Atopic Dermatitis in Children (2+ Years Old)
Reviewed by: HU Medical Review Board | June 2017 | Last updated: March 2021
Atopic dermatitis (eczema) is a common chronic skin disease in children. It most commonly begins in infants. Approximately 60% of cases develop in the first year of life, and 90% of all cases develop by 5 years of age.1 Atopic dermatitis is caused by a combination of factors, including a genetic predisposition, environmental factors, a dysfunction in the immune system, and a dysfunction of the skin barrier.2,3 There are some differences depending on the age of the person affected.
What causes childhood eczema?
The majority of children who develop atopic dermatitis have someone in their family with the condition. A child’s chances of developing the condition are 2- to 3-fold higher in children who have a parent with it. If both parents have atopic dermatitis, the child’s chances of developing the skin condition increase to 3- to 5-fold.1
Atopic dermatitis is more common in urban areas, and children living in cities are at a higher risk of developing it. The mother's age at the child’s birth also seems to increase a child’s risk, with children being born to mothers who are later in their childbearing years being more likely to develop atopic dermatitis.4
Atopic dermatitis ranges in severity from mild to severe. In children, it frequently appears as a rash on the inside creases of the elbows or knees, the neck, wrists, ankles, and/or the crease between the buttocks and the thighs. Atopic dermatitis makes the skin dry, itchy, and scaly, and it may cause bumps. Areas of skin where the rash occurs may get lighter or darker in color.
Over time, the skin affected by atopic dermatitis can become thickened or leathery, also called lichenification. Lichenified skin may also develop knots. The lichenified skin is itchy all of the time, and proper treatment is important to reduce the development of permanently itchy, thickened skin patches.4,5
Triggers that can worsen atopic dermatitis include:
Most children go into remission, although some experience relapses in their teen years and some (about 10-30%) continue to have symptoms into adulthood.1
Possible complications for children
Some children develop complications from atopic dermatitis, including infection, issues with sleeping, food allergies, asthma, hay fever, and/or experience psychological effects due to living with a chronic skin condition.
Because atopic dermatitis causes cracks and breaks in the skin and there is immunologic dysfunction in the skin, there is a greater potential for infection. In addition, the intense itching leads to scratching, which also increases the risk of infection by bacteria, viruses, or fungi.5
Many children with atopic dermatitis repeatedly wake during the night to scratch due to excessive itchiness. The repeated waking and loss of sleep is one of the most distressing impacts on children living with the condition, as well as their family members.5,6
Atopic dermatitis puts children at a higher risk of developing food allergies, with an estimated 20-40% of children with atopic dermatitis having food allergies that worsen their disease. The most common food allergies that worsen atopic dermatitis include cow’s milk, eggs, fish, peanuts, soy, tree nuts, and wheat. Children with food allergies often outgrow their sensitivity, developing a tolerance over time. Even if a person tests positive for food allergies, it does not necessarily mean that all their food allergies are relevant to their atopic dermatitis. Food allergies are true triggers of atopic dermatitis in only a small subset of patients, and experts do not generally recommend food elimination diets solely based on positive food allergy testing.7,8
Children with atopic dermatitis are at an increased risk of developing asthma, a chronic condition of the lungs that involves inflammation of the airways after exposure to a trigger. Asthma makes it difficult to get air in and out of the lungs and cause symptoms such as wheezing, coughing, shortness of breath, and chest tightness.9,10
Atopic dermatitis also puts a person at a higher risk of developing hay fever or allergic rhinitis. Hay fever symptoms include runny and/or stuffy nose, sneezing, fatigue, and itchy eyes, mouth, or skin. Hay fever may be seasonal, with a flare in symptoms due to allergic sensitivity to airborne mold spores or pollens, or perennial, with symptoms year-round due to sensitivity to pet dander, mold, dust mites, or cockroaches.9,10
Some children with atopic dermatitis experience teasing or bullying, and many experience poor self-esteem. Children with the condition may be more likely to have behavioral problems, such as attention deficit or hyperactivity, or poor school performance, which may be linked to the disrupted sleep caused by the itch-scratch cycle.5,6,11
How is it treated?
A key part of treating atopic dermatitis in children is rehydrating the skin. Some ways to hydrate the skin include:
- Lukewarm soaking baths or showers (less than 10-20 minutes)
- Mild soaps that are fragrance free and with a neutral or low pH
- Moisturizing skin immediately after bath with an emollient8
For children who have repeated skin infections, adding 2 teaspoons of bleach per gallon of water can reduce the chance of infections. These are known as bleach baths. (A typical bathtub holds between 25-40 gallons of water.)12
Topical corticosteroids, topical calcineurin inhibitors, antibiotics, immunosuppressants, biologics and/or antihistamines may also be prescribed for children with atopic dermatitis.1