Winter’s icy outdoor temperatures and dry indoor heat can be tough on children’s tender skin, making it feel dry, irritated and scratchy. Colder weather can be especially trying for those with a severe dry skin condition known as atopic dermatitis, commonly called eczema.
The condition affects about 17 percent of children, most of whom first develop it before age 5 and usually as infants, says dermatologist Richard Antaya, MD, director Pediatric Dermatology at Yale Medicine. Its cause is unknown. But doctors say people with this condition have a problem with their skin barrier—known as the stratum corneum—that makes it more sensitive.
It’s important to have a healthy stratum corneum because this barrier is the body’s defense against the world, protecting your child from everything from bacteria to irritants such as the sun or chemicals. People with atopic dermatitis (eczema) have a compromised barrier that doesn’t function normally. It’s less able to retain water to stay hydrated and is more likely to become irritated and unable to fight off microbes that can cause infection. Winter dryness challenges the barrier’s ability to function further and can cause flare ups.
“Atopic dermatitis is hereditary and is usually seen in families where other members have eczema, allergies, hay fever or asthma,” explains Dr. Antaya. It can crop up on the legs or hands, and in children, it frequently affects the face.
That’s the case for Morgan Voeker, 4, of Guilford, Conn. “One afternoon after playing outside, I noticed a dry, bumpy red patch of skin on her cheek,” says her mother Sue Voeker. “I knew it was eczema—something my husband’s family deals with, too.”
Atopic dermatitis can run the gamut from mild like Morgan’s to severe. “For children with mild disease, it can be easily managed, but for patients who have moderate to severe disease, it can be life altering,” says Dr. Antaya. “It’s comparable, in terms of stress and expense, to other severe diseases in children, and it has a profound effect on quality of life,” he says.
There is no cure for eczema. Dry, irritated, bumpy patches can crust over and are difficult not to scratch, especially for youngsters. And scratching only makes matters worse—those patches with further damage to the natural barrier of the skin are at even higher risk of infection. But proper treatment can help the child and her family.
“When a child has atopic dermatitis,” explains Dr. Antaya, “she doesn't sleep well, which means her parents aren't sleeping well, and everyone involved experiences the stress associated with sleep deprivation.” Generally, within four or five days of proper therapy, he says, most of our patients are more comfortable (and sleeping better at night).
Fragranced skincare products, prickly fabrics like wool or polyester, heat and sweating can all be triggers. Adjusting how you care for your child’s eczema with the steps below can help. Try these tips year-round—they’re helpful for anyone whose skin is even mildly dry or sensitive:
#1 Adjust bath-time routines
It’s okay to skip a night. Daily baths or showers aren’t necessary for children ages 6 to 11, according to The American Academy of Dermatology. “Excessive bathing can increase water loss from the skin, worsening the dryness associated with eczema," says Yale Medicine dermatologist Sara Perkins, MD.
To prevent that from happening, try these tub tips:
- Bathe children only as needed for hygiene.
- Shorten bathing or showering time to less than 10 minutes.
- Use tepid temperatures, which are less irritating to the skin. “Hot water stimulates nerve endings,” says Dr. Antaya. “It only makes the itching and dryness worse.”
- Pat skin dry with a towel. Rubbing further irritates the already compromised skin barrier.
#2 Don't soap up
It’s important to reconsider what you’re washing your child’s skin with as well. "The soap you wash with may be part of the problem, and that 'squeaky-clean' feeling likely means you've removed too much moisture," says Dr. Perkins. To try:
- Use a soap-free cleanser from face to toe that is less likely to strip skin of its protective natural oils. Dermatologists often recommend Cetaphil Gentle Skin Cleanser or Olay Complete Body Wash. Look for products with the National Eczema Association Seal of Acceptance on product labels.
- Skip sudsy bubble baths—the detergents in them further dry out skin, she says.
- Do not use deodorizing soap. The added scents can irritate sensitive skin.
Thick emollients, or moisturizers, are a must to combat dryness. “For kids with a family history of atopic dermatitis, allergies or asthma, start moisturizing them as soon as you can after birth,” Dr. Antaya says. “Early moisturizing has been shown to decrease incidence of atopic dermatitis, presumably by protecting the skin barrier.”
Here are some moisturizing musts to note:
- Use moisturizer liberally at least twice a day.
- Apply moisturizer from head to toe within three minutes of bathing when the skin is still damp to seal in moisture and help replenish skin hydration, says Dr. Antaya.
- Use a scent-free product such as Aquaphor or CeraVe Moisturizing Cream.
#4 Rethink clothes—and how to wash them
“Fragranced products of any kind that come in contact with the skin can potentially cause an allergic reaction,” says Yale Medicine dermatologist Christine Ko, MD. “Any residue left on clothing can also lead to skin irritation.” If you or your child has sensitive skin, adjust how you wash clothing, sheets and blankets to help prevent allergic and irritant reactions, she says.
- Don’t use fragranced detergents, fabric softeners, dryer sheets or antistatic sheets.
- Always wash clothes before wear to remove finishing chemicals such as formaldehyde, flame retardants and dyes that can trigger sensitivity or allergic skin reactions.
- Opt for 100 percent cotton or silk clothing, mittens and hats as opposed to wool, which can be prickly, or polyester, which can cause sweating (another trigger for eczema).
- Avoid overdressing your child in heavy clothing. It’s better to dress them in layers and to open or remove jackets, as necessary, to avoid excessive sweating.
#5 Talk to your doctor
If you think your child may have something more than garden-variety dry skin, see a dermatologist for eczema evaluation, says Dr. Antaya. It’s best to make an appointment when there is a flare up. Your doctor will perform a visual inspection of dry skin patches to make a diagnosis—there is no blood test for atopic dermatitis.
Here are some ways dermatologists help children with this type of eczema:
- They may prescribe a hydrocortisone cream to apply topically to control itchiness. Though some people may be concerned about potential side effects, few actually experience problems, says Dr. Antaya.
- Your doctor may recommend an oral anti-itch medication such as an antihistamine like diphenhydramine (Benadryl). Be sure to follow the dermatologist’s or pediatrician’s guidelines on age, usage and dosage.
- Biologic medications are now becoming available for atopic dermatitis. The newest—dupilumab—was approved by the U.S. Food and Drug Administration in 2017. Biologics are immunotherapy drugs made from natural proteins, not synthetics. They target specific parts of the immune system instead of suppressing it in its entirety. To date, these drugs are currently only approved for patients 18 years and older, but studies show that they may be effective for children. Further research will be required.
In the end, always use your judgment. If your child is having a hard time sleeping due to itchiness or the condition seems to be worsening, make an appointment with a dermatologist. He or she can help care for your child’s skin and identify specific triggers in winter or at other times of year.
Find out more about atopic dermatitis, or click here to see a dermatologist about a skin concern.