What You Need to Know About Your Child's Atopic Dermatitis

This article is for the parents and caregivers of children who are living with atopic dermatitis (AD), or anyone who wants to learn more about AD. The goal of this activity is to help you talk to and work with your child's doctor about AD.

You will learn about:

• What AD is and how it may look and feel

• How severe AD can be

• Making a treatment plan with your child's doctor

• Ways to manage AD

• Questions to ask your child's doctor

Atopic dermatitis, or AD, is a chronic inflammatory (long-lasting swelling) skin condition and is the most common type of eczema.

You can have AD at any age, but it tends to happen more often in children, usually before age 5.

AD is not contagious. It is thought to be caused by a combination of genes (traits inherited from parents) and allergens (substances in the environment that cause allergic reactions), like dust or pollen. People who have asthma or allergies, or a family history of them, are more likely to have AD.

AD usually starts with dry, itchy skin patches or rashes. It can happen on any area, but is often found on the hands, wrists, feet, ankles, inside of elbows and knees, upper chest, neck, face, eyelids, and scalp.

Patches of skin or rashes that are a different color from the rest of your skin often happen with AD, but how they look can depend on your skin tone and race or ethnicity. In people who have lighter skin, patches are often red and scaly. People who are Asian may have red patches covered with thick, silvery scales. And for darker skin or brown or black skin, patches can be dark brown, purple, brownish-grey, or ashen grey.

Most people will have dry, itchy skin patches or rashes that can come and go. But AD symptoms can vary from person to person and also include:

• Skin that's:

  • Swollen, scaly, cracked, or thickened

  • Sensitive or raw

  • Covered by tiny bumps

  • Hard or more thickened on the palms and soles

  • Darker or lighter than the surrounding skin after healing

• Scalp or face patches that bubble up and ooze, especially in babies

• Itching that's especially bad at night

For some people, symptoms can get worse (flare-up), then get better or go away, with the cycle repeating for years.

How bad AD can be can also vary, and range from:

• Mild: skin patches that itch sometimes with small areas that are red or a different color. For many, this won't affect everyday activities, sleep, or mental well-being

• Moderate: more frequent itching and more skin symptoms that affect everyday activities and mental well-being and cause sleep problems

• Severe: widespread dry skin, constant itching, and additional skin symptoms that limit everyday activities, impact mental well-being, and cause nightly sleep loss

If your child has AD symptoms, contact their doctor. They may recommend seeing a dermatologist, who specializes in treating skin conditions, or an allergist, who specializes in allergies.

Together you'll make a treatment plan to help manage your child's AD. This can include lifestyle changes and ways to help prevent flare-ups that may be triggered by factors such as sweat, stress, allergens, and skin irritants like certain fabrics, soaps, detergents, and cleaners. Sometimes, though, flare-ups can happen without any known cause.

Your child's treatment plan can also include a skincare routine and treatment. But you may need to try different ways to help manage AD over time.

Skincare tips to help manage your child's AD can include:

• Giving them short baths or showers with warm, not hot, water and using mild soap

• Using fragrance-free moisturizer during the day and after baths or showers

• Keeping your child's fingernails trimmed and having them wear gloves while sleeping to prevent scratching

• Using a humidifier to add moisture to the air

• Dressing your child in clothes that don't rub

• Avoiding very hot or very cold temperatures

Depending on your child's age and how bad their AD is, treatments your doctor may recommend, alone or in combination, can include:

• Topical medicine you apply to their skin, such as crisaborole, desonide, pimecrolimus, tacrolimus, or ruxolitinib

• Systemic medicine, such as dupilumab given by injection or upadacitinib taken by mouth

• Wet dressings applied to their skin

Your child's doctor may also recommend other treatments or medicines to help with itching and other AD symptoms.

All treatments can have side effects. Some common ones that may happen with medicines used to treat AD can include:

• A skin reaction where medicine was applied or injected, such as mild pain, burning, itching, or stinging

• Skin thinning or changes in color, such as lighter areas

• Eye problems such as inflammation, infection, itching, or dryness

• Headache

• Cough, fever, or ear, nose, or throat infections

Not all possible side effects are listed here -- be sure to ask your doctor or pharmacist for a full list.

Questions you can ask your child's doctor about AD can include:

• How can AD symptoms look?

• What could be causing flare-ups or making AD worse?

• Are there any lifestyle changes we should make that can help?

• What skincare routine do you recommend?

• What treatments are available and what are their side effects?

Congratulations!

You have successfully completed the program What You Need to Know About Your Child's Atopic Dermatitis.

View Additional Materials on this topic that you may find useful:

Atopic Dermatitis

Who Gets Atopic Dermatitis?

What Are the Symptoms of Atopic Dermatitis?

How Is Atopic Dermatitis Treated?

Eczema (Atopic Dermatitis) Causes and Strategies for Prevention

Living With Atopic Dermatitis

Eczema (Atopic Dermatitis) Treatment