Eczema: Pediatric Atopic Dermatitis

Medically Reviewed by Stephanie S. Gardner, MD on March 06, 2024
Written by Shishira Sreenivas
5 min read

Red, itchy, and dry patches on your child’s skin may look alarming. But pediatric atopic dermatitis (eczema) is a common skin condition that affects babies and children. It usually starts between 3 and 6 months and affects about 15% to 20% of children.

This type of eczema usually goes away as kids grow older. But some kids may have it worse and it may last longer.

Experts aren’t sure what causes eczema in babies and children. But there are some common risk factors that link children with eczema such as:

Family history. Genes may play a role especially if one or both parents have or had the skin condition.

Immune system. If your child’s immune system isn’t fully formed, they may be more prone to have sensitive skin.

Environmental factors. Exposure to cold weather, bathing in hot water, chemicals in soaps, or other products may trigger an eczema flare-up.

Some children may just have more sensitive skin that reacts or gets easily irritated if they come in contact with:

  • Sweat
  • Rough clothing that causes friction
  • Heat
  • Synthetic chemicals in skin care or cleaning products
  • Allergens

However, figuring out what your kid is allergic to may not help soothe their eczema.

Signs of eczema can include:

  • Itching
  • Redness
  • Rashes or bumps
  • Very dry or patchy skin
  • Open, crusty wounds that can leak, or “weep,” fluids

Eczema symptoms may come and go. When it gets worse, doctors call this a “flare-up.” The dry rashes are also more noticeable at night for some. The location and type of eczema symptoms may vary depending on the child’s age, and also varies from child to child.

In infants younger than 1-year-old, the rashes and bumps tend to show up on their cheeks, forehead, or scalp. It may spread to the knees, elbows, or other creases in the belly.

In kids and teens, the eczema may appear on the bends of the knees, elbows, neck, inner wrists, and ankles. The skin may also appear more scaly or dry. The itching causes scratching, which over time, can turn the skin darker, thicker, and cause scarring. This is called lichenification.

There’s no specific test to confirm or diagnose eczema in children. But if you notice eczema-like symptoms, tell your doctor about it. The doctor will do a complete physical exam and take a detailed medical history.

They may ask also important questions regarding family history such as:

  • Do any close family members have atopic dermatitis?
  • Does anyone have a history of asthma?
  • Are any family members prone to nasal allergies like hay fever or allergic rhinitis?

The doctor may also perform certain tests to confirm signs of atopic dermatitis. This includes:

  • Blood tests to check for immunoglobulin E (IgE) levels, a substance your body’s immune system releases. It’s common for children with allergies to have high levels of IgE.
  • Skin tests to check for allergies or other skin conditions.

There’s no cure for atopic dermatitis in children or adults. But there are several treatment options like medications and lifestyle changes available to help the symptoms and keep it from getting worse during flare-ups.

The type of treatment will depend on your child’s age, symptoms, and general medical history and health. Treatment includes over-the-counter (OTC) solutions as well as prescription medications.

Over-the-counter treatments include:

  • Eczema-friendly moisturizers
  • Petroleum jelly
  • Gentle cleansers
  • Mild corticosteroid creams
  • Mineral oils
  • Shampoos
  • Antihistamines -- a type of drug that helps ease any allergic reactions like swelling, redness, and inflammation
  • Pain relievers to help with pain and inflammation

Prescription treatments include:

Corticosteroid cream. This is something you put on the skin to help quickly soothe itchiness. Follow your doctor’s instructions carefully as long-term use can have side effects.

Calcineurin inhibitor cream or ointment. It eases itching and swelling on the skin.

JAK inhibitors. A topical cream or pill that blocks immune system signals and lowers inflammation on the affected area.

Topical PDE4 inhibitors. Phosphodiesterase 4 (PDE4) is a type of enzyme you apply on the affected area on the skin.

Phototherapy (light therapy). This treatment exposes your child’s skin to ultraviolet B rays. It’s prescribed for difficult eczema cases.

Antibiotics. Your child may need to take liquid or pills by mouth to treat bacterial skin infections.

Immunosuppressant medicines. These drugs work to suppress your immune system and stop eczema flare-ups. Your doctor will recommend it only if your child has a really bad case of eczema and other treatments haven’t worked.

Biologic medicines. If your child has a bad case of eczema, they may need a new genetically engineered medicine, such as dupilumab, to bring the symptoms under control.

Besides medications and creams, to soothe itching, try:

Wet wrap therapy. Cover the eczema-affected area with a cool, wet cloth to hydrate and calm the irritated skin. You can also add the wrap on top of topical medications to help them soak in.

Bleach baths. If your child has a difficult case of eczema with skin infection, doctors may recommend adding a small, measured amount of bleach to a bath. The concentration should be similar to a chlorinated swimming pool. Let your child soak for a maximum of 5 to 10 minutes. This can help reduce inflammation and fight off bacterial infections. If the bleach bath irritates the skin or makes the eczema worse, tell your doctor about it.

Good skin care and hygiene with certain lifestyle changes are key to managing your child’s flare-ups. This includes:

  • Put your child in a lukewarm bath for a maximum of 5 to 10 minutes.
  • Use a gentle unscented hydrating cleanser and avoid scrubbing.
  • Soon after bathing your child, apply any topical creams or ointments to affected areas.
  • Within 3 minutes, generously apply moisturizing cream all over the body to avoid dry skin.
  • Use moisturizer as needed to avoid dryness.
  • Dress your kid in breathable materials like cotton; avoid wool or polyester.
  • Keep your kid’s nails short to lessen the itch-scratch cycle.
  • Make sure your kid drinks enough water to help keep skin hydrated.
  • Don’t allow your child to become too hot.
  • Get rid of any known allergens in the house that can trigger eczema.
  • Stress can make eczema worse; help your child with calming exercises like meditation or deep breathing.

It’s important to follow your doctor’s treatment plan closely and attend follow-up appointments to properly manage your child’s eczema. If your child isn’t responding well to the treatment, let your doctor know.

Children with atopic dermatitis are prone to skin infections. Keep an eye out for early signs like:

If you notice these symptoms, call your doctor right away. If your child has an allergic reaction to the OTC or prescription treatments, call 911 or head to the nearest hospital for medical attention.