7 Things Doctors Wish You Knew About Eczema

Medical Experts: Sheilagh Maguiness, MD; Alexis Stephens, DO, FACOD, FAAD; Mona Omin, DO, FAAP; Jessica Hui, MD; Karan Lal, DO, MS, FAAD

At least 1 in 10 children suffer from eczema, and if your child is one of them, you know just how uncomfortable the skin condition can be. Eczema—also known as atopic dermatitis—can look like a rash and is often present on the scalp, face, creases of elbows, and the backs of knees. The intensity of this non-contagious, chronic skin condition can fluctuate. It is most commonly developed before the age of 5, and while some children may grow out of it, it is hard to know who will and when.

Kids who have eczema often have lower levels of a special protein called filaggrin, which is needed to create a layer of protection between the body and the environment, explains the American Academy of Pediatrics (AAP). Without that strong defense, the skin becomes more susceptible to environmental irritants.

“Children with eczema have a skin barrier problem that results in excess water loss through the skin,” Dr. Sheilagh Maguiness, MD, a pediatric dermatologist in Minneapolis, Minnesota, and president-elect of the Society for Pediatric Dermatology, told Pregnancy & Newborn. “When they lose so much water, their skin feels dry, itchy and it is prone to both inflammation and infection.”

Eczema is much more complex than a typical rash, so we consulted experts to learn more about the basics and debunk myths surrounding this common chronic skin issue.

Eczema Looks Different on Different Skin Colors

Though Black children are almost twice as likely as their white peers to develop eczema, nearly all the images in advertisements and on search engines regarding eczema show caucasian children. It’s problematic from both a representation standpoint and a diagnostic one. With their Eczema Equality Initiative, Aveeno Baby is working to increase the visibility of children of color who suffer from this skin condition.

While speaking at the Aveeno Baby’s Eczema Equality Panel, dermatologist Dr. Alexis Stephens, DO, FACOD, FAAD, who practices in Coral Springs, Florida, explained that on lighter skin tones, eczema patches are often red. But on darker skin tones, patches may be hyperpigmented, or darker than the surrounding skin.

“And in darker skin, the pigmentation will far outlast the initial flare, and that can be extremely distressing,” she said.

It Could be Nature, Nurture, or Both

So which one is it? Is eczema caused by the environment or genetics? The perhaps frustrating answer is that it could be either or both. If a parent has eczema, their child may be predisposed to it as well. There are also plenty of external factors that can be at play. The AAP says some triggers include dust mites, fragrances (more on that later), hormones, insect bites, pet dander, pollen, tobacco smoke, and wool or synthetic fabrics.

Eczema Isn’t Necessarily Seasonal

There is a misconception that eczema is entirely a cold-weather problem. Perhaps it’s because cold weather can cause drier skin in general. But while some children have worse eczema in the winter, others may have it worse in the summer. Dr. Mona Amin, DO, FAAP is a pediatrician practicing in Hollywood, Florida, and host of the PedsDocTalk podcast who has worked across the country and seen how different climates affect kids differently.

“For some children, the humidity, the moisture in the air, actually helps their eczema, [and] they look better in the summer,” she said at the Eczema Equality Panel. “Another family could come into my office and say that when summer hits, it’s game over.”

Resist the Urge to Itch

Possibly the most unpleasant part of eczema is the itchiness. It’s uncomfortable and irritating, distracting during the day, and can make it hard to sleep at night. Scratching also increases the risk of infection. So what can be done about it? Keep your child’s nails short, dress them in breathable fabrics, and use cool compresses, and/or wet wraps for added relief.

As kids get older, The National Eczema Society suggests teaching them how to press a fingernail onto the skin or pinch it gently instead of scratching. Additionally, one of the best ways to try and keep your kid from scratching is a distraction.

“Distraction is always one of the best methods to prevent scratching from happening,” Dr. Stephens said. “Even putting something in front of them that they have to reach for is a good way to keep their hands away from their body that is itchy.”

The American Academy of Dermatology Association says that though it might seem intuitive to use anti-itch cream or to tell your child to stop itching, both can have adverse effects. Ingredients in such creams and/or the stress of being told to stop can cause flare-ups.

Steer Clear of Fragrances

It may take a while to find the right products that ease your child’s eczema. Ingredients that may help eczema-prone skin include oat or shea butter, aloe, honey, and calamine lotion. Topical steroids can also be effective, but be aware that withdrawal from these products can sometimes be worse than eczema.

If you remember one thing while shopping, it’s that you should be choosing fragrance-free products. Fragrance-free lotions, bath products, soaps, and laundry detergents are gentler on the skin, while products formulated with perfumes or essential oils can be irritating. Make sure the product says “fragrance-free” and not “unscented.”

“Unscented products are still allowed to use a masking fragrance in their formulation, so be aware that unscented does not mean fragrance-free,” Dr. Maguiness said.

You can also look for products that feature the National Eczema Association’s (NEA) Seal of Acceptance, which means it meets the standards set by the NEA’s Scientific Oversight Committee, their ingredients have been assessed, and they’ve undergone testing for sensitivity, irritation, and toxicity.

Get Squeaky Clean

Another misconception is that only bathing a baby once or twice a week will prevent their skin from drying out and is better for their eczema, but Maguiness said frequent baths are a “great way to give dry skin a drink of water” and can lead to improvement in skin prone to eczema.

Use soft washcloths and towels, and when you take your baby out of the tub, pat them dry rather than rubbing them. As soon as you’re done patting, apply a thick layer of lotion or ointment over the body to lock in moisture.

“This method is generally referred to as the ‘soak and smear’ method for bathing infants and it is very helpful for infants prone to eczema,” Dr. Maguiness said. “Bathing daily to every other day will help remove dirt, debris, and bacteria while adding moisture to the skin.”

In between baths, Dr. Karan Lal, DO, MS, FAAD, a pediatric dermatologist in Scottsdale, Arizona, and member of the Society for Pediatric Dermatology told Pregnancy & Newborn he discourages parents from cleaning their baby’s face and body with baby wipes. Instead, reserve them for the diaper area only. “Baby wipes are full of irritants and these can dry out your baby’s face,” he said.

There Is a Relationship Between Eczema and Food Allergies

It’s not uncommon for a child with eczema to develop a food allergy. In fact, Dr. Jessica Hui, MD, pediatric allergist and immunologist at National Jewish Health in Denver told Pregnancy & Newborn that nearly one-third of babies with eczema will go on to have a food allergy.

“Eczema and food allergies are part of what we refer to as the ‘atopic march’ in the allergy world,” she said. “It is a progression of allergic conditions, starting with eczema in infancy, leading to a food allergy, asthma, and environmental allergies over time.”

When skin is inflamed and broken, it is easier for allergens to penetrate and enter the body, Dr. Hui explained. Once this happens, she says, the immune system gets activated and an allergy may develop. Though it may sound scary, parents should feed their babies allergenic foods early and regularly.

“This helps maintain tolerance to these foods,” Hui said. “We recommend this for all babies, especially those with eczema.”

Although the timing of food introduction at around 4 months old coincides with when you can really start seeing eczema on the skin, Dr. Maguinness urges parents to understand that food is not the cause of a defective skin barrier.

“Thus, restricting foods or delaying the introduction of foods is not helpful for most babies with atopic dermatitis.”

Although many children with eczema will suffer from similar symptoms, experts agree that no two children with eczema are the same. While using fragrance-free products, bathing frequently, and trimming nails regularly are all good practices to ease the effects of eczema, some children may need to use prescription treatments. If you suspect your child may suffer from the skin condition, speak with their pediatrician or dermatologist to create a comprehensive care plan.