Question: My 3-year-old grandson has eczema. He itches so badly at night that he scratches and bleeds. My daughter has to wrap his legs to keep him from scratching. Do you know of something that can help?

Dr. Hibberd's Answer:

Your grandson needs this corrected before his situation deteriorates. Eczema is a generic term for skin irritation. There are many causes, and each is treated very differently. A visual examination is required to help you.

Most dry eczemas respond to topical therapies, while heavily weeping eczemas will often require oral and topical therapies. Some get better on their own, while others are persistent or progressive.

Contact dermatitis, caused by irritation from substances that come in contact with the skin, is very common and is not usually treated with topical agents. Atopic dermatitis, which is inflammation associated with allergies, is also not usually treated with topical agents.

Remember that our skin often reflects underlying disorders, so proper diagnosis and evaluation is essential. When in doubt, scrapings and superficial biopsies help guide treatment decisions and verify the need for anti-bacterial, anti-fungal, and anti-viral treatments. Many internal medical conditions often are reflected as eczema or dermatitis. Rarely, some are life-threatening if not diagnosed and treated properly.

I do not recommend you wrap your grandson's legs. Our skin is a protective organ that requires integrity to protect us from infection. When skin integrity is broken, we are at risk for infection gaining entry to our body. Serious infections, including sepsis (blood poisoning), can devastate and kill, especially when skin involvement is extensive and weeping.

Our skin also serves other functions including heat regulation (i.e. by sweating), fluid balance, and as a flexible covering for our bones, joints, and muscles. Just as burn patients have their lives at risk when 20 percent or more of their skin is burned, some eczema patients can share similar risks, especially if it is extensive or there are co-existing blood, immune system, or fluid -balance disturbances.

Eczemas may reflect dietary deficiency, allergy, topical or chronic irritation, infections, and internal disorders of growth and metabolism. Treatment may include topicals, such as Burrow’s solution or Eucerin-based topical agents, and may include skin care products containing oils such as Aveeno.

Oral antihistamines may be used as needed for itch. Leukotiene-blocking agents are occasionally used in children as well as immune suppressants when indicated. While some skin disorders require immune suppression and oral and/or intravenous treatments, most children’s eczemas can be easily treated, especially when treated early while irritation is limited. Seek professional guidance without delay.