How can I treat my child's eczema (atopic dermatitis)?

This is a very common skin problem of infants and children. In fact, probably 50% of infants have at least mild eczema at some point during their first year of life. Eczema is caused by irritation of skin that is already dry and sensitive. It's not contagious or harmful in any way -- it's just not very attractive.

The good news about eczema is that it can be easy to treat with over-the-counter creams, available in any pharmacy or grocery store.

The bad news about eczema is that it can recur again and again. Many parents will use the creams only once in a while, and then get frustrated because the patches keep coming back.

1. Preventive lubricating cream: like Eucerin, Curel, or Lubriderm. The name-brand creams can be expensive; ask your pharmacist to recommend an inexpensive substitute. These creams help moisturize sensitive skin and prevent irritants from settling in the skin. To use: Apply a thin layer of moisturizing cream once or twice a day all over your child's body. After his or her bath is a good time.
2. Flareup cream: like 1% hydrocortisone. areas three times a day. To use: Apply a small amount of hydrocortisone to the roughest, reddest spots on your child's body. Avoid the face: steroid creams can cause thinning of the skin there, and steroid cream in the eyes or mouth can be harmful. (If your child's eczema is worst on the face, read on about alternatives to steroid creams.) Never use a steroid cream for more than 2 weeks in a row unless we specifically tell you otherwise.

About 10% of children with eczema will need a flareup cream that is stronger than 1% hydrocortisone. There are several options:

1. prescription steroid creams, like triamcinolone and betamethasone. These have been mainstays for many years in the treatment of severe eczema.
2. prescription non-steroid creams, like tacrolimus (Protopic) and pimecrolimus (Elidel). These can be used safely on parts of the body where steroid creams aren't recommended, like the eyelids, cheeks, and diaper area. However, they are much more expensive than many steroid creams.

Skin creams work great when used consistently, but they are only half of the treatment for atopic dermatitis. The other half involves avoiding things that dry out, chafe, or irritate the skin. We recommend the following:

• Wash the skin only with a mild, "hypoallergenic" soap. A good soaps for this purpose is white Dove soap. Soaps with perfumes or dyes smell good and look pretty, but these chemicals can irritate the skin. The same goes for shampoos and other baby care products.
• Wash the child's clothes with mild, unscented detergents. Just as with soaps, some detergents contain perfumes which can chemically irritate the skin. Look for products that say "fragrance-free," "dye-free," or "perfume-free." Also, be sure all the detergent is rinsed out. Switching to a liquid detergent (rather than a powder) and using a second rinse cycle can be helpful.
• Wash new clothes before wearing them the first time. Chemicals used in fabric sizing can be irritating.
• Avoid situations that expose the skin to extremes in temperature. Hot, sticky perspiration dries and irritates the skin. Cold air chaps and dries the skin.
• Try to maintain constant humidity. Air conditioning during the summer keeps the skin cool, and a humidifier in winter helps prevent excess skin dryness.
• Reduce sun exposure. Use sunscreens to prevent sunburn, but be aware that sunscreens can contain irritating chemicals. Too much time in the sun can cause sweating and drying of the skin.
• Avoid heavily chlorinated water, such as that found in hot tubs and swimming pools. After swimming, rinse the skin well and don't sit around in a wet bathing suit.
• Bathe in cooler water. Hot water dries out the skin. Your child doesn't have to bathe in an iceberg, but wash him in the coldest water he (and you) can stand.
• Limit baths to only ten minutes, once a day or every other day. Longer or more frequent bathing also dries out the skin.
• Avoid wool clothing. Wool is notorious for irritating sensitive skin.
• Avoid tight clothing. Loose-fitting, cotton-containing garments are better.
• Benadryl syrup can be used if itching is making your child miserable. Benadryl children's liquid can be given every 6 hours as needed. (We don't recommend Benadryl cream for eczema, however -- it seems to dry the skin and make eczema worse.)

Some families tell us they have a hard time finding fragrance-free products. Here are some brands to look for (there are many others):

• Arm and Hammer Perfume and Dye Free: detergent
• California Baby: shampoo, moisturizer, sunblock, cleanser
• CeraVe: moisturizer, cleanser
• Drypers: diapers
• Free and Clear: shampoo
• Neutral Tooth Gel: toothpaste
• Neutrogena: sunblock, cleanser
• Seventh Generation: diapers, baby wipes, detergents
• Tender Care: diapers
• Tide Free: detergent
• Tom's of Maine: toothpaste
• Vanicream: moisturizer, sunblock, cleanser