Atopic dermatitis is a type of eczema that affects the skin. Atopic dermatitis causes the skin to become inflamed and itchy, and it is characterized by a red, scaly rash. Atopic dermatitis is quite a common condition in children and even in babies, usually first appearing between the ages of three to six months. If you are a parent, it is likely that you have seen or heard of children having atopic dermatitis. In fact, a research review from 2017 estimated that atopic dermatitis affects nearly 15 to 20 percent of children in developed countries.(1, 2)
Here’s everything you need to know to better understand and treat atopic dermatitis in children.
What is Atopic Dermatitis?
Atopic dermatitis is a long-term skin condition. It is a type of eczema, and it makes the skin get inflamed and itchy, causing a red, scaly rash. It is estimated that the rate of atopic dermatitis in children in the United States alone is around 10.7 percent. Meanwhile, the National Eczema Association (NEA) puts the rate at a slightly higher number, approximately 13 percent.(3, 4, 5, 6)
There is no particular age for when a child may develop atopic dermatitis. However, it is known to typically begin early in life, as early as three to six months. Nearly 90 percent of atopic dermatitis cases develop before a child reaches the age of five. And almost 60 percent of cases tend to develop within the very first year of life.(7)
What are the Symptoms of Atopic Dermatitis in Children?
The most common and often the worst symptom of atopic dermatitis is the itching. Doctors call the itch as pruritus, but it really involves severe itching in the affected area. Some of the other common symptoms of atopic dermatitis in children include:
- Dry, scaly skin
- Red rash or just general redness in the affected area
- Sores that can be open, crusted over, and even oozy
In some cases, the symptoms simply begin as dry skin that starts to redden and eventually develops into a rash. This rash is more likely to appear in the creases of the knees or elbows, and the child may also develop some dry, scaly patches inside the rash. You may also find some redness on their scalp, on their hands and feet, or behind their ears. In some cases, the rash may go on to get worse, developing into open sores that ooze out liquid.
Since atopic dermatitis causes a very itchy rash, you are going to notice your child scratching a lot at the affected skin. Unfortunately, this can worsen the condition and accidentally tear open the skin, which may even cause infection. This is why in smaller children, it is important to keep an eye on the rash. The itching can be so bad that it prevents the child from sleeping properly at night. And eventually, over a period of time, this itching can cause the skin to thicken, a condition known as lichenification.(8, 9)
It is common to observe that your child’s symptoms do not remain constant. They tend to get worse from time to time after having subsided for a while. The sudden worsening of the symptoms is known as a flare-up.
What Causes Atopic Dermatitis in Children?
Children with atopic dermatitis are known to have sensitive skin that tends to be more easily irritated. This can happen due to rough clothes, heat, sweat, and even harsh detergents, cleansers, soaps, moisturizers, etc. Children who have atopic dermatitis may also be allergic to certain foods, dust mites, pollen, grasses, pet dander, or other animals. However, it is not really clear whether these allergies are the cause of atopic dermatitis in children. It has been seen that identifying these allergies has not helped in treating or reducing the occurrence of the eczema. In some rare cases, some children with atopic dermatitis may also develop allergies to certain chemicals present in topical medications, skincare products, or clothing.(10, 11)
The exact cause of atopic dermatitis, unfortunately, is not known clearly. However, some things are associated with it. For example, many children who have atopic dermatitis tend to have a family history of eczema, hay fever, or asthma. However, it is believed that atopic dermatitis is caused by a combination of genes and other external factors, including the winter weather, living in dry, hot temperatures, using certain soaps, or even using hot water for taking a bath.
An immune system that is not yet fully developed is also believed to play a part in the development of atopic dermatitis, as an underdeveloped immune system does not offer much protection that the skin can provide against eczema.(12, 13, 14)
How is Atopic Dermatitis Diagnosed in Children?
If you see a scaly, red rash on your child that seems to have suddenly developed and you are unable to think of a potential cause of the rash, it is best to first keep observing it. If you notice your child scratching it, make sure to make a note of that. If the rash persists after a week or does not get better and the itching seems to get worse, schedule an appointment with your child’s pediatrician.
There is no single test that can be prescribed to determine if your child has atopic dermatitis. However, your doctor will want to check the child’s blood work to search for an antibody known as immunoglobulin E (IgE). This blood test is known as the immunoglobulin E test, and it is a common test prescribed as part of initial screenings for different types of allergies.(15, 16) Children with atopic dermatitis and allergies usually have high levels of IgE in their bloodstream because their immune system overreacts to some triggers or allergens and produces more of the IgE antibody.
Regardless of whether this testing is done, your child’s pediatrician will still conduct an in-depth examination of your child’s skin and also ask you questions about their health history. If you know that your family has a history of eczema, allergic rhinitis, or even some food allergies, it is important to let your doctor know, as there could be a link to atopic dermatitis.
How is Atopic Dermatitis Treated in Children?
Any parent who is told that their child has atopic dermatitis instantly becomes concerned about how the condition can be treated. However, it is essential to understand that atopic dermatitis cannot be cured. It can be managed with medications, and many children find that their symptoms tend to naturally get better as they get older. Treatment helps improve the child’s skin and also their overall mood, considering that they are able to finally get a good night’s sleep.
The ultimate goal of treatment is to improve the overall quality of life for the child and also reduce the risk of or eliminate any complications or infections. Studies from 2015 have shown that the treatment approach to atopic dermatitis in children should ideally include these three major factors:
- Controlling the skin inflammation
- Hydrating the skin
- Restoring the skin barrier to prevent infections
This means that you need to ensure moisturization of the skin by applying lotions or creams to keep the affected area of the skin hydrated. Your child’s doctor will be the right person to guide you on which lotions or creams to apply and how many times a day.(17, 18, 19)
Your doctor will also recommend a topical treatment to the affected skin to bring down inflammation. You will be told to do this after a bath and after drying the skin (gently). Topical corticosteroids work well to reduce the inflammation as well as the itching, especially if your child is experiencing a flare-up of the condition. Another type of topical treatment used for inflammation is known as a calcineurin inhibitor cream. This type of cream can help improve the symptoms as it blocks the immune system from producing the chemical that is responsible for the flare-up.(20, 21, 22, 23)
In some cases, your doctor may even suggest trying out phototherapy for atopic dermatitis. In this form of treatment, a doctor exposes the child’s affected skin to safely controlled doses of lift. Phototherapy is primarily used as a second line of treatment for atopic dermatitis in moderate to severe cases. So if your child’s skin does not respond to other treatments, your pediatrician may suggest phototherapy as a treatment option.(24)
In cases of severe atopic dermatitis, doctors may prescribe other medications, including biologic drugs and immunosuppressants. These medications target the very specific parts of the child’s immune system to suppress the eczema. For example, in children over the age of six years who have moderate to severe cases of the condition can be potential candidates for getting an injection of dupilumab (brand name: Dupixent), which is a biologic drug. However, this is only done if the topical treatments and any other therapies have failed to provide a positive response.(25, 26, 27)
Are There Any Home Remedies for Treating Atopic Dermatitis in Children?
Even while the medical treatment for atopic dermatitis continues, there are many other steps you can take to help make your child’s life more comfortable. Here are some home remedies that you can try to reduce the effect of atopic dermatitis:
- Give your child a lukewarm bath, and make sure to use gentle, no-smell, or flavor cleansers.
- Avoid irritants or triggers that may cause further inflammation to the skin.
- Apply moisturizer regularly to the affected area of the skin.
- Keep your child’s fingernails trimmed so that even if they scratch, they do not tear the skin.
- Make efforts to keep your child cool and comfortable.
If your child is experiencing a flare-up of their eczema, applying a cold compress on the affected skin for a short term can help. Another home remedy you can try is known as wet-wrap therapy. In this type of remedy, you apply wet dressings (make sure they are clean) to the inflamed skin. This helps soothe the inflammation and also reduces the itching. You typically apply a dry dressing over the wet dressing to ensure that your child is able to gain benefit from the moisture for at least a few hours, or sometimes even overnight, to get some sleep and avoid having to wake up to scratch themselves in the middle of the night. (28, 29)
Last but not the least, the American Academy of Dermatology recommends trying a short bleach bath.(30) This involves filling a bathtub with water and just a little bit of six percent bleach. Let your child take a quick soak in this bleach water, and after the bath, gently dry their skin and apply a good layer of moisturizer. However, make sure to consult your child’s pediatrician before going ahead with a bleach bath.
If you think that your child’s skin is acting up and the rash or scales on the skin tend to persist, you should call their pediatrician. A good time to call their pediatrician would be if you find that your child’s skin has gotten increasingly red and the inflammation is worse, or your child has a fever, as it might be an indication that there is an infection. Atopic dermatitis can be a challenging condition to manage as a parent. However, it is possible to keep the condition under control and keep your child comfortable.
Even though there is no cure for atopic dermatitis, many children outgrow the worst of the flare-ups as they get older. Even after this, though, they may continue to have a tendency to have dry skin, so it is always better to keep using moisturizer. If you notice any new symptoms, you should make sure to let your child’s pediatrician know, as it might be time to change the treatment strategy, or it might be a new symptom of a flare-up.
- Carmela Avena-Woods, B.S.P. (no date) Overview of atopic dermatitis, AJMC. MJH Life Sciences. Available at: https://www.ajmc.com/view/overview-of-atopic-dermatitis-article (Accessed: October 4, 2022).
- Spergel, J.M. and Paller, A.S., 2003. Atopic dermatitis and the atopic march. Journal of Allergy and Clinical Immunology, 112(6), pp.S118-S127.
- Leung, D.Y., Boguniewicz, M., Howell, M.D., Nomura, I. and Hamid, Q.A., 2004. New insights into atopic dermatitis. The Journal of clinical investigation, 113(5), pp.651-657.
- Dharmage, S.C., Lowe, A.J., Matheson, M.C., Burgess, J.A., Allen, K.J. and Abramson, M.J., 2014. Atopic dermatitis and the atopic march revisited. Allergy, 69(1), pp.17-27.
- Berke, R., Singh, A. and Guralnick, M., 2012. Atopic dermatitis: an overview. American family physician, 86(1), pp.35-42.
- Atopic dermatitis in children (2020) National Eczema Association. Available at: https://nationaleczema.org/eczema/children/atopic-dermatitis/ (Accessed: October 4, 2022).
- Pyun, B.Y., 2015. Natural history and risk factors of atopic dermatitis in children. Allergy, asthma & immunology research, 7(2), pp.101-105.
- Pugliarello, S., Cozzi, A., Gisondi, P. and Girolomoni, G., 2011. Phenotypes of atopic dermatitis. JDDG: Journal der Deutschen Dermatologischen Gesellschaft, 9(1), pp.12-20.
- Nakahara, T., Koga, T., Fukagawa, S., Uchi, H. and Furue, M., 2004. Intermittent topical corticosteroid/tacrolimus sequential therapy improves lichenification and chronic papules more efficiently than intermittent topical corticosteroid/emollient sequential therapy in patients with atopic dermatitis. The Journal of Dermatology, 31(7), pp.524-528.
- Fuiano, N. and Incorvaia, C., 2012. Dissecting the causes of atopic dermatitis in children: less foods, more mites. Allergology International, 61(2), pp.231-243.
- Page, S.S., Weston, S. and Loh, R., 2016. Atopic dermatitis in children. Australian family physician, 45(5), pp.293-296.
- Williams, H.C. ed., 2000. Atopic dermatitis: the epidemiology, causes and prevention of atopic eczema. Cambridge University Press.
- Cookson, W.O., Harper, J.I. and Moffatt, M.F., 2002. Genetics of atopic dermatitis. Immunology and Allergy Clinics, 22(2), pp.199-209.
- Morar, N., Willis-Owen, S.A., Moffatt, M.F. and Cookson, W.O., 2006. The genetics of atopic dermatitis. Journal of Allergy and Clinical Immunology, 118(1), pp.24-34.
- Amarasekera, M., 2011. Immunoglobulin E in health and disease. Asia Pacific Allergy, 1(1), pp.12-15.
- Duran‐Tauleria, E., Vignati, G., Guedan, M.J.A. and Petersson, C.J., 2004. The utility of specific immunoglobulin E measurements in primary care. Allergy, 59, pp.35-41.
- Giam, Y.C., Hebert, A.A., Dizon, M.V., Van Bever, H., Tiongco-Recto, M., Kim, K.H., Soebono, H., Munasir, Z., Diana, I.A. and Luk, D.C.K., 2016. A review on the role of moisturizers for atopic dermatitis. Asia Pacific Allergy, 6(2), pp.120-128.
- Horimukai, K., Morita, K., Narita, M., Kondo, M., Kitazawa, H., Nozaki, M., Shigematsu, Y., Yoshida, K., Niizeki, H., Motomura, K.I. and Sago, H., 2014. Application of moisturizer to neonates prevents development of atopic dermatitis. Journal of Allergy and Clinical Immunology, 134(4), pp.824-830.
- Lodén, M., 2003. The skin barrier and use of moisturizers in atopic dermatitis. Clinics in dermatology, 21(2), pp.145-157.
- Szczepanowska, J., Reich, A. and Szepietowski, J.C., 2008. Emollients improve treatment results with topical corticosteroids in childhood atopic dermatitis: a randomized comparative study. Pediatric Allergy and Immunology, 19(7), pp.614-618.
- Atherton, D.J., 2003. Topical corticosteroids in atopic dermatitis. Bmj, 327(7421), pp.942-943.
- Hultsch, T., Kapp, A. and Spergel, J., 2005. Immunomodulation and safety of topical calcineurin inhibitors for the treatment of atopic dermatitis. Dermatology, 211(2), pp.174-187.
- Carr, W.W., 2013. Topical calcineurin inhibitors for atopic dermatitis: review and treatment recommendations. Pediatric Drugs, 15(4), pp.303-310.
- Rodenbeck, D.L., Silverberg, J.I. and Silverberg, N.B., 2016. Phototherapy for atopic dermatitis. Clinics in dermatology, 34(5), pp.607-613.
- Fabbrocini, G., Napolitano, M., Megna, M., Balato, N. and Patruno, C., 2018. Treatment of atopic dermatitis with biologic drugs. Dermatology and therapy, 8(4), pp.527-538.
- Montes-Torres, A., Llamas-Velasco, M., Pérez-Plaza, A., Solano-López, G. and Sánchez-Pérez, J., 2015. Biological treatments in atopic dermatitis. Journal of clinical medicine, 4(4), pp.593-613.
- Ludwig, C.M., Hsiao, J.L., Lio, P.A. and Shi, V.Y., 2021. Transitioning from immunosuppressants to dupilumab in pediatric atopic dermatitis. Dermatitis, 32(1S), pp.S4-S7.
- Devillers, A.C. and Oranje, A.P., 2012. Wet‐wrap treatment in children with atopic dermatitis: a practical guideline. Pediatric dermatology, 29(1), pp.24-27.
- González‐López, G., Ceballos‐Rodríguez, R.M., González‐López, J.J., Feito Rodríguez, M. and Herranz‐Pinto, P., 2017. Efficacy and safety of wet wrap therapy for patients with atopic dermatitis: a systematic review and meta‐analysis. British Journal of Dermatology, 177(3), pp.688-695.
- Atopic dermatitis: Bleach bath therapy (no date) American Academy of Dermatology. Available at: https://www.aad.org/public/diseases/eczema/childhood/treating/bleach-bath (Accessed: October 4, 2022).