Caring for young children with eczema

The excitement of a newborn baby turned to worry when a few weeks after Lorenzo Torres-Ramirez was born his parents started to notice red spots on his face.

"At first it was just red dots, but he was so fussy and seemed uncomfortable. We took him to a doctor who said it was normal, but I knew this wasn't normal," said Lorena Ramirez, Lorenzo's mom.

Lorenzo's condition continued to worsen and his parents, Lorena and Miguel, became concerned that there might be scaring as the rash spread across his face and extremities. For months they couldn't find anything to relieve their son's scratching. Referred by a family friend, the couple made an appointment with Bridget Boyd, MD, pediatrician at Loyola University Health System and assistant professor in the Department of Pediatrics at Loyola University Chicago Stritch School of Medicine.

"When they brought Lorenzo in he was only a few months old and in agony. I could see the concern on his mom's face. He had been scratching at the rash until it bled and that led to an infection," said Dr. Boyd. "I knew he had eczema and was happy that I could bring relief to Lorenzo and his parents."

Dr. Boyd prescribed an oral antibiotic to treat the skin infection and topical steroids to relieve the itching from the eczema breakout.

"In just a few weeks he was like a different child," said Mrs. Ramirez. "He wasn't fussy, he stopped scratching and fortunately there was no scaring."

Eczema occurs when the skin becomes inflamed or irritated. It often is associated with allergic conditions. It affects about 10 to 20 percent of infants in the U.S. and many outgrow it by age 10.

"Eczema is a relatively common condition among infants. It occurs most often in children with a family history of allergic conditions. Up to one-third of infants with eczema can have a sensitivity or allergy to foods. The biggest problem with eczema is the itching. It is often referred to as the 'itch that rashes' because if you control the itching, the rash will subside," Dr. Boyd said.

She suggests the following for caring for children with eczema:
•Moisturizing the skin is key. Use very thick creams that come in a tub and are scooped out with your hands. Lotions that come in pumps are too thin. Also, lotions should be unscented, with no artificial dyes.
•Dry itchy spots need to be treated with topical steroids with the lowest effective potency. Scarring is usually caused by chronic itching. Steroids can cause temporary light or dark spots to the skin but these usually subside.
•Baths should be relatively short with warm water. No bubble baths. Pat the child dry and apply steroid cream to any rough or itchy spots. Apply moisturizing cream to the entire body.

Although the exact cause of eczema is unknown, it can run in families. When the Torres-Ramirez family found out they were having twin girls it was important to them that the girls be under Dr. Boyd's care as well.

"As soon as they were born we said their pediatrician is Dr. Boyd," said Ramirez. "We are so confident in her care and thankful for her compassion."
Maria and Marta are doing well and showing no signs of eczema.

Dr. Boyd said, "We are watching to ensure they don't have the same issue as their brother. They are a wonderful family and I love being able to watch Lorenzo become a great big brother."