A scaly, red, itchy, dry rash can show up in the first weeks of life. It signals a vexing but treatable skin problem called atopic dermatitis (AD), often known as eczema.
The main symptom of AD is itching. When the child chronically scratches or rubs the area, this can lead to inflamed, rough, thickened skin. Skin areas affected by AD can become red and oozing.
In younger children, the rash usually occurs on the face, scalp and on the outer areas of the arms and legs. In older children, the rash appears in the creases of the elbows, knees and wrists.
Most children outgrow AD, but in some cases, it may recur in the teenage years or in adulthood. It then becomes chronic dermatitis.
Up to 20 percent of infants and young children have symptoms of AD, according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). Researchers don't know the exact cause, but many factors can make AD worse. If one or both parents had AD, there's a good chance their child will, too.
"Kids also are more likely to have atopic dermatitis when there's asthma, allergy, hay fever or food allergy in the family," says Anthony J. Mancini, M.D., professor of pediatrics and dermatology at Northwestern University.
Recent research also has found a possible link between exposure to antibiotics as an infant and an increased risk for AD and asthma in childhood.
The itch of AD can vary from mild to severe. In some cases, it can disrupt sleep, cause problems in school and lead to emotional upset in families. Occasionally, kids with AD are teased and set apart by peers, leading to a loss of self-esteem.
Kids with AD are more susceptible to skin infection, says Dr. Mancini. Their scratching can spread bacteria or viruses in the areas of rash.
What's the best preventive measure for AD? Keeping skin moist, Dr. Mancini says.
A treatment approach
The goals of treatment are to control inflammation and itching, and prevent the problem from getting worse. Treating AD involves a broad approach:
The entire family should learn about AD. "Kids old enough to understand are taught about their condition, and it's vital for parents to learn," says Dr. Mancini.
Topical steroid creams control inflammation and itching, he says. "These creams are very safe when used correctly and don't have the side effects associated with steroids taken orally." Use the cream at the first sign of itching.
Children with AD should use emollients (skin moisturizing creams) frequently to keep skin moist.
To minimize the risk for infection, keep your child's fingernails cut short and the child's hands clean.
Give your child an antihistamine at night if the itching interrupts your child's sleep or makes it hard for him or her to get to sleep.
New drugs called topical non-steroidal immunomodulators can help treat AD.
Buy cotton clothing for your child; wool clothing can make eczema worse.
Protect your child from excessive heat and cold; dry air; chlorine and other harsh chemicals; and soap.
During grass pollen season, tell your child to avoid rolling or playing in the grass.
To avoid complications, keep any child with eczema away from anyone who has recently received a smallpox vaccination
Children with eczema should not get the smallpox vaccine.
When is eczema serious?
Call your child's health provider immediately if the rash looks infected and your child has a fever, or if the rash flares up after contact with someone with fever blisters (herpes simplex virus).
Call within a day if the rash becomes raw and open, or if the rash has not improved after a week of self-care.