Doctors Notes:


Lauren Mortensen

Today on the blog we will be discussing eczema, also known as atopic dermatitis. This is a very common skin condition, especially in areas with colder temperatures (MICHIGAN!). In the United States, it is estimated that about 11 percent of the population is affected. Most commonly, if eczema will occur in an individual, it does so before age 5.

Eczema is an inflammatory skin condition that causes red, itchy, dry patches on the skin. Sometimes these patches are crusty, oozing, scaly or bumpy. Doctors are not 100% certain what causes eczema (likely MANY different factors) but it does seem to run in families and occur more often in individuals with allergies (both environmental and food related) and asthma. Eczema is a chronic condition that waxes and wanes over years.

How does eczema occur exactly? Our skin is our first line of defense against all of those irritants, allergens, bacteria and viruses in the world around us! Intact skin prevents these from entering our body and causing inflammation. The skin of an individual with eczema has an impaired barrier function.

The distribution of where eczema occurs is different depending on an individual’s age. In babies, eczema tends to occur most often on the extensor surfaces (surfaces of elbows/knees), cheeks, trunk, and scalp. In older children, eczema tends to occur on the flexural surfaces (the areas behind our elbows and knees) and also other areas on the skin.

Eczema is diagnosed CLINICALLY by a doctor. There is no specific test for it.

The first step in successful treatment of eczema is eliminating exacerbating factors. What does this mean? Sometimes, eczema is exacerbated by environmental and food allergies. Thus, eliminating these triggers can decrease symptoms. Some of these could include: dust mites, animal dander, molds, pollens, cow’s milk, egg, wheat, and peanut, fragrances.  Allergy testing may be necessary at times. However, very often NO identifiable trigger is discovered. That brings me to the next and likely most important step – HYDRATION, HYDRATION, HYDRATION of the skin! Most individuals think this means putting more lotion on their children but lotions have a high water content and low oil content and this can sometimes worsen eczema! Thick creams (EUCERIN) or ointments (PETROLEUM JELLY or AQUAPHOR) have low or zero water content, are more oily and protect better against eczema. These emollients are super greasy and should be applied often during the day (at least 3-4 times to truly be helpful). Nightly baths (with luke warm water for no longer than 5-10 minutes) followed by patting your child dry and putting a thick layer of the emollient on the skin and cotton pajamas can help to moisturize the skin and lock in the moisture all night long!

Sometimes, eczema is very severe and may require topical steroids, wet wrap therapy or immunotherapy – your primary care physician will let you know if your child needs any of these treatments.

AVOID soaps or lotions with scent, hot baths, scented detergents, wool or synthetic fabrics. Try and not keep your house too dry.

Ultimately, eczema is a breakdown of our skin’s defensive barrier and this can allow bacteria and viruses to get in! If your child’s eczema is looking angry – call your doctor! Your child may need antibiotics to help treat a secondary bacterial infection. Other conditions like molluscum contagiosum (pearly flesh/pink colored bumps with a central dimple) and herpes can be more common in children with eczema as well. Additionally, pityriasis alba (subtle patches of hypopigmented skin on the face), keratosis pilaris (small flesh colored bumps on the skin most often on the arms and legs), and darkening under and around the eyes are all more common in individuals affected with eczema.

How do you prevent eczema? Sometimes there is no preventing it but keeping your baby/child’s skin well moisturized with daily use of an emollient is the first and best step!

See your doctor at HPA for more information about eczema and to find out if your child has it!