Eczema Management
Moisturizing
Apply moisturizer at least daily, especially within 3 minutes after bathing to lock in the moisture. Waiting too long after bathing can dry out a child’s skin. Make sure to wash hands before applying the moisturizer, to avoid trapping any allergens or germs that may be on hands against the child’s skin. Use moisturizers that are fragrance- and dye-free, as they will be less irritating on the child’s skin.
Soak and Seal Method
The child should be given a bath daily in lukewarm water with gentle cleanser. The caregiver should gently pat (not rub) off the water using a towel and leave the skin slightly damp. Topical steroids or medications should be applied as prescribed after the bath. Moisturizer should then be applied all over the body, within 3 minutes. The moisturizer should be absorbed into the skin before clothes are placed on the child.
Steroid Use
Topical steroids are effective in the treatment of eczema. If topical steroids are needed, recommend applying 1-2 times a day for 7 days on active lesions and continue application for 2-3 days after eczema lesions have resolved. Make sure to prescribe a weaker steroid for the face.
For eczema that is more difficult to manage, consider using the techniques below:
Wet Wraps
Wet wrap therapy can be useful for eczema flares. After the bath, caregivers should apply moisturizers, moisten clean clothes or gauze, and wrap the affected areas on the patient. The wet wraps should then be covered with dry covers and left on overnight.
Bleach Baths
In children with moderate to severe eczema, bleach baths may reduce the severity (1). Use unconcentrated household bleach. Fill a bathtub with lukewarm water (about 40 gallons) and add 1/2 cup of bleach. Have the child soak for 10 minutes and then rinse off fully with warm tap water and continue with the child’s skincare routine.
References
- Bakaa L, Pernica JM, Couban RJ, et al. Bleach baths for atopic dermatitis: A systematic review and meta-analysis including unpublished data, Bayesian interpretation, and GRADE. Ann Allergy Asthma Immunol. 2022;128(6):660-668.e9. doi:10.1016/j.anai.2022.03.024
- Northwestern Medicine. (n.d.). Infant Atopic Dermatitis Severity Scorecard: vIGA-ADTM with examples. iREACH Training Materials (Early Peanut Product Introduction Tools for Pediatric Clinicians. https://www.feinberg.northwestern.edu/sites/cfaar/docs/Pediatric%20Clinician%20Atopic%20Dermatitis%20Severity%20Scorecard2.pdf