Eczema is a very common skin condition in infants and children and typically results in patches of dry, itchy, and inflamed skin. The first skin lesions may appear before infants are 6 months old, but eczema most commonly occurs before the age of 5 years.
Eczema refers to a noncontagious group of skin conditions that causes inflamed, irritated, and often itchy skin, with atopic dermatitis being the type that most commonly affects children. The condition usually flares after exposure to a trigger that irritates the skin. Although pediatric eczema is often not a serious medical condition, symptoms can cause pain, discomfort, and interrupt sleep.
While many cases of eczema may clear during childhood, some can persist into adulthood. Additionally, many people who experience the condition as a child may go on to develop food or environmental allergies.
This article discusses eczema in children, possible triggers, and available treatment options.
Eczema is the name for a group of noncontagious conditions that causes the skin to become dry, itchy, inflamed, or have a rash-like appearance. Eczema is common in children — a
Many people often use the word “eczema” when referring to atopic dermatitis, the type of eczema that most commonly affects children. The term “atopic” refers to conditions involving the immune system, while dermatitis refers to inflammation of the skin.
Eczema’s appearance varies slightly across different age groups. While the condition can develop on any area of the skin at any age, it is more likely to appear in certain areas depending on a person’s age.
In babies, eczema typically forms on the scalp and face, particularly the cheeks, and often presents as a dry, raw, scaly rash. It may also appear on the elbows and knees. Symptoms of itching may come and go, and in some cases, the skin may bubble up and weep fluid.
Infants rarely develop atopic dermatitis in the diaper area, as the skin typically stays too moist. A diaper rash is more likely to result from irritant contact dermatitis.
When eczema develops in children between 2 years of age and puberty, it typically begins as itchy and scaly patches in areas such as the creases of the elbows and knees. It may also occur on the neck, wrists, ankles, and crease between the buttocks and legs.
Over time, the skin may change in appearance, causing it to become bumpy, discolored, and thicker, which may result in the skin becoming persistently itchy.
Researchers are still unsure of the exact cause of pediatric eczema. However, the American Academy of Allergy, Asthma, & Immunology suggests that it may result from the “leakiness” of the skin barrier. This can lead to the skin drying out, making it more prone to irritation and inflammation. Factors that can contribute to the development of eczema in children
- Genetics: Children with a family history of eczema, allergies, or asthma are more susceptible to developing eczema. Mutations in certain genes, such as CARD11 and FLG, also have associations with eczema.
- The immune system: A person may experience a flare of eczema when their immune system overreacts and causes an exaggerated response to a trigger.
- The environment: The “envirome” refers to potential triggers an individual may have exposure to, including pollutants, such as tobacco smoke, climate factors, such as temperature, and social factors, such as stress.
Evidence also highlights a link between allergies and eczema in younger children. Many experts refer to the progression of allergic conditions as the
The American Academy of Dermatology notes that African American and Asian American children are more prone to developing eczema than white children. Additionally, children with very dark skin may receive a diagnosis late, or even not at all, because the condition is less obvious.
People with eczema are
In infants up to the age of 2 years, eczema often appears as a rash on the face or scalp. Older children typically have rashes behind the knees, in the bends of elbow and wrist joints, on the scalp, and behind the ears.
The most common symptoms of atopic dermatitis include:
- itchy skin
- dry, cracked, or scaly skin
- weeping clear fluid after scratching the affected skin
- skin infections
When diagnosing eczema, doctors will likely ask about:
- symptoms, including when they began
- if there is a family history of skin conditions, allergies, and asthma
- the child’s health and whether they have allergies or asthma
- which areas of skin eczema is affecting
In some cases, the doctor may perform a skin biopsy, which involves taking a tiny sample of skin to test and investigate. This is a painless procedure where a healthcare professional will numb the skin first.
Currently, there is no cure for eczema, but the condition is manageable. Treatments typically involve keeping the skin moist and reducing inflammation. A treatment plan may include:
- using emollient creams frequently to relieve dryness and itching
- avoiding scratching
- avoiding triggers, which includes anything that can cause an allergic reaction
- using natural fibers, such as cotton, on the skin
- choosing unfragranced and “soap-free” washing products
- avoiding extremes of temperature
wet wrap therapy, involving taking lukewarm baths before applying medication and moisturizers to the skin, then wrapping the skin in wet gauze
A doctor may also recommend or prescribe stronger treatments, which can include:
- medicated topical creams and ointments, including corticosteroids
- biologic medicines, such as Dupilumab, which can help in more severe cases in adults and children over the age of 6 years
- phototherapy, which exposes skin to UV light to help reduce inflammation
It is advisable to speak with a doctor if symptoms become more severe or if it is difficult to manage the condition at home. If eczema is beginning to impact a child’s everyday life, such as disrupting sleep or there are frequent infections from scratching their skin, a parent caregiver can consider contacting a doctor.
When treating eczema, caregivers need to follow the treatment plan and try to reduce symptoms in the child. Equally, they should remain vigilant for any skin infections, monitor the child’s condition, and schedule doctor’s appointments as necessary.
However, this can be stressful for caregivers. A 2020 study highlights that many experience sleep disturbance, exhaustion, worry, and social isolation relating to their child’s atopic dermatitis. Following treatment regimens, coordinating appointments, and communicating with insurance can create time and financial pressures.
This highlights the need for caregivers to seek support and advice for both emotional and physical well-being.
Atopic dermatitis is the most common skin condition affecting children. It typically causes dry, itchy, and inflamed skin that can lead to discomfort and sleep disturbances. In infants and children, it often presents on the face and the creases of the elbows and knees.
While the exact cause is unknown, genetics, the immune system, and the envirome all play a role. Treatment plans typically involve applying creams and avoiding triggers to keep the skin moist and reduce inflammation.