Treating eczema in kids: as easy as 1-2-3?

Treating childhood eczema effectively requires a 3-pronged approach. This article goes through the steps I recommend (with practical tips!)

Check out my prior article if you’re looking for more of an overview of eczema in children.

As easy as 1, 2, 3?

Any parent that has dealt with eczema can share how frustrating it is. Eczema (or atopic dermatitis) flares wax and wane in response to triggers (sometimes on a daily basis) and you have to stay on top of your game if you want to prevent worsening. Focus on these 3 steps to help manage it more effectively.

Note: for more severe eczema, I’m including some other tips at the bottom of this post, but I always recommend talking to your pediatrician as well.

Step 1: Moisturizer

The MOST IMPORTANT way to prevent eczema flares is to replenish & protect the skin barrier.

• Use an ointment because it has a thicker consistency

• Apply 2-3 times per day, and always within 5-10 minutes of a lukewarm bath.

• Pick a product that is hypoallergenic, unscented, and contains the National Eczema Association Seal of Acceptance.

The Pediatrician Mom tip: You can mix ointment + cream to cut some of that tacky feeling for children who don’t like the way ointment feels on the skin.

My favorite products

There are many products that work well for eczema care. In general, what you are going for is something that is hypoallergenic, fragrance-free, and thick in texture.

You may have to do some trial and error to find the product that works best for your child. Many of my patients do well with Aquaphor, but I found that it did not help my own child as much as Vaniply ointment. Other great brands include Cerave, Cetaphil and Aveeno. Make sure you’re thoughtful not just about moisturizer, but also about the bath products you use for your child. We have had success with Cetaphil and Cerave, but have found the Vanicream bath products work best for my son.

Check out my Favorites page for a selection of the products I’ve found work the best.

Step 2: Treat flares

• Steroids:

  • It is important to treat flares appropriately. Follow your doctor’s instructions and use any prescription ointments (such as steroids) as recommended. I find that too many parents are nervous to use topical steroids because of the internet or fear-mongering from relatives. Remember: under-treated eczema can cause thickening of the skin, discoloration, infection and scarring (and it is very uncomfortable). Obviously, over-using a steroid is also problematic. Extended use can also harm the skin. This is why you want to check in with your physician frequently if your child is on any medication and discuss when you should stop it.

  • It is okay to use a higher strength steroid if it is prescribed. In my experience, the stronger topical steroids are better than over-the-counter options because they do a better job of more effectively tamping down a flare. And often, that means you use them for a shorter period of time. But because overuse can also be problematic, it is very important to use these only as instructed by your doctor.

The Pediatrician Mom tip: always apply the steroid under the moisturizer.

• Other medications:

  • Certain non-steroid medications are sometimes prescribed for eczema as well. Examples include immunomodulators like Tacrolimus (Protopic) and Pimecrolimus (Elidel). These are often very effective and can be used in areas with thinner and more sensitive skin (such as the face) but they are not approved for children under age 2. I’ve seen dermatologists prescribe them off label in this population but this is why they need to be done under the supervision of an expert.

  • Other therapies that dermatologists use including UV therapy and other immunosuppressants for very severe cases.

Eucrisa is a topical non-steroid anti-inflammatory treatment that targets the phosphodiesterase enzyme but is really only about 17% more effective than Vaseline alone. I have not found it to be very helpful for my patients, and some have complained about burning sensations.

Step 3: Minimize trauma

Children with eczema often fall into an “itch-scratch” cycle that can be hard to break. This is because there are a variety of triggers that irritant the skin and lead to scratching, which then damages the skin surface, leading to further inflammation (and more itching).

Ways to minimize trauma to the skin include:

• Keep nails short.

• Minimize exposure to known triggers (see separate post).

• Pick hypoallergenic, unscented products.

3 pediatrician pro-tips that are often overlooked in eczema care

Many parents don’t know about these three additional pro-tips that I have learned over the years can make a huge difference in eczema management.

Wet Wraps

Wet wraps are an effective way to hydrate the skin during a flare and provide comfort and relief because of the “Soak & Seal” approach. Basically, adding these helps trap moisture on the skin surface to replenish the barrier.

This method is best done overnight (although even 2-3 hours can be effective). For little kids who have eczema on the ankles or wrists, wet wraps can be a great way to provide relief (you can use gloves or socks).

1. Lukewarm bath for 15 minutes.

2. Pat dry gently.

3. Immediately apply a thick moisturizer to the affected areas. Your goal here is get the moisturizer fully on the body within about 3 minutes!

4. Dampen cotton clothing or gauze with warm water and wring out excess water. Wrap around the affected areas of the body immediately to try to seal in the moisturizer. Your goal here is to make sure the fabric is damp but not dripping.

5. Add another layer of dry gauze or a set of dry pajamas (you may need to size up to maintain comfort).

You can repeat this a few times a week as necessary during flares. Here are some additional instructions.

Bleach Baths

Parents always balk when I bring this option up. Most children with eczema have a high bacterial burden on their skin. There is promising data that shows a significant decrease in the bacterial load with consistent use of bleach baths (when done correctly). With that said, there have been other studies that suggest that bleach baths are not better than plain lukewarm water baths for eczema for some kids. So my recommendation? Worth a try. For kids for whom they work, they can really make a huge difference.

Here are step-by-step instructions.

Colloidal oatmeal

My old favorite again. This is one of my best hacks for care of irritated skin.

Here are step-by-step instructions.

I’m an eczema mom and I can honestly say - giving advice on managing eczema, and actually doing it are two very different things. I think I often underestimated how much it can feel like an endless battle, or how helpless it can feel to see your child uncomfortable and itchy and struggle to figure out what will help.

There are many studies trying to find effective treatment options for eczema. And many parents are interested in natural remedies, although the evidence for these is mixed (I review it on instagram).

The good news is that many children do outgrow eczema. In the meantime, I hope this 3-pronged approach helps you and your child!