Management of Severe Atopic Dermatitis in Children: Essential Tips for Parents

Eczema can be challenging to manage effectively, but there are strategies to make it easier, says Nada Mallick, MD, a pediatric critical care specialist at Children's National Hospital in Washington, DC.

"You can help children with severe atopic dermatitis in a number of ways, including greater focus on daily routines that can control skin inflammation and minimize itching," she says. Here's a look at how this condition affects children, and what you can do to manage symptoms in a way that brings relief.

• Intense itching or burning sensation
• Widespread swelling
• Secondary skin infections
• Difficulty sleeping
• Trouble concentrating in school
• Redness on light skin; purple, brown, or ashen gray in people of color
• Flaking, cracking, or crusting on skin
• Skin sensitivity

"If those aren't controlling symptoms, systemic treatments may be necessary, and those are always prescribed by a medical professional," Mallick says. "Parents and caregivers should consult a dermatologist when treatments such as moisturizers and topical corticosteroids aren't working."

Most likely, treatment options will be combined on the basis of a child's symptoms and frequency of severe flares, says Tanya Evans, MD, a dermatologist and the medical director of the skin cancer program at the melanoma clinic at MemorialCare Saddleback Medical Center in Laguna Hills, California.

"We have so many oral, topical, and injectable medications that reduce the inflammatory pathway that causes atopic dermatitis but don't suppress the immune system," she adds. "There are also many different medications in the pipeline for atopic dermatitis for both children and adults, so we have many options when it comes to tailoring treatment."

• Give the child one to three short baths (under 15 minutes) in lukewarm water every day, patting the skin dry (not rubbing) and then moisturizing the skin.
• Wash sheets and clothing in unscented, dye-free laundry products, preferably those designated for sensitive skin.
• Use a humidifier in your child's room, particularly in winter months.
• Identify and avoid triggers, such as food allergies or sensitivity to pet dander or pollen
• Provide distractions, such as fidget toys, when a child is itching frequently.
• Apply cool compresses when skin is warm and irritated.

"If you're establishing daily habits like these but symptoms seem to be worsening, be sure to talk with your health provider to see if there are other treatment options," suggests Mallick.

One aspect of severe atopic dermatitis that may get overlooked is how the condition is affecting your child emotionally. Frequent and intense scratching can be frustrating, but the psychological effects can go much deeper than just irritation.

"We know that atopic dermatitis can come with significant sleep disruption, which brings many psychosocial effects such as changes in academic performance," says Mallick. "The intense itching and skin appearance may also affect self-esteem. If parents see any symptoms of mood changes or sleep problems related to eczema, they should immediately reach out to their pediatrician or a mental health professional."

• Moderate to severe atopic dermatitis can be more challenging to manage in children than a milder form of the condition, but there are many treatments and strategies that can help.
• The first-line treatment for children is moisturizers and topical treatments that reduce inflammation, but if those aren't effective, your dermatologist may recommend prescription options.
• Daily routines like short baths, regular moisturization, and avoiding triggers can go a long way toward complementing a child's eczema treatment.