HealthInfo Canterbury

Treating atopic eczema in children

Atopic eczema is a dry skin condition that causes skin to become red (inflamed) and itchy.

Most children will grow out of their eczema, though a small number will have eczema into adulthood.

While there's no cure for eczema, the key to controlling it is for your child to avoid irritants (triggers), bathe regularly, keep their skin well moisturised and use topical (rub-on) steroids when they need them.

Avoid irritants (triggers)

If your child has eczema, their skin barrier doesn't work well and is sensitive to irritants, which can make their eczema worse.

Common irritants (known as triggers) include soaps, detergents, wool and scratchy fabrics and heat. Food isn't often a trigger for eczema and avoiding food groups doesn't usually help eczema.

Once you know their triggers you can try to avoid them. For example, avoid wool and scratchy fabrics next to their skin, instead dress them in soft cotton and use cotton bedding.

Moisturise your baby or child's skin

Moisturisers (sometimes called emollients) add moisture to the skin and can help protect it, which relieves dryness and itch. There are many types of moisturisers and they come in different forms such as lotions, creams and ointments. Talk to your GP or pharmacist about which is best for your child.

You can buy moisturisers at the pharmacy, but it's usually cheaper to get them on prescription from your GP.

Tips on using moisturisers:

• It's important to use moisturisers all the time, not just when your child has symptoms.
• Apply the moisturisers as often as you need to keep their skin moist.
• Always wash and dry your hands thoroughly before applying.
• Don't put your fingers into the container – use a clean spoon or a pump. This helps to stop bugs getting into the moisturiser and helps prevent infection.
• Apply a thick layer to all areas of your child's body (not just the areas affected by eczema), moving in the direction your child's hair grows.
• Don't rub it in – their skin will absorb it in about 10 minutes.
• When using the moisturiser after a bath or shower, pat their skin dry and apply the moisturiser while their skin is damp.
• Watch this video about how moisturisers help children with eczema.

Bathing

Having a bath or shower every day will help to rehydrate your child's skin and remove dry skin and any build-up of moisturisers. This video shows how bathing once a day can help children with eczema.

Tips on bathing:

• Use warm water, not hot and limit the bath or shower to 15 minutes at the most.
• Don't use soap, as it can dry out your child's skin. Instead, use soap substitutes such as aqueous cream or emulsifying ointment (you can buy these at a pharmacy or get them on prescription from your GP). Or use your child's moisturiser. Put them on before your child gets into the bath or shower, then wash them off.
• If you wash your child's hair in the bath or shower, use a shampoo that has fewer irritants. If you use a normal shampoo, make sure you wash their hair over a sink, rather than in the shower or bath, so the shampoo doesn't touch the rest of their skin.
• If your child often gets skin infections, it may help if they have a bleach bath once or twice a week. Use plain bleach without added fragrance or detergent. Bleach comes in different strengths, so the factsheet tells you how much bleach to use for each strength.

Topical steroids

Topical steroids are creams or ointments you apply to your child’s skin to reduce the inflammation (red, angry bits). Steroids come in different strengths. The strength your child needs depends on the areas of inflammation and its severity. Your doctor will tell you the right strength to use and give you specific instructions on how to use it.

Tips for applying steroids:

• Apply enough of the steroid cream or ointment to make the skin shiny.
• Apply to all the areas that are red and inflamed, not just the worst bits.
• You can apply your child's steroid cream before or after applying their moisturiser.
• Keep using the steroid cream or ointment until the eczema inflammation is gone and restart if it returns.

Watch this video How to care for eczema in 3 easy steps.

You can also read more information on Patient.info about steroids and how they work.

Other treatments

Other treatments for eczema in children include:

• Pimecrolimus – A topical steroid-free medication that can reduce inflammation and itching.
• Antihistamines – Antihistamines may reduce itching and scratching but aren't always helpful for eczema. Often the skin is itchy because it's dry. Check with your doctor or nurse before giving your child an antihistamine for eczema.
• Wet wraps – Wet wraps help to cool your child's skin and ease itching. Talk to your doctor or nurse about the best way to use this treatment for your child. Don't use strong steroids under wet wraps unless your GP tells you to.

Watch for infected eczema

It's important to watch your child's skin for signs and symptoms of infected eczema, including:

• weeping skin
• small, pus-filled sores (pustules)
• crusts on the skin.

If you think your child has a skin infection, it's important to see your GP promptly.

Consider these things as well

• Keep your child's nails short.
• Discourage them from scratching. Consider putting cotton mittens on your baby and using tight stretchy clothes or Lycra pyjamas.
• Avoid your child overheating.

Food allergies need separate treatment

For most children, a food allergy doesn't cause their eczema. Also, removing food groups from their diet won't cure eczema.

If your child has eczema and a food allergy, you'll need to treat their eczema and allergy individually. Talk to your child’s GP if you have any concerns about food allergies or foods you think may be causing a flare-up of their eczema.

Getting help for my child's eczema

Ask your doctor or nurse about an eczema action plan. This is a useful way to keep track of the moisturisers, soap substitutes, antiseptics and steroid creams that your child uses.

Eczema can be challenging for both your baby or child, you and your family. The treatment is time consuming, and children often dislike it. Eczema not only impacts their skin but can also affect quality of life, such as sleep and mood. See your child’s GP if their eczema is affecting their mood or you're concerned about the impact it's having on them or you.

If your child's eczema isn't getting better despite treatment, or is getting worse, you should see your GP. Your GP may refer you to see a specialist at the hospital.

If you prefer, you can pay to see a private dermatologist. Find a private dermatologist on:

Healthpages

Healthpoint

  HealthInfo recommends the following pages

• KidsHealth NZ – Eczema

  Information about eczema in children including what causes it, signs and symptoms and management including complications.

• Ministry of Health – Eczema

  Leaflet about what to do about eczema including infected eczema.

Written by HealthInfo clinical advisers. Last reviewed August 2021. Last updated February 2022.

Sources

Page reference: 47145

Review key: HICOD-326084