DRY SKIN for older kids
also goes by the names of: Atopic Dermatitis, Eczema, and Seborrheic
Dermatitis; they are all the same thing. Dry skin looks like pinkish red,
thickened, inflamed patches of skin that itch. As it gets more severe it can
ooze a yellow-clear body fluid. Dry skin generally occurs on the face (cheeks,
eye brows, around mouth), head (aka cradle cap), elbows, knuckles, torso,
knees and outer surfaces of the upper arms and legs. Occasionally it takes the
form of skin-colored to pink-red hard bumps the size of pin-heads especially on
the outer surfaces of the upper arms and thighs (aka Keratosis Pilaris).
It can also occur on the hands and feet of children who sweat there excessively.
Many people mistake the dry skin on the feet as athleteís foot, but
athleteís foot is in the creases of the toes, while dry skin is on the flat
exposed under surface.
is like an allergic reaction to anything that dries out or irritates the skin.
There is definitely an inheritance pattern, but some kids have it without either
parents having it, and some kids donít have it when both parents have it. The
exact cause is unknown, but it is not contagious.
Most white children will have a form of the rash for at least a brief
period. It is much more common in white than blacks and Asians.
The exact incidence is unknown.
Anything that dries, irritates, or damages the skin will make it worse.
Drying soaps, scrubbing the skin, washing excessively, or not enough, hot water,
abrading the skin when drying, scratching, and sometimes laundry detergents,
will start, or worsen, a case of dry skin.
do we treat it?
Basically, you should avoid things that irritate the skin (prevent),
moisturize (to prevent and treat), and then consider topical anti-inflammatory
medications (steroids). Occasionally, we use anti-itch medicines or antibiotics.
There is also a distinct difference between prevention and treatment.
Most of the following are preventive measures. The treatment will not work
without the prevention.
the child as frequently as you want. Some recommend washing more frequently,
and some less frequently. Some children respond better to more washing, and
some to less washing. If one isnít working, then try the other. It is much
more important that you follow the rules about washing correctly given
comfortably cool water instead of hot, as the heat destroys the natural oils
that protect the skin.
a couple of tablespoons of MINERAL OIL in the bathtub and wisk it in (this
acts as a moisturizer).
a moisturizing soap or no soap. Generally, stick with unscented DOVE, TONE
use bubble bath.
use wash cloths, or at least use them gently, as abrasion worsens dry skin.
the child play as long as he / she wants.
the skin dry, or air dry, rather than rubbing.
on a good moisturizer WITHIN 3 MINUTES of getting out of the tub. The skin
will dry out after 3 minutes. This seals in moisture rather than covering up
dry skin. By good moisturizer, we mean avoid the baby lotions, use: CUREL,
KERI, LUBRIDERM, EUCERIN, CETAPHIL, or AQUAPHOR.
the dry skin is worse, use the ointment (thick and greasy) moisturizers
(extra strength hand versions of the above brands) as ointments are
Cortaid (or prescription topical steroids if given those) when the dry skin
an over the counter triple antibiotic ointment if the dry skin is severe or
is oozing a yellow substance, and call if it does not improve with the
the child scratches the rash, then it will worsen it; therefore, use oral
Benedryl to help relieve the itch, and keep the finger nails short. Also,
avoid sweating as this may worsen the itch.
wool or synthetic fabrics; use cotton instead.
generally donít cause dry skin, but avoid foods you feel may worsen the
doing the above isnít enough, then you should call the office during
business hours to make an appointment.
If the above plan does not work
If the dry skin looks infected
If the skin is painful
If the child canít stop scratching it even with Benedryl
A pediatrician can handle the vast majority of cases of dry skin. Most
pediatricians will have a limit for how much medicine they will prescribe, how
severe the case is, or if there is another problem associated with the illness,
and once we reach that limit we will usually offer a referral. Most routine
referrals to a Dermatologist take 6 Ė 8 months; therefore, we have learned to
handle more and more with experience.
this go away with age?
About 50% of those who still have dry skin will improve or be cured at
these ages: young childhood, pre-adolescence, and then adulthood. Therefore,
most children with dry skin will not have it as an adult. Generally, the more
severe cases will last longer.
Keratosis pilaris is the name for those white bumps that people with dry
skin get on the outer upper surfaces of the arms, thighs and sometimes the
cheeks. They are a special type of dry skin where the outer (keratin) layer of
skin thickens. You can prevent them with the above measures, but theey usually
wonít get rid of them. Topical steroids (Cortaid or Rx if one was given) will
sometimes reduce the bumps. Lactic acid is the best therapy for them. Lactic
acid acts to dissolve away the bumps and is a moisturizer. It occasionally
stings when it first goes on, but not much. Brand names of 5% lactic acid are
Epilyt or Lacticare (also known as Ammonium Lactate).
dry skin is actually a break in the skin, it makes a skin infection much more
likely to occur. Fever blisters (herpes labialis) can invade the dry skin patch
and cause a significant and painful infection. Once you get a fever blister
infection in a location (like the lip, fingers, cheeks), then it may come back
in that area over and over again.