Atopic dermatitis - children - homecare

Severe itching is common. Itching may start even before the rash appears. Atopic dermatitis is often called the "itch that rashes" because the itching starts, and then the skin rash follows, sometimes partly as a result of scratching.

To help your child avoid scratching:

• Use a moisturizer, topical steroid cream, barrier repair cream, or other medicine the child's provider prescribes.
• Keep your child's fingernails cut short. Have them wear light gloves while sleeping if scratching at night is a problem.
• Give antihistamines or other medicines by mouth as prescribed by your child's provider.
• As much as possible, teach older children not to scratch itchy skin.

Daily skin care with allergen-free products may cut down on the need for medicines.

Use moisturizing ointments (such as petroleum jelly), creams, or lotions. Choose skin products that are made for people with eczema or sensitive skin. These products do not contain alcohol, scents, dyes, and other chemicals. Having a humidifier to keep air moist will also help.

Moisturizers and emollients work best when they are applied to skin that is wet or damp. After washing or bathing, pat the skin dry and then apply the moisturizer right away. Your provider may also recommend placing a dressing over these skin moisturizing ointments.

When washing or bathing your child:

• Bathe less often and keep water contact as brief as possible. Short, cooler baths are better than long, hot baths.
• Use gentle skin care cleansers rather than traditional soaps, and use them only on your child's face, underarms, genital areas, hands, and feet.
• Do not scrub or dry the skin too hard or for too long.
• Right after bathing, apply lubricating cream, lotion, or ointment while skin is still damp to trap moisture.

Dress your child in soft, comfortable clothing, such as cotton clothes. Have your child drink plenty of water. This may help add moisture to the skin.

Teach older children these same tips for skin care.

The rash itself, as well as the scratching, often causes breaks in the skin and may lead to infection. Keep an eye out for redness, warmth, swelling, or other signs of infection. Call your child's provider at the first sign of infection.

The following triggers can make atopic dermatitis symptoms worse:

• Allergies to pollen, mold, dust mites, or animals
• Cold and dry air in the winter
• Colds or the flu
• Contact with irritants and chemicals
• Contact with rough materials, such as wool
• Dry skin
• Emotional stress
• Getting too hot or too cold, as well as sudden changes of temperature
• Perfumes or dyes added to skin lotions or soaps
• Taking frequent baths or showers and swimming often, which can dry out skin

To prevent flare-ups, try to avoid:

• Foods, such as eggs, that may cause an allergic reaction in a very young child. Always discuss with your provider first.
• Wool, lanolin, and other scratchy fabrics. Use smooth, textured clothing and bedding, such as cotton.
• Sweating. Be careful not to over dress your child during warmer weather.
• Strong soaps or detergents, as well as chemicals and solvents.
• Sudden changes in body temperature, which may cause sweating and worsen your child's condition.
• Stress. Watch for signs that your child feels frustrated or stressed and teach them ways to reduce stress such as taking deep breaths or thinking about things they enjoy.
• Triggers that cause allergy symptoms. Do what you can to keep your home free of allergy triggers such as mold, dust, and pet dander.
• Skin care products that contain alcohol.

Using moisturizers, creams, or ointments every day as directed may help prevent flares.

Antihistamines taken by mouth may help if allergies cause your child's itchy skin. These medicines are often available over the counter and do not require a prescription. Ask your child's provider what kind is right for your child.

Atopic dermatitis is usually treated with medicines placed directly on the skin or scalp. These are called topical medicines:

• The provider will probably prescribe a mild steroid cream or ointment at first, such as hydrocortisone. Topical steroids contain a hormone that helps "calm" your child's skin when it is swollen or inflamed. Your child may need a stronger medicine if this does not work.
• Medicines that regulate the immune system of the skin called topical immunomodulators may also be recommended.
• Moisturizers and creams containing ceramides that restore the barrier of the skin are also helpful.

Other treatments that may be used include:

• Antibiotic creams or pills if your child's skin is infected.
• Medicines that suppress the immune system to decrease inflammation.
• Phototherapy, a treatment in which your child's skin is carefully exposed to ultraviolet (UV) light.
• Short-term use of systemic steroids (steroids given by mouth or through a vein as an injection).
• A biologic injection called dupilumab (Dupixent) may be used for moderate to severe atopic dermatitis.

Your child's provider will tell you how much of these medicines to use and how often. Do not use more medicine or use it more often than the provider says.

Contact your child's provider if:

• Atopic dermatitis does not get better with home care
• Symptoms get worse or treatment does not work
• Your child has signs of infection, such as redness, pus or fluid-filled bumps on skin, fever, or pain

Infantile eczema; Dermatitis - atopic children; Eczema - atopic - children

Eichenfield LF, Tom WL, Berger TG, et al. Guidelines of care for the management of atopic dermatitis: section 2. Management and treatment of atopic dermatitis with topical therapies. J Am Acad Dermatol. 2014;71(1):116-132. PMID: 24813302 pubmed.ncbi.nlm.nih.gov/24813302/.

Eichenfield LF, Tom WL, Chamlin SL, et al. Guidelines of care for the management of atopic dermatitis: section 1. Diagnosis and assessment of atopic dermatitis. J Am Acad Dermatol. 2014;70(2):338-351. PMID: 24290431 pubmed.ncbi.nlm.nih.gov/24290431/.

McAleer MA, O'Regan GM, Irvine AD. Atopic dermatitis. In: Bolognia JL, Schaffer JV, Cerroni L, eds. Dermatology. 4th ed. Philadelphia, PA: Elsevier; 2018:chap 12.

Sidbury R, Davis DM, Cohen DE, et al. Guidelines of care for the management of atopic dermatitis: section 3. Management and treatment with phototherapy and systemic agents. J Am Acad Dermatol. 2014;71(2):327-349. PMID: 24813298 pubmed.ncbi.nlm.nih.gov/24813298/.

Sidbury R, Tom WL, Bergman JN, et al. Guidelines of care for the management of atopic dermatitis: section 4. Prevention of disease flares and use of adjunctive therapies and approaches. J Am Acad Dermatol. 2014;71(6):1218-1233. PMID: 25264237 pubmed.ncbi.nlm.nih.gov/25264237/.

Tom WL, Eichenfield LF. Eczematous disorders. In: Eichenfield LF, Frieden IJ, Mathes EF, Zaenglein AL, eds. Neonatal and Infant Dermatology. 3rd ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 15.

Updated by: Elika Hoss, MD, Assistant Professor of Dermatology, Mayo Clinic, Scottsdale, AZ. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.