throughout the day, it usually itches more at night, causing loss of sleep and therefore possible daytime academic and behavior consequences.  Older children with eczema might even develop anxiety and depression from their chronic misery and lack of sleep.

Eczema usually represents the child as having an atopic predisposition, meaning that the child is one of 1-=15 percent of humans genetically prone to developing allergic diseases.  One-half of children with eczema will develop asthma in their lifetime, and three-fourth will develop seasonal or perennial allergies.  This is known as the "atopic march".  Early recognition and treatment of eczema may slow this march, and make it less likely the child will go on to develop either of these conditions.

About 10 to 20 percent of children will develop eczema.  Two-thirds who do will do so before the age of 12 months, and 90 percent will do so before age of 5 years.  The most common age to begin seeing eczema is between 6 and 12 weeks.

Male and female children are equally affected.  Eczema is more common in formula-fed infants, and in children formula-fed as infants.  Two-thirds of affected children will have "mild"  disease, and one-third "moderate or severe".

The majority of young children with eczema will go into "remission" as they get older, although some will find their eczema returns with puberty.  Between 1 and 3 percent of adults continue to have eczema.

Where Does Eczema Occur?

Eczema may occur anywhere on the body.  In infants, the usually places are on the cheeks, behind the ears, and on the outer surfaces of the arms and legs.  Some infants might also develop seborrheic eczema, a weepy yellow oily type of eczema in the diaper area, behind the ears, or on the scalp or forehead.

Pre-teens with eczema often have the rash on their torso, and on the inner surfaces of the arms and legs (especially at the elbows wrist, knees, and ankles), as well as the buttocks.  Some have nummular eczema, with coin-shaped patches often confused for ringworm.  Others may have dyshidrotic eczema, with itchy irritated blistery areas on the palms or soles - this is especially common in older children and teenagers.  Teens with eczema most commonly have it on their face, the back of their hands and feet, and on their upper back.

What Causes Eczema?

The better question is:  "What triggers eczema?"  It is an allergic disease.  Some children have triggers in their environment, such as dust mites, mold spores, pet dander, or grass and/or tree pollens.  Others, especially young infants, may have cow milk (and its beta-casein protein) as their trigger.

Breastfeeding babies with eczema may be showing an allergy to the dairy, soy, wheat, peanut, or eggs in the mother's diet.  Dairy is by far the most common trigger.  Do not, however, change your baby's milk or your diet without first discussing it with the baby's doctor.

Other irritants that trigger or worsen eczema include perfumed soaps and detergents, fabric softeners, bleach, skin lotions and oils, wool clothing, bubble baths, alcohol-containing shampoos, nylon, tight clothing, dry air, sweat, and high wind (which evaporates the skin's moisture).

Older children (about th or ⅓ rd) with eczema may have food triggers as well:  dairy, eggs, wheat, fish, and peanuts are the most likely foods to worsen eczema.  A two-week elimination trial of each food, guided by your doctor, may help to determine if one of these foods is at fault.  However, food allergies do not alone cause eczema, they only worsen it.  And the presence of both a food allergy and eczema in an individual does not necessarily mean that they are related.

Does Eczema Always Itch?

Not always, depending on the child's age.  Young infants seldom seem bothered by their eczema, unless it covers a large part of their body.  However, by the age of 6 months, most infants are able to begin to rub or scratch their dry patches, making the eczema worse.

Older children almost always have some degree of itching.  Just ahead we'll discuss how to manage this, because allowing them to scratch will only worsen the eczema. Eczema is known as "the itch that rashes".

Does It Ever Go Away?

In about 80 percent of very young children, their eczema will improve with age, often resolving by age 5, if not sooner.

However, it is very important that parents understand that eczema is a chronic disease; treatment is suppressive not curative, a marathon not a sprint.  Be happy when your child's eczema is better, but don't be surprised when it returns.  Such is the nature of eczema.

Does Eczema Increase My Child's Risk For Other Skin Condition?

Yes.  Because the skin is not healthy, secondary infections are more likely.  Children with eczema are more likely to suffer bacterial infections, especially Staph aureus, in 80-90% of children with eczema, in the areas affected by the eczema.  They are also more prone to Group A Strep (especially with eczema on the face), to scabies, to yeast infections, to herpes infection, and to Molloscum (tiny, wart-like lesions).

All children but especially those with atopic dermatitis, should avoid antibacterial soaps & lotions.

Children with eczema are all more likely to have other skin conditions, especially seborrhea (oily skin patches, especially in the scalp, behind the ears, in the groin, and in the eyebrows), and keratosis (bumpy skin on the cheeks, behind the upper arms, and on the thighs)  Both these conditions tend to be life long.

They are also more likely to have pityriasis alba, light areas of skin especially on the face where the eczema has caused fewer pigment cells to exist.

How Can I Make My Child's Eczema Better?

When Should I Call The Doctor?

What About Allergy Testing?

As frustrating and time-consuming as eczema can be, many parents ask about allergy-testing for their child to see what their triggers are.  But eczema is not always an allergy to a food or something in the air, therefore, testing won't often find the answers.  And, positive results to allergy testing don't necessarily mean that we've found the trigger(s) to your child's eczema...your child might just instead have hayfever or asthma secondary to those triggers.  Nevertheless, if your child's eczema is longstanding, and/or difficult to treat, allergy testing will likely be ordered in hopes of identifying POSSIBLE reasons for why the eczema is so stubborn.