Eczema and Atopic Dermatitis
Eczema and atopic dermatitis are some of the most common rashes in kids and babies. We like to call these entities “the itch that rashes.” That saying hints at the fact that the rash occurs not because of irritation at the surface of the skin, but a bit further down the skin layers. If a child did not itch, irritate, or scratch the patch of skin that is prone to eczema, we would not see evidence of a rash. When the outer protective layers of the skin are compromised, antigens (foreign substances) and microscopic intruders start making their way through these cracks deeper in the skin where a specialized part of your immune system tries to get rid of them. In doing so, histamine is released and causes lots of itching, and with itching, you release more histamine and damage the skin more. You can see how this eczema cycle can keep perpetuating.
So what causes this breakdown of the skin’s defenses? Well lots of things actually, which is why eczema and atopic dermatitis are so frustrating for a lot of parents. It could be cold weather, hot weather, certain soaps, certain detergents, warm baths, cold baths, perfumes, irritation from certain fabrics, viral infection, etc.
It is not really a rash that we treat once and goes away; it is a pathology of certain kids’ skin that will wax and wane and flare with different insults to this protective layer for their whole lives. The good news is that as the kiddos grow up, we learn more and more about their particular eczema triggers, what to do to prevent those triggers from causing the skin to react, and which ointment or combination of ointments helps your kiddo’s skin the fastest.
The mainstay of treatment is prevention. The more hydrated the outer layer of skin is, the more swollen the outer skin is, and the better it serves as a wall of protection against outside entities. CeraVe, Cetaphil, and Aquaphor are my favorite go-to moisturizers for kids with eczema. They are thick, super hydrating, and you can tell when they are on the skin because your kids will sort of look like a 1980s Arnold Schwarzenegger when you have enough on the problem parts of their skin to provide good protection throughout the day. We also ask families to bathe kiddos in lukewarm water, only pat dry when getting out of the bath/shower, and keep the kids very well hydrated.
If the simple moisturizers are not cutting it and the skin rashes are flaring, we will at times start topical steroids. The steroids work in two ways. One, the base that the steroid is mixed in is a very hydrating and protective ointment or cream to help hydrate the skin. Two, the actual steroid medication will stop the itch and histamine release and stop that inflammatory cycle on the skin long enough to let the skin start healing and form back the protective outer shield layer. Make sure to follow your pediatrician’s or dermatologist’s instructions for the steroid cream as parents will often stop the steroid ointment as soon as the skin looks better, but remember, the actual rash we see is only the tip of the iceberg. Treatment with the ointment for a full 7-14 days is often needed to calm down the inflammatory cycle and give the skin the time it needs to fix itself. If you stop too early, the rash will come right back within 1-2 days.