Eczema

Pediatrics for Parents, March, 2008 by Roy Benaroch

Q My child has eczema. Will intense moisturizers help the problem? What other remedies do you suggest?

A Eczema is chronic, itchy rash of childhood. In babies, it's mostly on the cheeks: in older kids, it might be mostly in the elbow and knee folds--but at any age, it can occur almost anywhere.

Moisturizers or emollients can certainly help. Choose one that is free of perfumes and preservatives. Plain Vaseline[R] (petroleum jelly) works well, and it's cheap. The best time to apply a moisturizer is right after a bath, while your child's skin is still wet. Other ways to increase the skin's moisture is to avoid soaking in soapy water, run a humidifier in the winter, and avoid rough scratchy clothes.

Other strategies that help with eczema include topical medications. The best medicines to use for most children are topical steroids. These are very safe and very effective when used correctly. Generic versions of most of these are available and they work well. Usually, the ointment forms of these medications are more effective and less "stingy" than the creams. There are many topical steroid products available at many different strengths, so work with your pediatrician to find one of these that's strong enough to treat your child's eczema well.

If your child seems to need a highly potent product, you ought to consult with a dermatologist for guidance. Though topical steroids are safe, you should avoid using oral steroids to treat all but the most super-severe eczema. And if oral steroids are needed, your child ought to be seeing a specialist.

It's also important to treat the itching that accompanies eczema. This is done with topical medication, soothing cool cloths, and sometimes oral medicines. Occasionally, eczema can flare up because of an infection in the skin, and a short course of oral antibiotics will be needed.

Some, but not most, children with eczema have one or more food triggers that worsen the rash. These can be difficult to find. as the effects of foods can be delayed. Sometimes, very common foods can be a trigger. If your child's eczema is moderate-to-severe, or you find it difficult to treat the eczema with safe medications and moisturizers, you may want to work with a physician skilled in eczema and allergies to try to find possible food triggers.

Roy Benaroch, MD, answers your questions this month. He practices in Atlanta, GA and is a frequent contributor to the newsletter and the Pediatrics for Parents podcast.