Dry Skin / Eczema / Atopic Dermatitis
What is eczema?
Remember that it has good and bad days, but often doesn’t completely go away. Sometimes it is related to allergies, especially milk in infants.
Cracked and dry lips are common in kids during the winter months. For more on that, see Lip Licker's Dermatitis (AKA chapped lips).
How do I treat eczema?
Proper cleaning of the skin
Choosing the right product for any person’s skin is very individual, but in general avoiding fragrances and heavy cleansers is helpful. Antibacterial products tend to be harsh on the skin. We also have “good” bacteria on our skin that is beneficial for natural skin balance. Cleansers that contain scrubbing forces to help exfoliate the skin may aggravate the natural skin barriers and make the dryness worse. Historically we recommended to limit bathing, but new research supports daily short baths, as long as moisturizers are applied immediately after bathing. Some experts recommend skipping the towel and applying moisturizers to damp skin. There is no preference to shower vs bath, except that occasional bleach baths might offer benefit (see below). Avoid soaps and use mild, non-soap cleansers.
Teens and adults need more frequent bathing to control body odors, but choosing a mild cleanser is important. Commonly recommended cleansers by dermatologists include Aveeno, Caress, Cetaphil, and Dove. Avoid harsh soaps and heavily fragranced soaps. Find products better for sensitive skin on the National Eczema Association website.
It is recommended to avoid soaps because they dry the skin. Cleansers have a less drying effect. In general any cleanser or soap should be fragrance free. Commonly recommended cleansers by dermatologists include Aveeno, Caress, Cetaphil, and Dove.
Bleach baths have been shown to improve eczema. Adding a half of a cup of bleach to a standard bath water (less for smaller amounts of water) and soaking 5-10 minutes twice per week is recommended. The theory is that the irritated skin becomes colonized with bacteria, which limit healing, and the bleach kills the bacteria, allowing the skin to heal. Be sure to keep colored clothing away from splashing!
Our water is very hard. Several of our providers have noticed a benefit to patients who have a water softener or add baking soda to bath water. NOTE: This is not research proven, but since several patients seem to benefit from it and it isn't harmful, you can try it. If you don't have a water softening system, you can soften the water by adding baking soda to the bath water. Use 1 cup per full tub of water, less for smaller amounts of water.
Moisturize often as soon as possible after cleansing the skin. Moisturize 2-3 times/day for most of the face and body, and more often for the hands as needed with the right moisturizer. Good choices include white, non-fragranced moisturizers. Creams that need to be scooped out of a container are stronger than lotions that can be pumped out of a bottle. Ointments are stronger than creams.
Commonly recommended moisturizers include Aveeno (especially Aveeno Advanced), Cetaphil (especially the RestoraDerm line), Dove, Eucerin, Lubriderm, Neutrogena, Petrolatum Jelly, Vanicream, and CeraVe. Daily use of a product with sunscreen is recommended on the face and other sun-exposed areas. The more expensive lotions are not necessarily better. Applying a lotion that soaks in and then covering with a barrier (ie petrolatum jelly or Aquaphor) can help overnight. Check out the National Eczema Association's website for best products.
Steroids are often recommended for severe patches. Mild steroids, such as over the counter hydrocortisone, can be used twice/day for a week at a time. More severe cases require a prescription strength steroid. Talk to your child's doctor if over the counter products are not sufficient.
Avoid harsh products
Laundry soaps and dryer sheets can irritate sensitive skin. Using the hypoallergenic soaps are best. Setting your washer to double rinse can help remove extra residues. Use cotton clothing and avoid synthetic fibers that irritate sensitive skin. Wash all family member's clothing in a hypoallergenic detergent.
If dry air contributes to your eczema (worse in the winter), adding extra water to the air in your home helps. A whole house humidifier is very helpful in this area during the winter months. Adding an extra room humidifier or vaporizer can be helpful also. Do not use these if your air conditioner is on, as the AC pulls water from the home and adding water will be a futile effort and cost money for little good. A room humidifier increases the humidity of the room and must have regular filter changes. A vaporizer adds bigger water droplets to the air. Let it dry out during the day to avoid mold buildup.
Wet to dry wraps
Using wet bandages with or without topical steroids or moisturizers first applied to the skin can help dry skin. A patient can soak in a bath for a few minutes, then get out and apply moisturizers or creams prescribed by the clinician. Water-soaked bandages then can wrap or cover the area. Dry bandages can be wrapped over the wet ones to protect clothing and bed sheets. For more information on these wraps, see DermNet and this great handout.
If the skin is itchy, you can cover the hands with mittens at sleeptime to keep your child from scratching. Diphenhydramine (Benadryl and other brands) orally can help the itch. It is NOT recommended to use antihistamine creams (ie diphenhydramine cream) because skin absorption of large areas can lead to overdosing. You can use steroid creams for itch. (See steroid section.)
Probiotics have been shown to decrease the risk of eczema. They can be given in a liquid, chewable, or capsule form. For more information on probiotics, visit US Probiotics.
When does my child need to be seen for eczema and what can be done?
Bring up any concerns at your routine visits. If the patches interfere with sleep because of itchiness, cover large parts of the body, look very red with a yellow crust or seem to be worsening with the above treatments, please make an appointment to see your provider. We sometimes use prescription steroids to control the inflammation of eczema. If infected, we may use an antibiotic. Sometimes we will change formulas or offer allergy testing because allergies account for many cases of severe eczema.
Why does it keep coming back?
Eczema can be very frustrating because even with the best care, sometimes it still flares, just like any other chronic condition. Be patient and keep using good skin care!
A comparison with hypertension (high blood pressure): A person with hypertension might be able to lower the blood pressure with diet and exercise. Another might need medicines to keep the blood pressure down. When the blood pressure normalizes, some people fall back into bad habits or forget their medicine. The blood pressure goes back up.
The diet and exercise is comparable to humidifying the air, moisturizing, and avoiding harsh products for the skin. The antihypertensive medication is analagous to steroids or other long term preventative mediation. Many people stop using good skin care when the skin looks healthy, but if there is an underlying predisposition to dry skin, it will quickly return.
Remember, it is easier to prevent the skin from becoming dry than it is to treat a dry patch once started. Keep up with routine good skin care between flares!