Eczema in Children & Teens

Symptoms of Eczema

• Itching, initially, followed by redness, swelling, and dryness that occurs in specific areas, typically the hands, face, scalp, wrists, behind the knees, and in front of the elbows
• Oozing blisters and crusting of the affected areas
• Peeling and chafing
• Thick and scaling patches of skin (chronic cases) due to scratching

What Is Eczema?

Dermatitis and eczema are general terms for many recurring noncontagious skin rashes. Sometimes eczema is used to refer to rashes that occur chronically and often without an identifiable external cause, while dermatitis includes symptoms caused by specific triggers that affect many people in much the same way. Often the two terms are used interchangeably. (Technically, dermatitis means inflammation of the skin and refers to the symptoms, not the cause of the irritation.)

There are various types of dermatitis, some grouped by causes, others by specific symptoms and locations on the body. All of them have symptoms of itching and redness, and they often worsen if scratched. The following are among the most common types.

• Atopic dermatitis. A chronic skin irritation, this condition is characterized by a hypersensitivity, or allergy, to common substances that don’t bother most people. (Atopic is derived from a Greek word meaning “away from the place.”) The condition is primarily inherited and usually affects people with a family history of the disorder, or of asthma or hay fever. Symptoms typically first appear in infancy, then flare up at intervals during adulthood.
• Contact dermatitis. This form of eczema, also known as allergic contact dermatitis, is an acute rash or irritation caused by substances—such as soaps, detergents, cosmetics, and other types of chemicals—that come in direct contact with the skin. Because the irritation is usually localized, you can often discover what the cause is—though sometimes the reaction won’t occur until several hours after you’ve come in contact with the allergen. Also, it may take more than one contact with a substance before dermatitis first occurs. But then the skin becomes sensitized so that any repeated contact produces a reaction.
• Seborrheic dermatitis. Flaking and scaling are typical of seborrheic dermatitis, which tends to occur around the scalp, eyebrows, and face. Dandruff may also be a form of seborrhea.
• Stasis dermatitis. A chronic ailment of middle-aged adults, this is caused by pooling of blood in the lower legs. Symptoms, which include red, scaly patches, usually first appear on the inside of the lower leg around the ankles.

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What Causes Eczema?

Dermatitis may be caused by allergies, as well as by irritants, sweating, and infections—though it may occur for no apparent reason. Sensitivity to irritants and/or allergens sometimes takes years to develop, and symptoms in some cases may appear only after prolonged exposure. Common triggers can include clothing (wool and silk, especially), skin lotions, detergents and soaps, stressful situations, antiperspirants, plants (poison ivy, oak, sumac), and medications.

Next to poison ivy, the most common cause of allergic skin rashes is nickel, which is used in costume jewelry, coins, keys, tools, zippers, and other fasteners. An estimated 6 percent of Americans are allergic to nickel. The incidence of an allergic reaction to nickel is higher among women than men because the needles used for ear piercing often contain nickel.

Other common allergens linked to contact dermatitis are cosmetics (especially nail polish), dyes, and leather. Some people are allergic to latex, which is used in a wide range of medical and consumer products; however, the allergy is relatively uncommon except among health-care workers who are frequently exposed to the material.

In some people, foods (especially wheat, milk, seafood, eggs) can trigger an outbreak. And occasionally, a previously tolerated medication turns into an allergen and causes itching.

Stasis dermatitis is often linked to varicose veins.

What if You Do Nothing about Eczema?

Some cases of dermatitis will clear up on their own. But if your skin is very itchy, it’s hard to avoid scratching, which can aggravate the eczema and cause it to appear in other areas where you scratch. When you can’t avoid the urge to scratch, make use of the self-care remedies or contact your physician for more potent treatments.

Home Remedies for Eczema

Self-care for most forms of dermatitis entails stopping the itch-scratch cycle and avoiding known triggers. Therefore, in addition to easing your discomfort, try to identify the substance that’s causing your symptoms. If you can discontinue using it or coming in contact with it, you may not need medical help.

Don’t scratch. Scratching worsens dermatitis, so try to resist the urge. Keep your fingernails clean and as short as possible to prevent possible infection.

Suppress the itch. Over-the-counter cortisone ointments and creams may help if the allergy or irritation is mild. As a rule, you should use creams or ointments only on dry rashes. If a lesion is oozing, use lotion or liquids. Oral antihistamines may also help relieve the itching. Be wary of “-caine” preparations, such as benzocaine. These deaden the itching, which may feel good momentarily, but they can cause secondary allergic reactions.

Compress the itch. Try a cold compress and that old standby, calamine lotion. Some people have also found temporary relief with milk compresses: pour very cold milk onto a washcloth and leave it on the affected area for three minutes or so; apply another wet cloth for three minutes; repeat several times throughout the day as needed.

Bathe less frequently. Limiting yourself to as few as two baths or showers per week can help keep your skin from drying out. It’s also helpful to bathe in lukewarm water rather than hot water.

Wear loose cotton clothing. Cotton clothing allows perspiration—a potential irritant—to evaporate easily. Avoid woolen and silk garments; their fibers may irritate your skin.

Try support stockings for stasis dermatitis. These special stockings can improve circulation in the legs.

Prevention of Eczema

Pinpoint the source of irritation. If your face is itchy and irritated, suspect a cosmetic. If your hands are cracked and itchy, suspect some chemical you handle (dish detergent, for example). Some people become allergic to nickel after having their ears pierced, and any form of nickel that touches the body produces intense itching and sometimes a rash that looks like poison ivy. The rash may appear anywhere on the body, not necessarily on the ear lobes.

Avoid irritants. Stay away from substances to which you are hypersensitive. If soap or detergent or other chemicals cause problems, wear rubber gloves. Make sure any jewelry is nickel-free. If you have your ears pierced, make sure it’s done with a stainless-steel needle, and be sure that your first pair of earrings are stainless steel or high-quality 18-carat gold studs. Let your doctor or dentist know if you're allergic to latex, since gloves, surgical tubing, elastic bandages, and many other medical supplies contain latex.

Moisturize. After bathing, apply unscented moisturizer on damp skin immediately to seal in the moisture. If you develop dermatitis on your hands in cold weather, apply moisturizer regularly to keep your hands soft. If you live in a dry climate, or are experiencing dry weather, moisten indoor air with a cool-mist humidifier.

When washing or bathing, avoid harsh soaps or detergents. Use your automatic dishwasher and clothes washer as much as possible to avoid contact with detergents.

Relax. Some dermatitis is triggered by stress. If that appears to be true for you, try to maintain emotional stability. Stress reduction techniques such as yoga or meditation can help.

Avoid swimming in chlorinated pools. Chlorine is an irritant. However, you may find that swimming in saltwater bays and the ocean isn’t a problem.

When to Call Your Doctor about Eczema

Contact your physician immediately if a bacterial infection develops (typically signaled by crusting or weeping sores). Also call your physician if a rash or other irritation doesn’t respond to self-treatment after a week, or if it keeps recurring.

An allergic reaction to latex is typically an itchy rash that develops at the site of exposure. But in some people, latex allergy can produce hives, breathing difficulties, and even anaphylactic shock—the same kind of potentially fatal reaction bee stings can cause. If you've ever had a serious reaction to latex, be sure to discuss it with your doctor. You should also carry some identification stating that you are latex-sensitive, in case you have to be treated in an emergency.

What Your Doctor Will Do

After a thorough examination, stronger prescription medications—including corticosteroid creams, antihistamines, and steroid pills—may be prescribed for symptom relief. Recently, the Food and Drug Administration (FDA) approved the first new type of drug in many years for treating eczema. Called Protopic, it is an ointment that can ease the itching of moderate to severe eczema in both adults and children. It is intended for use when other treatments either don’t work or can’t be tolerated because of side effects.

For More Information about Eczema

• American Academy of Dermatology
• National Eczema Association for Science and Education

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