Dry Skin - Kids First Pediatric Partners

My child has red, dry, itchy patches on her skin. Could she have eczema?

Eczema is a general term used to describe a number of different skin conditions. It usually appears as reddened skin that is dry and peeling or may start oozing, occasionally resulting in small, fluid-filled bumps. When eczema becomes chronic (persists for a long time), the skin tends to thicken, dry out, and become scaly with coarse lines.

Eczema (also known as atopic dermatitis) and contact dermatitis are the two main types of skin conditions.

Eczema or Atopic Dermatitis

Atopic dermatitis often occurs in infants and children who have allergies or a family history of allergy or eczema, although the problem is not necessarily or always caused by an allergy. Eczema usually develops in three different phases. The first occurs between two and six months of age, with itching, redness, and the appearance of small bumps on the cheeks, forehead, or scalp. This rash then may spread to the arms or trunk. Although eczema often is confused with other types of dermatitis, especially seborrheic dermatitis, severe itching and additional allergy problems are clues that atopic dermatitis is the problem. In many cases the rash disappears or improves by two or three years of age.

The second phase of this skin problem occurs most often between the ages of four and ten years, and is characterized by circular, slightly raised, itchy, and scaly eruptions on the face or trunk. These are less oozy and more scaly than the first phase of eczema, and the skin tends to appear somewhat thickened. The most frequent locations for this rash are in the bends of the elbows, behind the knees, and on the backs of the wrists and ankles. All types are very itchy, and the skin generally tends to be very dry.

The third phase, characterized by areas of itching skin and a dry, scaly appearance, begins at about age twelve and occasionally continues on into early adulthood.

Contact Dermatitis

Contact dermatitis can occur when the skin comes in contact with an irritating substance or allergen. One form of this problem results from repeated contact with irritating substances such as citrus juices, bubble baths, strong soaps, certain foods and medicines, and woolen or rough-weave fabrics. In addition, one of the most common irritants is the child’s own saliva. Contact dermatitis doesn’t itch as much as atopic dermatitis and usually will clear when the irritant is no longer present and improves when babies no longer drool on their skin.

Another form of contact dermatitis develops after skin contact with substances to which the child is allergic. The most common of these are:

Nickel jewelry or snaps on jeans or pants
Certain flavorings or additives to toothpastes and mouthwashes (These cause a rash around or in the mouth.)
Glues, dyes, or leather used in the manufacture of shoes (They produce a reaction on the tops of the toes and feet.)
Dyes used in clothing (These cause rashes in areas where the clothing rubs or where there is increased perspiration.)
Plants, especially poison ivy, poison oak, and poison sumac. This rash usually appears within several hours after contact (one to three days with poison ivy); as well as being itchy, it may cause small blisters
Medications such as neomycin ointment

Treatment

If your child has a rash that looks like eczema, your pediatrician will need to examine it to make the correct diagnosis and prescribe the proper treatment. In some cases she may arrange for a pediatric dermatologist to examine it.

Although there is no cure for eczema, it generally can be well controlled and often will go away after several months or years. The most effective treatment is to prevent the skin from becoming dry and itchy and to avoid substances that cause the condition to flare. To do this:

Use skin moisturizers (e.g., creams or ointments) regularly and frequently to decrease the dryness and itchiness.
Give your child frequent soaking baths in lukewarm water. After a bath, rinse twice to remove any residual soap (which might be an irritant). Then apply the cream or ointment within three minutes of getting out of the bath to lock in the moisture.
Avoid harsh or irritating clothing (wool or coarse-weave material).
If there is oozing or exceptional itching, use tepid (lukewarm) compresses on the area, followed by the application of prescribed medications.

There are many types of medicated prescription creams and ointments available, so ask your pediatrician to suggest one that he prefers to control inflammation and itching. These preparations often contain a form of cortisone, but there are also several types of nonsteroidal medications. These creams or ointments should be used on an as-needed or daily basis, but only under the direction of your child’s doctor. In addition, other lotions or bath oils might be prescribed. It’s important to continue to apply the medications for as long as your pediatrician recommends their use. Stopping too soon will cause the condition to recur.

In addition to the skin preparations, your child also may need to take an antihistamine by mouth to control the itching and antibiotics if the skin becomes infected.

The treatment of allergic contact dermatitis is similar, although your pediatric dermatologist or allergist also will want to find the cause of the rash by taking a careful history or by conducting a series of patch tests. These tests are done by placing small patches of common irritants (or allergens) against your child’s skin. If the skin reacts with redness and itching, that substance should be avoided.

Alert your pediatrician if any of the following occurs:

Your child’s rash is severe and is not responding to home treatment.
There is any evidence of fever or infection (i.e., blisters, redness, yellow crusts, pain, or oozing of fluid).
The rash spreads or another rash develops.