General aspects of skin care for your child's eczema

There is no single medication which will cure eczema. However, for most children, it is possible to treat eczema effectively and keep it in check using a simple treatment plan that focuses on preventing excessive drying of the skin and keeping the skin soft. The skin of the child with atopic dermatitis tends to dry out quickly because of the lack of a substance called “NMF” (for natural moisturizing factor), in the following diagram. This results in the protective layer of the skin developing fine cracks that make it prone to being easily irritated and itchy. This is illustrated in the following picture. That portion of the outer layer of dead skin is call the "stratum corneum." The stratum corneum and a natural skin oil called the "barrier lipid" provide protection for the living skin cells with their sensitive nerve endings. An important component of the substance that holds water in the outer layer of dead skin is a family of substances called ceramides, which are deficient in the skin of someone with atopic dermatitis. In a child with atopic eczema, the skin lacks the ability to retain water and the barrier is defective. The living cells with their sensitive nerve endings therefore can be easily irritated which causing itching.

An important part of treating atopic eczema is therefor reestablishment of the protective barrier of the skin. This is illustrated in figure 2:

The strategy is to get water to be absorbed by the outer layer of skin, the stratum corneum and then to seal the water in the skin before it evaporates (which it will do rapidly). Sealing the water is done with emollients.

Emollients and lubricants

These are products which can prevent drying of the skin, thereby moisturizing and softening the skin. This restores the elasticity and suppleness of the skin and helps to reduce the itching and scratching. Emollients and lubricants are safe and should be used frequently as first-line treatment. There are many emollients that are acceptable to use. Use only those that are unscented. Common ones that are useful and well tolerated include Moisturel, Eucerin, Aquafor, Cetaphil, and Lubriderm.

To obtain the greatest benefit from these, the child should be bathed nightly, soaking in warm (not hot) water for at least 10 minutes. Since soap removes natural oils from the skin and is drying, a soap substitute, such as Cetaphil cleansing bar or Oil of Olay bath bar should be used instead of soap. An emollient should then be applied liberally to all areas of dry skin while the skin is still damp. Once the child leaves the bath, it is therefore essential that no more than 2 minutes elapse before the emollient is applied. Simply pat the child with a towel to remove excess water and lubricate the skin well with the emollient. Application of the emollient should be generous and repeated at least one more time during the day, more often if needed (especially after any daytime washing) to keep the skin soft and moist. After the evening bath and emollient application, the child should wear soft cotton pajamas with long sleeves and legs to minimize irritation. This moisturization procedure will prevent the skin from drying and keep the skin smooth. This will make it less likely to itch or to become red.

Other general measures for skin care

• Fingernails should be kept short to minimize skin damage when scratching occurs.
• Wear loose-fitting cotton clothing
• Avoid overheating of skin
• Keep the skin lubricated by keeping a small tube of the emollient on hand to use whenever the child washes his hands or face. 

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