For Eczema

Eczema History:

This text can be used in the patient history to document how the patient’s family manages and treats the patient’s eczema. You can copy and paste it into your EMR system to use during well-child visits or follow up appointments.

The patient [HAS/HAS NOT] not been prescribed topical steroids. If so, they are [LIST STEROIDS WITH POTENCY AND FORMULATION)]. The patient uses it [INSERT AMOUNT PER DAY] a day and needs it [INSERT FREQUENCY/MONTH] month. Other skincare regimen consists of [INSERT SKINCARE REGIMEN – INCLUDE MOISTURIZATION AND OTHER MEDS, SUCH AS CALCINEURIN INHIBITOR]. Eczema has been complicated by [CHOOSE ONE OR MORE: NONE, HYPOPIGMENTATION, SCARRING, SUPER INFECTION, NEED FOR ORAL STEROIDS, NEED FOR ORAL ANTIBIOTICS, NEED FOR ORAL ACYCLOVIR]. The caregiver [DOES/DOES NOT] wash his/her/their hands before applying topical creams and/or ointments.

Eczema Management Techniques

These sections contain the same information as in the PDF handouts throughout this section, but are formatted for easier placement within EMR systems to place in after visit patient handouts.

General Skincare:

Apply moisturizer at least daily, especially within 3 minutes after bathing to lock in the moisture. Waiting too long after bathing can dry out your child’s skin. Make sure to wash your hands before applying the moisturizer, as you want to avoid trapping any allergens or germs that may be on your hands against your child’s skin. Use moisturizers that are fragrance-free and dye-free, as they will be less irritating on your child’s skin.

Eczema Management:

Soak and Seal Method

Give your child a bath in lukewarm water with gentle cleansers. After getting out of the bath, gently pat (do not rub) off water using a towel and leave the skin slightly damp. Apply any topical steroids or treatment to the skin. Apply moisturizer all over the body, within 3 minutes, and wait for the moisturizer to absorb into the skin before putting on clothes.

Steroid Use

Topical steroids are effective in the treatment of eczema. If topical steroids are needed, apply 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 use less strong steroids on the face.

Wet Wraps

Wet wrap therapy can be useful for tougher to manage eczema. After getting out of the bath and applying moisturizers, moisten clean cloth/gauze and wrap the affected areas. Cover the wet wraps with dry covers and leave overnight.

Early Food Introduction

Skincare and Eczema Management

IgE Mediated Food Allergy

Non-IgE MediatedFood Allergy

EMR
Documentation

Patient
Instructions

Cutaneous Allergen Sensitization Skincare and Eczema Management Referral for Dermatology/Allergy

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.

Courtesy of the Food Allergy Center for Food Allergy & Asthma Research

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