Q&A:
What's the best treatment for my 10-month-old's eczema?

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Answered by Anthony Mancini M.D.

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Dr. Mancini received his undergraduate and medical educations at the University of Arizona, and trained in pediatrics, pediatric dermatology, and dermatology at Stanford University. He is currently Associate Professor of Pediatrics and Dermatology at Northwestern University's Feinberg School of Medicine and Head of the Division of Dermatology at Children's Memorial Hospital in Chicago, Illinois.

Dr. Mancini has served as a member of the AAP Executive Committee, Section of Dermatology since 2001. He is a member of the AAP Super CME Planning Group and the AAP Pedia Link Pediatric Dermatology Project Team, and is Secretary-Treasurer of the Society for Pediatric Dermatology. His teaching accomplishments include the Faculty Excellence in Education Award from the Department of Pediatrics at Northwestern, which he has received for the last eight years. Dr. Mancini is a peer reviewer and/or sits on the editorial board for several academic journals, and has published over 75 peer-reviewed articles, abstracts, and book chapters. He is co-author of Hurwitz Clinical Pediatric Dermatology, 3rd edition, and is an associate editor for the comprehensive dermatology textbook Dermatology. His special interests include infectious skin diseases and exanthems of childhood, vascular malformations and hemangiomas, and neonatal skin maturation and skin disorders.

Dr. Mancini is a Fellow of the American Academy of Pediatrics and the American Academy of Dermatology. He and his wife, Nicola, a neonatal intensive care nurse, have three children (Mallory, Christopher, and Mackenzie) and reside in Evanston, Illinois.

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Question

What's the best treatment for my 10-month-old's eczema?

Answer

Eczema, or atopic dermatitis, is a common condition in babies and toddlers. It causes red, scaly, itchy areas of skin that may become secondarily infected. Although petroleum jelly can be a useful moisturizer for affected babies, you're right in noting that it may result in heat rash ("prickly heat") during humid summer months. Here are some tried-and-true tips for treating atopic dermatitis:

1.Give your baby a brief daily bath (no longer than 10 minutes) using lukewarm water.
2.Blot-dry the skin, leaving some water droplets behind, and then apply the topical medicine, if needed, followed by a moisturizer (see below).
3.An anti-inflammatory ointment is often needed, and is applied twice daily. Over-the-counter hydrocortisone may be useful for mild cases; for moderate or severe involvement, see your child's health care provider to discuss prescription preparations.
4.If your baby is quite itchy, consider using an oral antihistamine to minimize scratching and the risk of secondary infection.
5.Keep nails trimmed short.
6.If there is oozing, crusting (scabs), or pustules (whiteheads), there may be a secondary infection. See your pediatrician to discuss the need for oral antibiotics.

Most children outgrow eczema, but it may wax and wane for years. The best maintenance program consists of the daily short bath and application of a good moisturizer. There are many moisturizers on the market; choose a thick cream or greasy ointment (such as petroleum jelly) in fall and winter, and use a cream or lotion for spring or summer months, especially if you live in a humid climate. More information is available at the Web site for the National Eczema Association for Science and Education, or NEASE.