HealthInfo Canterbury

Treating atopic eczema in children

Te whakarauora i te mate harehare

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 is 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 does not 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 is not often a trigger for eczema and avoiding food groups does not 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 general practice team or pharmacist about which is best for your child.

You can buy moisturisers at the pharmacy, but it is usually cheaper to get them on prescription from your general practice team.

Tips on using moisturisers:

• It is 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.
• Do not 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.
• Do not 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.

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.

Tips on bathing:

• Use warm water, not hot and limit the bath or shower to 15 minutes at the most.
• Do not 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 does not 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 are not always helpful for eczema. Often the skin is itchy because it is dry. Check with your general practice team 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 general practice team about the best way to use this treatment for your child. Do not use strong steroids under wet wraps unless your general practice team tells you to.

Watch for infected eczema

It is 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 is important to see your general practice team 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 does not cause their eczema. Also, removing food groups from their diet will not cure eczema.

If your child has eczema and a food allergy, you will need to treat their eczema and allergy individually. Talk to your child’s general practice team 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 general practice team 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 their quality of life, such as sleep and mood. See your child’s general practice team if their eczema is affecting their mood or you are concerned about the impact it is having on them or you.

If your child's eczema is not getting better despite treatment, or is getting worse, you should see your general practice team. Your general practice team may refer you to see a specialist at the hospital.

If you prefer, you can pay to see a private dermatologist. You can find a private dermatologist on 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