Atopic dermatitis is a type of eczema, a chronic skin condition that causes your skin to get itchy and inflamed. You can recognize it by the hallmark red, scaly rash.
If you’re a parent, you’ve likely seen or heard of kids with atopic dermatitis. That’s because it’s very common in children. In fact, in a 2017 research review, experts estimated that it affects 15 to 20 percent of children living in industrialized nations.
Those same experts estimate that the rate of atopic dermatitis in kids living in the United States hovers around 10.7 percent. Others, like the National Eczema Association (NEA), put the number a little higher, around 13 percent.
Atopic dermatitis can develop at any age. But it overwhelmingly starts early in a child’s life.
About 90 percent of cases develop before a child turns 5 years old, according to the 2017 review. About 60 percent of cases will develop within the first year of a child’s life — and many of those cases show up when a baby is somewhere between 3 and 6 months old.
The worst symptom of atopic dermatitis is the itch. The experts call it “pruritus,” but we all know it more simply as severe itching.
Other common symptoms of atopic dermatitis in kids are:
- redness or a red rash
- dry, scaly skin
- sores that can be open and weepy or crusted over
Sometimes, the symptoms will start out as dry skin that eventually reddens and develops a rash.
The rash might appear in the creases of elbows or knees, and your child might get some scaly patches within the rash. You might also spot some redness behind their ears, on their scalp, or even on their hands and feet.
Sometimes the rash will go on to develop open, weepy sores or bubbles that ooze liquid.
Because atopic dermatitis tends to itch a lot, you may notice your baby or small child scratching the itchy skin. Unfortunately, they can accidentally tear open the skin, which can lead to infection. So, especially with young children, you may want to keep an eye on it.
The itching can also keep them awake at night. And over time, the itching can lead to a thickening of the skin, called lichenification.
Also, you may notice that your child’s symptoms don’t always remain constant. They can get worse from time to time. This is known as a flare-up.
Many children who develop atopic dermatitis have a family history of eczema, asthma, or hay fever. But it’s likely caused by a combination of external factors and genes, according to the NEA.
If you spot a red, scaly rash on your child that wasn’t there before — and it doesn’t have a cause that you can think of — keep an eye on it. And if you notice some scratching, take note of that, too. It may be time to visit the pediatrician.
There’s not one single definitive test that your child’s doctor can run to determine whether atopic dermatitis is the culprit. However, the doctor might want to check your child’s blood for a type of antibody known as immunoglobulin E (IgE).
Kids with allergies and atopic dermatitis tend to have higher levels of IgE because their immune systems tend to overreact to certain allergens or triggers and pump out more of this antibody. A skin (or patch) test might also be useful.
Regardless of whether any bloodwork or patch testing is done, your child’s doctor will likely do an in-depth examination of your child’s skin and ask you questions about it. If you know about a family history of eczema, food allergies, or allergic rhinitis, be sure to let the doctor know, since those are sometimes linked.
If you’re like most parents, you’re probably less concerned about why your itchy, cranky child has atopic dermatitis and more concerned about how to treat it — and hopefully improve their skin and their mood (and maybe their ability to sleep at night).
Ultimately, the goal of treatment is to improve your child’s quality of life and minimize or eliminate any infections or complications.
- restoration of the skin barrier
- control of skin inflammation
What that means in practical terms is that you’ll want to apply moisturizing cream or lotion to the affected areas of skin on a regular basis. (Your child’s doctor can give you guidance on the specific number of times per day.)
You might also need to apply a topical treatment to the affected areas to reduce inflammation. Usually, you can do this after bathing your child and gently drying their skin.
Topical corticosteroids can help reduce swelling and itching during a flare-up. Another type of topical treatment is a calcineurin inhibitor cream. It can also improve those types of symptoms by blocking the immune system from producing a type of chemical that causes a flare.
In some cases, your pediatrician might suggest trying phototherapy.
In phototherapy, a healthcare professional exposes your child’s skin to controlled doses of light. It’s used more as second-line treatment for moderate to severe cases of atopic dermatitis than a first-line treatment, according to
Doctors will sometimes prescribe other medications to treat more severe cases of atopic dermatitis, including immunosuppressants and biologic drugs. These target very specific parts of the immune system.
For example, children over 6 years old with moderate to severe cases could be candidates for injections of a biologic drug called Dupixent (dupilumab), if they’ve already tried topical treatments without adequate responses.
Even if your child needs medical treatment, you can still take other steps to help them live more comfortably with atopic dermatitis and its effects. Here are a few strategies to try:
- Avoid triggers or irritants that might lead to inflammation.
- Give your child lukewarm baths and use gentle cleansers.
- Trim your child’s fingernails so they can’t tear their skin if they scratch.
- Apply moisturizer to your child’s skin regularly.
- Keep your child as cool and comfortable as much as possible.
Occasionally, a flare-up might warrant the short-term application of a cold compress on the skin.
Another home remedy that some parents swear by is wet-wrap therapy. It’s just what it sounds like: You apply clean wet dressings to your child’s inflamed skin to soothe the itch and inflammation. Typically, you apply a dry dressing to cover the wet dressing so your child can benefit from the moisture for a couple of hours — or even overnight, which might reduce some middle-of-the-night scratching.
Finally, if you’re game for trying a bleach bath, the American Academy of Dermatology suggests that a short soak in a bathtub filled with water mixed with a small amount of 6 percent bleach and followed by a layer of moisturizer might be helpful.
But definitely talk with your child’s doctor about whether this is a good option for your little one or not.
If you think your child’s skin is showing signs of infection, give their pediatrician a call. For example, if you notice that your child’s skin has gotten increasingly swollen and red and feels warmer to the touch, an infection might be brewing.
Hopefully, you won’t have to deal with any skin infections. But if an infection does develop, your child might need a round of oral antibiotics.
Additionally, if you notice any new symptoms, let your child’s doctor know. It may be time to discuss changing treatment strategies.
Atopic dermatitis can be tough — but as a parent, you can definitely make your child a lot more comfortable.
And here’s some good news: While there’s no cure for atopic dermatitis, many kids do eventually outgrow the worst of it. They may still have a tendency toward dry skin, but it can be much easier for them to manage when they’re older.