Eczema, also known as atopic dermatitis, is a common skin problem that affects infants, children, and adults. In this guide, I will provide an overview of eczema, its causes, symptoms, diagnosis, treatment, and prevention.
Eczema Overview
Eczema is a skin problem that causes dry, itchy, scaly, red skin. It can affect people of all ages but is more common in certain families. Eczema can be treated with moisturizers and prescription ointments and creams.
Eczema Causes
Although the cause of eczema is not completely understood, genetics appear to play a strong role, and people with a family history of eczema are at increased risk of developing the condition. In most people with eczema, there is a genetic abnormality in the outermost layer of the skin, called the epidermis. The epidermis is the first line of defense between the body and the environment. When the epidermis is intact, it keeps environmental irritants, allergens, and microbes from entering the body and prevents the skin from losing too much water. In people with eczema, this barrier is less strong and more permeable than it should be.
Despite popular belief, in children, eczema is rarely linked to food allergies. If you think your child might have a food allergy, you should consult an allergy specialist for evaluation.
Eczema Symptoms
Most people with eczema develop their first symptoms as children, before the age of five. Intense itching of the skin, patches of inflamed skin, small bumps, and skin flaking are common. Scratching can further inflame the skin and worsen the itching. The itchiness may be more noticeable at nighttime.
Eczema symptoms vary from one person to another and can change over time. Although eczema is usually limited to specific areas of the body, it may affect multiple areas in severe cases:
- In infants, there may be inflamed, scaly, and crusted areas on the front of the arms and legs, cheeks, or scalp. The diaper area is not usually affected.
- In children and adults, eczema commonly affects the back of the neck, the elbow creases, and the backs of the knees. Other affected areas may include the face, trunk, wrists, and forearms. The skin may become thickened and darkened, or even scarred, from repeated scratching.
Scratching can also lead to infection of the skin. Signs of infection include painful red bumps that sometimes contain pus; if you think your child might have an infection, consult your doctor or nurse, as they may need treatment.
Other findings in people with eczema can include:
- Dry, scaly skin
- Plugged hair follicles causing small bumps, usually on the face, upper arms, and thighs
- Increased skin creasing on the palms and/or an extra fold of skin under the eye
- Darkening of the skin around the eyes
Eczema Diagnosis
Calgary Weather and Its Effects on Eczema
The weather in Calgary can be challenging for those who suffer from eczema, as the city experiences cold and dry winters, and moderate summers. The climate in Calgary can affect eczema in various ways:
Cold weather — The cold, dry air during Calgary’s winter months can cause the skin to lose moisture, which may exacerbate eczema symptoms. It’s essential to keep the skin moisturized and protected during this time to reduce the risk of eczema flare-ups.
Low humidity — Calgary’s climate is typically quite dry, which can cause the skin to lose even more moisture. Using a humidifier indoors, especially in your child’s bedroom, can help maintain adequate humidity levels and prevent skin dryness that can trigger eczema symptoms.
Wind — The wind in Calgary, especially during the winter months, can be harsh on the skin, causing further dryness and irritation. Protecting your child’s skin from the wind with appropriate clothing, such as hats, scarves, and gloves, can help minimize the impact of wind on their eczema.
Rapid temperature changes — Calgary can experience rapid temperature fluctuations, which can be a trigger for some people with eczema. To minimize the impact of these temperature changes on your child’s skin, dress them in layers to maintain a consistent body temperature and avoid overheating.
Sun exposure — While moderate sun exposure can be beneficial for some people with eczema, it’s essential to protect your child’s skin from excessive sun exposure during the warmer months in Calgary. Use a broad-spectrum, fragrance-free sunscreen with an SPF of 30 or higher and encourage your child to wear a wide-brimmed hat and protective clothing when outside.
In conclusion, the weather in Calgary can have a significant impact on your child’s eczema. By taking preventative measures and being mindful of the environmental factors that can exacerbate eczema symptoms, you can help your child better manage their condition and maintain healthier skin.
There is no specific test used to diagnose eczema. The diagnosis is usually based upon your child’s medical history, symptoms, and a physical examination. Factors that strongly suggest eczema include long-term and recurrent itching, symptoms that began at a young age, and a personal or family history of certain allergic conditions (including asthma and seasonal allergies as well as eczema). Another factor to consider is symptoms that get worse after exposure to certain triggers.
Eczema Treatment
Eczema is a chronic condition; it typically improves and then flares (gets worse) periodically. Some people have no symptoms for several years. Eczema is not curable, although it is possible to control your child’s symptoms with a variety of self-care measures and medications.
Who treats eczema?
Many children with eczema can initially be treated by their primary care provider. However, you may need to see a dermatologist (skin specialist) in certain situations, such as if your child’s condition does not improve with treatment, if certain areas of their body are affected (face or skin folds), or if another condition could be causing symptoms.
Identifying triggers
Eliminating factors that aggravate your child’s eczema symptoms can help to control the symptoms. Possible triggers may include:
- Cold or dry environments
- Sweating
- Emotional stress or anxiety
- Rapid temperature changes
- Exposure to certain chemicals or cleaning solutions, including soaps and detergents, perfumes and cosmetics, wool or synthetic fibers, dust, sand, and cigarette smoke
Keeping your child’s skin hydrated
Emollients — Emollients are lotions, creams, and ointments that moisturize the skin and prevent it from drying out. The best emollients for children with eczema are thick creams (such as Eucerin, Cetaphil, and Nutraderm) or ointments (such as petroleum jelly, Aquaphor, and Vaseline), which contain little to no water. Emollients are most effective when applied immediately after bathing. They can be applied twice a day or more often if needed. Lotions contain more water than creams and ointments and are less effective for moisturizing the skin.
Bathing — It is not clear if showers or baths are better for keeping the skin hydrated. Lukewarm baths or showers can hydrate and cool the skin, temporarily relieving itching from eczema. An unscented, mild soap or non-soap cleanser (such as Cetaphil) should be used sparingly. Apply an emollient immediately after bathing or showering to prevent your child’s skin from drying out as a result of water evaporation.
Hot or long baths (more than 10 to 15 minutes) and showers should be avoided since they can dry out the skin.
In some cases, health care providers may recommend dilute bleach baths for children with eczema. These baths help to decrease the number of bacteria on the skin that can cause infections or worsen symptoms. To prepare a bleach bath, one-fourth to one-half cup of bleach is placed in a full bathtub (about 40 gallons) of water. Bleach baths are usually taken for 5 to 10 minutes twice per week and should be followed by the application of an emollient.
Treating skin irritation
Topical steroids — Your doctor may suggest a steroid (also called “corticosteroid”) cream or ointment if your child has mild to moderate eczema. Steroid creams and ointments are available in different strengths; the least potent are available without a prescription (e.g., hydrocortisone 1% cream). Stronger versions require a prescription.
Steroid creams or ointments are usually applied to the skin once or twice per day. These help to reduce symptoms and moisturize your child’s skin. As the skin improves, you can switch to a non-medicated emollient. Strong topical steroids may be needed to control severe flares of eczema; however, these should be used for only short periods of time to prevent thinning of the skin that can result from long-term use.
Other skin treatments — Other skin
treatments for eczema include tacrolimus ointment (brand name: Protopic) and pimecrolimus cream (brand name: Elidel). These are effective in controlling eczema, although they do not work as quickly as topical steroids. They are useful in sensitive areas such as the face and groin and can be used in children over age two. Due to concerns about the long-term safety of these medications, it’s important to carefully follow your health care provider’s instructions about how and how long to use them.
Oral steroids — Oral steroids (e.g., prednisone) occasionally are used for a very short period of time to treat a severe flare of eczema, although this treatment is not usually recommended on a regular basis or for prolonged periods of time because of potential side effects.
Ultraviolet light therapy (phototherapy) — Ultraviolet light therapy (also called phototherapy) can effectively control eczema. However, this therapy is expensive and may increase your child’s risk of skin cancer, and is therefore recommended only for children with severe eczema whose symptoms do not respond to other treatments.
Injectable medications — The injectable “biologic” medication dupilumab (brand name: Dupixent) may be beneficial for treating eczema. Due to its high cost and potential side effects, this drug is reserved for children aged six months and older with moderate to severe eczema that has not responded to other treatments.
Another similar medication called tralokinumab (brand name: Adbry) can also be used in adults.
Immunosuppressive drugs — Drugs that weaken the immune system may be recommended for children with severe eczema who do not improve with other treatments. However, treatment with these drugs can cause serious side effects, including an increased risk for infection. They are not recommended for use in infants or young children.
Relieving itching
Oral antihistamines — Oral antihistamines sometimes help relieve the itching of eczema. The over-the-counter antihistamine diphenhydramine (sample brand name: Benadryl) and prescription antihistamines, such as hydroxyzine (sample brand names: Vistaril, Atarax) and cyproheptadine, cause drowsiness; these may be especially beneficial for children who have trouble sleeping due to itching.
The nonsedating antihistamines such as cetirizine (brand name: Zyrtec) and loratadine (sample brand names: Alavert, Claritin) may relieve itching; both are available without a prescription and cause less drowsiness.
Wet dressings — Wet dressings (wet wraps) help soothe and hydrate the skin, reduce itching and redness, loosen crusted areas, and prevent skin injury due to scratching. Dampened cotton garments (e.g., gauze) may be worn over the affected area and covered with a dry garment. Your child can wear these dressings for a few days, overnight, or during the day (change to a fresh dressing every eight hours).
Mood problems — Talk to your health care provider if your child’s eczema is making them feel anxious or depressed. There are treatments that can help with this.
Can eczema be prevented?
Experts don’t know if there is a way to prevent eczema. Babies who have a parent or sibling with eczema have a higher risk of developing eczema as well. For these babies, good skin care might be helpful, especially in cold or dry climates. Good skin care includes using moisturizing creams or ointments.
Disclaimer
Please note that the information provided in this article is for informational purposes only and should not be considered as medical advice or treatment recommendations. Always consult with a healthcare professional, such as your family physician, pediatrician or dermatologist, before making any decisions about your child’s eczema care. Individual circumstances may vary, and the advice provided here may not be suitable for everyone.
MD, FRCPC, FAAP, Consultant Pediatrician
