Ditch the Itch

Ditch the Itch

Dr. Jennie Berkovich

Eczema. Atopic dermatitis. Call it what you want, this common chronic skin condition tends to flare up in winter months and colder temperatures. Eczema causes discomfort, can lead to missed school days, and may be difficult and frustrating for kids — and their parents. Here’s what you need to know:

What is eczema?

Eczema is a chronic inflammatory skin condition that’s commonly associated with food allergies and asthma. It can be seen in early infancy all the way through adulthood and often runs in families.

What does it look like?

1. Dry, itchy skin usually on the arms, legs, skin folds, and face.
2. Eczematous skin can become infected with viruses such as herpes simplex, or bacteria that live on the skin such as staph. When this happens, the skin may become red and inflamed or develop small vesicles.

If the eczema is flaring, how can we treat it?

1. Steroid creams, which come in varying degrees of strength, are the first thing to try. You can get 1% hydrocortisone cream in most pharmacies without a prescription.
2. Topical steroids are typically only used for short periods of time. Using high potency steroids for too long can result in a loss of skin pigment called hypopigmentation and is not recommended.
3. Topical calcineurin inhibitors are non-steroid medications, such as tacrolimus (Protopic) cream. They can be considered for use in areas of sensitive skin such as around the eyes. However, long-term side effects aren’t well known and they aren’t always covered by insurance.

How can we prevent eczema flare-ups?

1. The key to prevention is moisturize, moisturize, moisturize!
2. About one-third of patients with eczema have associated food allergies, so avoiding food that triggers eczema can help reduce flares.
3. The “soak and seal” method: Give your child a lukewarm bath for 5 to 10 minutes, then pat dry, and cover the damp skin with a thick cream such as Vaseline. Try to use cream or ointment (think Vaseline and Aquaphor) rather than lotion, which is less potent.
4. For more severe dryness, consider the “wet dressing” technique: After doing the soak and seal described above, put on a pair of wet pajamas followed by a pair of dry pajamas.
5. Keep nails short, dress them in cotton clothing, and avoid fragrance in soaps, lotions, detergents, and fabric softeners.
6. To help reduce the scratching that happens when dry skin gets itchy, consider giving an oral antihistamine like cetirizine (Zyrtec). Reducing scratching keeps the skin more comfortable and prevents infection.

Eczema is like a volcano. It’s always there, even when not erupting. The key to reducing “eruptions” is prevention with lots of moisturization. When the eczema volcano does erupt, short-treatment courses can prevent infection.