(The following are directions for young patients with eczema. Use these notes as guidelines
only. Please contact your allergist to amend the directions to suit
your child's individual needs.)
- Evaluation for offending food triggers is important!
especially milk, eggs, wheat, chocolate, oranges, nuts, peanuts
and tomatoes are often a factor. In younger children, soy, and corn
are also often factors.
- An allergy elimination diet with a “serial
of one offending food at a time for a period of three to four days while carefully
monitoring symptoms) may be necessary.
- Children often outgrow
food sensitivities. Be sure to discuss appropriate re-evaluation
with your physician in order to avoid over-restricting
your child's diet for
longer than is really necessary.
- New articles of clothing for your child are best washed before worn.
- Dreft detergent
- No fabric softeners or strong laundry soaps of any kind
should be used.
- Best to avoid dressing your child in wool, tight clothing, “rubberized” or
and sometimes polyester (especially bare or exposed stitches.)
- Cotton clothing should be worn next to the skin.
- Double rinse when doing your child's laundry (two or three rinse cycles).
- For children with very dry skin, decrease water exposure to two-three
times per week, and
limit duration of water exposure to less than ten minutes at any given time.
bath substitute may be used (yes, one will smell clean and the skin will
also actually be cleansed without the drying effects of water).
- Best to bathe your child before
or after supper, or at least one hour before bedtime. The skin
is too warm immediately after a bath to get right into a nice, warm
bed. Prurititis would result from doing so.
- Bath water should not be too hot-this
increases histamine release into the skin, and increases pruritis.
Bath water should be tepid (room temp) or cool.
- Do not use commercial alkaline
soap. Hypoallergenic soap or sudsing agents (Aveeno- bar, Neutrogena,
Basis) are preferable.
- Avoid deodorant or perfumed soaps; they are very
- If necessary, add emulsified oil or oatmeal
colloid to the bath water.
Lubricants and Emollients
- Be certain to make the application
of an overall lubricant a routine part of your child's day.
- The best emollient
for any individual is often a trial and error process. Your physician,
after examining the skin, will have a better
idea of which
might best suit your child's needs.
- Ointments are used for thicker skins, while
creams tend to be most beneficial for the mild-moderate eczema
often are ineffective as the
skin “drinks” the
lotion immediately, not allowing for maximal efficacy.
- It is not unusual for
a patient to have to change creams (“rotate” creams,
much as you would alternate anti-histamines) to allow the skin to respond
maximally to the prescribed treatment. Some work for a while, and then
a substitute needs
to be made.
- DON'T SCRATCH!
- If your child is “itchy,” pat or
slap gently. Do NOT scratch, as it destroys the top layer of the
skin, and 1) allows for skin infection and 2) worsens the
- You may use ice or cool compresses to relieve itching.
- Avoid “reflex” or “habit” scratching.
anti-itch medicine is important if your child tempted to scratch.
- Children should be given an anti-itch medicine
before bedtime. Clean white socks may be affixed to a child's hands
(once asleep), and prevents
of the skin that may occur with overnight scratching.
- In moderation, it may be beneficial.
- Avoid sunburn!
- Avoid excessive heat. Perspiration may
irritate the eczema.
- PABA-FREE sun lotions (screens) are recommended.
Carefully test sunscreen lotions on a small area of the skin before
- Avoid Jacuzzis, hot steam baths, and the sauna-they
may worsen the eczema.
- Swimming is beneficial for select patients. Showering
immediately after chlorine
exposure, and applying a lubricant all over the body immediately
- Avoid perfumes.
- Use non-perfumed lipsticks.
- Use very simple shampoos-Neutrogena
- Use hypoallergenic deodorants, avoid antibacterial deodorants.
acrylic nails and be very careful what agents are used on nails for manicure.
Oral medications may be used to help control eczema.
- These are extremely helpful in reducing
itching, promoting mild sedation, and perhaps protecting the skin
from the action of the histamine.
- These should NOT be applied in ointments
(i.e. Caladryl) on the skin as they may cause allergic reactions.
are particularly important to be used at night when subconscious scratching takes place.
- Oral antibiotics are indicated when the eczema
becomes infected (often heralded by oozing, dark red or purulent
of scab marks,
painful lesions, and/or malodorous discharge from the affected areas.)
- Should not
be applied topically.
- Water-washable creams and ointments, Vaseline,
vegetable oils and a variety of other ointments may be recommended
on an individual
- Best to avoid lanolin and paraben-containing medications.
all labels carefully.
- Used by most physicians as creams or ointments
to severely affected areas except the face, mucous membranes and
genitals, where special
- Systemic absorption is variable depending upon multiple
factors (the condition of the skin at the time of application,
area is occluded after
application, whether an emollient is pre-mixed with the steroid, what
type of steroid is used,
etc.) Systemic absorption can certainly be minimized-speak with your
physician regarding specific recommendations which would be appropriate
for your child's specific
- Occasionally oral steroids may be needed to decrease
the inflammation of moderately severe eczema. Usually only a short
course is necessary.
of steroid by your physician may actually allow for less overall exposure
to medication, and may increase subsequent control over the eczema.
(EXACERBATION OF ECZEMA) AND CHANGES:
- Immediately report any severe flare-ups
of eczema. Your physician needs to know when there is any significant
change from the normal course
Remember! Your physician is not a mind-reader. If the
eczema is out of control, it is time to have the specialist re-evaluate
on a change of
plan.” Keep skin cool, calm, and comfortable-eczema is essentially
that rashes”-DON'T SCRATCH!
8 “Treating Eczema”, by Catherine
G. Fuller, M.D., Board Certified Asthma and Allergy.