Joseph Pierson, MD, is a dermatologist at The University of Vermont Medical Center and assistant professor at the Larner College of Medicine at UVM. He is also residency program director for dermatology.

Joseph Pierson, MD, is a dermatologist at The University of Vermont Medical Center and assistant professor at the Larner College of Medicine at UVM. He is also residency program director for dermatology.

“Eczema” (also known as atopic dermatitis) is a common skin disease that affects more than 10 percent of all children in the U.S., and there is evidence that the incidence of eczema is rising. Fortunately, there are ways to identify eczema and to treat it. Let’s review how to do just that.

What are the warning signs of eczema?

The main feature of eczema is a chronic, itchy rash. In fact, some people refer to it as “the itch that rashes.” Itching is required for the diagnosis as is the frequent presence of the rash on certain body sites – notably, the face in infants. The rash transitions over time to other flexural areas such as the creases and folds of the elbows, knees, and neck. Note that lesions can appear anywhere on the body.

Important features of eczema that are not necessarily required for the diagnosis include:

  • Early age of onset, most commonly between 3 and 6 months, with 90 percent of cases presenting by age 5.
  • Dryness of the skin.

In addition, either the child or immediate family members are often afflicted with other “atopic” conditions, such as asthma or “hay fever,” underscoring a genetic role.

The disease can wax and wane, and though severity may diminish in later childhood, some degree of eczema or “sensitive skin” often persists into adulthood.

Parents often worry that infants with diaper rash have eczema. This is usually not the case. Infants rarely get true eczema in the diaper area.

Why is eczema a problem?

Quality of life can be severely impacted by eczema. Approximately 60 percent of those who have eczema experience difficulty sleeping. This number rises to 80 percent during “flares,” which is when the eczema gets worse. There is also an increased incidence of depression for those entering the teen years and beyond.

How can I manage mine or my child’s eczema?

The cornerstone of eczema management is liberal moisturization of the skin. The choice of agent involves parental and patient preference, as well as cost.

In general, ointments are more effective at lubricating dry skin, though some find them too “greasy,” petroleum jelly being a notable inexpensive option. It is important to apply moisturizer immediately after bathing, while the skin is wet, as it enhances its effect.

Bathing should happen no more than once daily in warm water for 5 to 10 minutes. If an eczema patient is prone to secondary bacterial infections, periodic dilute bleach baths are often recommended.

Beyond moisturizers, topical steroids play a critical role. Unfortunately, parents are sometimes reluctant to use these agents, despite a decades-long track record of safety when used appropriately (when one considers a child’s age and the sites of application). Over-the-counter hydrocortisone is the mildest topical steroid, and is often the initial choice. Stronger topical steroids as well as the non-steroid agents pimecrolimus or tacrolimus may ultimately be prescribed in a variety of regimens.

Rarely, eczema’s severity will require supervised light therapy or certain oral medications. Immunologic agents termed monoclonal antibodies, widely used for other diseases, are being developed for eczema.

Read More: If you are interested in learning more, I encourage you to review the American Academy of Dermatology’s guidelines for eczema.

Joseph Pierson, MD, is a dermatologist at The University of Vermont Medical Center and assistant professor at the Larner College of Medicine at UVM. He is also residency program director for dermatology.

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