Ask Dr. Doug: Eczema, the Itch That Rashes
Q: My 9-month-old baby has pretty bad eczema. Is it painful? She seems to be scratching all the time, even at night when she’s trying to fall asleep. Is there anything I can do to make this better?
A: A dermatologist friend of mine likes to call eczema “the itch that rashes” and I agree. Babies and children with eczema can be pretty miserable, and it absolutely can impact sleep, mood, and even attention spans in older kids. This time of year, with the cold, dry air, it often gets worse. The good news is with consistent skin care, eczema can be a manageable condition.
Eczema, or atopic dermatitis, is very common, affecting around 15 percent of children. It can be as mild as a few itchy patches on the hands and elbows in the winter, or as serious as an inflamed, scaly, oozy rash on the face and body that flares up year-round. It usually shows up by 6 months of age and tends to get better as we get older. The exact cause isn’t known, but genetics plays a role. Eczema often goes along with other allergic issues like asthma, seasonal allergies, and food allergies.
Those who suffer from eczema have skin that doesn’t keep water in and bacteria and irritants out as well as it should, causing inflammation and itching. Scratching only makes the inflammation worse.
So how to make it better? I break it down into two parts: hydrating the skin and controlling the inflammation. Plain water baths and moisturizers are the first line of defense. The frequency of bathing probably doesn’t matter, as long as you use plain water and a non-soap cleanser on just the dirty bits at the end of the bath. Soap is not your friend. After the bath, pat dry and within a few minutes apply any prescribed ointments, followed by sealing them in with a thick layer of moisturizer. The thicker, the better – I like Vanicream, Cerave, Eucerin, Aquaphor, or Vaseline. Coconut oil will make your baby smell delicious, but is not thick enough to be a good moisturizer for most cases of eczema.
The best medications to control inflammation are steroid ointments like hydrocortisone. I tell parents to use these twice a day until the skin is smooth. When used as prescribed, these are safe and they work – it’s like putting out a fire. Once the skin is smooth, keep moisturizing, twice a day, every day. Antihistamines can also help with itching and sleep. In some cases, food can be a trigger for a flare up, but getting overzealous with elimination diets can cause more harm than good without a clear history. As always, make sure you talk to your pediatrician about recommendations unique to your little one. And enjoy some moisturizer massage time with your baby!