A first post in a series I am starting called Pediatric Pathology for Parents…This is will be a series of posts about common childhood illness and basic descriptions of their underlying causes.
Eczema is also know is atopic dermatitis (atopy means allergy and dermatitis means skin inflammation).
Symptoms:
- Dry skin
- Itching (some people call eczema the itch that rashes)
- Red and crusty lesions on cheeks and outside of elbows/knees (infants)
- Thick scales on the insides of the elbows/knees (children)
Statistics:
- 10% of children in the United States have eczema
- 60% of people with eczema have symptoms before age 1
- 85% have symptoms by age 4
- 60% carry some symptoms into adulthood
Pathology:
There are basically 3 main categories when talking about the causes of eczema: skin barrier, allergy and genes.
Skin barrier-The skin is the primary barrier for your body from infection and things out there in the community which you could be allergic to. One of the key factors for keeping the skin barrier together is keeping it well hydrated (moist). Some people lose more moisture through their skin and cannot keep their skin as protected than others and this puts them at more risk for eczema. Trauma to the skin by recurrent scratching also causes it to lose more water and have more risk of eczema (this is another reason why it is the itch that rashes). This is why applying lotion to eczema actually makes the problem worse because the alcohol in the lotion leaves the skin drier than before. I recommend putting Vaseline or Aquaphor on so thick that you can see it at each diaper change (as many times a day as you can think about it)
Allergy-Some people have a higher risk of developing allergies to substances that have passed through the skin barrier. There are cells just under the skin that love to find new substances and cause a reaction. This reaction leads to redness on the skin surface that you see with eczema. Applying a steroid cream (over-the-counter hydrocortisone or stronger prescription strength steroids) twice a day will decrease your body’s response to these substances and break the cycle. Do no apply the steroid for more than 10-14 days at a time or the skin will begin to thin and make the problem worse.
Genetics-Most people believe that eczema does have a genetic basis. We do not know for sure which genes are involved but there are several possibilities and research continues to determine which is the most likely one. Sorry, I don’t have any suggestions to change your family or origin (even though you might want to for this or many other reasons).
Any follow up questions about eczema or what causes it? If I don’t know the answer I will look it up for you.
DoctorJSmith 
Once you’ve used the steroid 10-14 days to gain control of the eczema can you then use it to spot treat as needed?
Yes, I am completely ok with that.
Good tips! Nathan has the dreaded eczema on backs of legs, arms, and face. Aquaphor/vaseline is good but not during the day when it gets smeared all over the place or clothes! I’m currently using Neosporin’s version of eczema lotion and it seems to work pretty well day to day. I do hydrocortisone when things get really red and itchy. It seems there is no silver bullet. What’s your lotion of choice other than aquaphor or vaseline?
We typically use Aveeno products especially those without scents or dyes.
Is there any way to tell if its eczema or just dry skin?
In many ways eczema is just another word for dry skin…There are a few kids that just seem to have mildly dry skin without much redness and inflammation but the majority of dry skin is eczema.
Is there any way to know if the red, patchy rash-looking blotches are just normal baby eczema or if there is something to be more concerned about? My 7 month old gets it bad around his knees, elbows, thighs, and bicep area. Aveeno works the best. Especially the Aveeno for eczema. If we skip just one day, though, it looks terrible. It doesn’t seem to bother him. It just looks really bad.
Sounds like eczema but it’s hard to know for sure without being able to see and feel it. Eczema does have a chronic come and go pattern so it fits but if you’re struggling with it I would recommend a visit to the doctor.
On Sun, Feb 24, 2013 at 7:32 PM, doctorjsmith