Eczema—a day in, day out battle

If your child has eczema, you know what a constant day in, day out war it is to keep his or her skin hydrated. Eczema is a condition where the skin can get dry and irritated, and it's something we see even in infants. It tends to occur in the bend of the arm opposite the elbow, behind the knees, on the cheeks, and in the neck folds. It may even cover most of the body.

It often starts as dry patches, and at this stage, usually a simple moisturizer works. Even on infants, I tend to use quality moisturizers such as hydrated petrolatum, Aquaphor, Lubriderm, Eucerin, or Moisturel. Applying moisturizers frequently all over is the key to success.

Bathing should be restricted to several times a week at most because soaking in water draws moisture out of the skin. A sponge bath for an infant is often all that is needed. After the bath, apply moisturizer when the baby's skin is still wet, to lock in some of the water. Some dermatologists advise putting a layer of petroleum jelly over the moisturizer for difficult patches.

For areas of skin that are starting to break down, using a low-grade steroid cream such as Hydrocortisone 0.5% or 1% (available over–the-counter) three times a day can help prevent further deterioration and reduce inflammation. It is safe to use these mild steroid creams even on the face if needed, but use them only if the dry skin is starting to crack or flake. 

Often with more severe eczema, a stronger medication is needed. Some dermatologists recommend prescription creams such as Protopic or Elidel to reduce inflammation. There have been some reports of linkage to cancer with these creams, but most dermatologists feel that when used appropriately, these drugs do not pose a risk and can be quite beneficial. Another option is a stronger, prescription strength steroid ointment or cream. These should only be used as directed.

Occasionally, the dry cracked skin of eczema leads to a bacterial or viral infection, when a bacteria or virus gets into the body via the cracks in the skin. When this happens, the eczema will not clear up and starts to look worse. Your doctor may prescribe an oral antibiotic or antiviral in this situation.

An eczema variant is a condition called nummular eczema. This condition is characterized by circular dry patches scattered throughout the skin. It can be confused with ringworm.

Parents who manage their child's eczema will tell you it is a frustrating and grueling challenge. I tell my patients whose children have eczema that we do not cure eczema, we manage it until the child, hopefully, outgrows it. Many parents come up with their own moisturizing regimes—through trial and error—that work quite well.

Do you have a child with eczema? What have you found works to treat it?

Dr. Victoria McEvoy graduated from Harvard Medical School in 1975 and is currently an Assistant Professor of Pediatrics at HMS. She is the Medical Director and Chief of Pediatrics at Mass General West Medical Group. She has practiced pediatrics for almost thirty years. She has been married to Earl for thirty six years and raised four children. She currently enjoys writing, traveling, reading, almost all sports, and spending time with her two grandsons.

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