Atopic eczema — formally atopic dermatitis — is one of the most common skin diseases in childhood. It affects approximately 15–20 % of children.
What atopic eczema is
A chronic inflammatory skin disease with a genetic basis. The skin barrier is impaired — the skin can't retain water or protect itself from external triggers.
It often appears as part of the atopic triad, with allergic rhinitis and/or asthma developing later.
When it appears and what it looks like
Most often in the first year of life — typically around 3–6 months of age.
Location by age:
- 0–2 years: cheeks, forehead, scalp, outer limbs, trunk
- 2–12 years: elbow folds, behind knees, neck, wrists, ankles
- 12+ years: face, neck, décolletage, hands, elbow and knee folds
Main symptoms: very dry skin, intense itching (evening and night), red flaky patches, weeping vesicles and crusts (acute), thickened skin (chronic), disturbed sleep.
Common triggers
- Dry air in overheated apartments
- Dust mites, dust, animal fur, pollen, mould
- Food allergens in infants (cow's milk, eggs, gluten, nuts)
- Soaps and detergents with fragrances and sulphates
- Synthetic fabrics and wool
- Sweat and heat
- Stress
- Viral infections
How it's treated
1. Daily hydration — emollients are the foundation
Emollients replace missing lipids. Apply 2–3× daily on the whole body, ideally within 3 minutes after bathing.
Recommended brands: Cetaphil, La Roche-Posay Lipikar, Avène Trixéra, Mustela Stelatopia, Bioderma Atoderm, Eucerin AtopiControl.
Tip: Use the emollient every day, even when the eczema isn't flaring.
2. Treating acute flares
- Topical corticosteroids (mometasone, hydrocortisone) — completely safe with proper short-term use
- Topical immunomodulators (tacrolimus, pimecrolimus) for sensitive areas
- Biologics and JAK inhibitors (e.g. dupilumab) for the most severe forms in children over 2
3. Identify and eliminate triggers
Allergy testing is recommended for repeated flares.
"Itch–scratch cycle"
- Keep nails short and smooth
- Cotton mittens or anti-scratch onesies at night
- Cool compresses before sleep (5–10 min)
- Antihistamines in the evening for severe itching (per doctor)
- Consistent hydration 2–3× daily
Home care
- Bathing: daily, brief (5–10 min), lukewarm water 32–34 °C, washing oil
- Drying: pat gently, don't rub!
- Clothing: 100 % cotton
- Air humidity: 40–60 %
- Diet: complete and varied; eliminating foods without medical reason can harm
When to see a paediatric dermatologist
- Eczema keeps coming back
- Child can't sleep due to itching
- Skin "weeps" or has yellow crusts (bacterial infection)
- Eczema affects face, eyes or more than 10 % of body
- Suspected food allergy
The future
- About 60 % of children outgrow eczema by age 5
- Another 20–30 % improve significantly during puberty
- A smaller share carry it into adulthood, often in milder form
Conclusion
With daily skin care, suitable topical treatment and trigger avoidance, the vast majority of children can live a fully normal childhood.
Medically reviewed: