Eczema Care Instructions (Atopic Dermatitis)

Important information:

Eczema is a common skin condition. It tends to run in families that have a history of asthma, eczema, and seasonal allergies. Although some children outgrow eczema, for many, eczema is a chronic condition and requires good skin care throughout life.

Eczema can occur on any part of the body. In younger children, it is common on the face, outside of the elbows and on the knees. In older children and adults, it is common on the hands and feet, the folds of the arms, and on the back of the knees.

Eczema may appear on the skin as:

• Dry, scaly skin

• Small bumps that open and weep when scratched

• Redness and swelling of the skin

• A thickening of the skin (with chronic eczema)

Instructions to manage eczema:

Avoid irritation

• Use only mild, fragrance-free soaps, cleansers, and laundry detergent.

• Don’t use fabric softener or scented dryer sheets.

• Avoid bubble baths, sponges, loofahs or wash cloths.

• Wear loose, soft, cotton clothing. Avoid wool or “scratchy” clothing.

Practice good skin care even if the skin is not flaring

• Apply fragrance-free moisturizing creams or ointments to the eczema areas twice a day. Moisturizing creams help to keep the skin hydrated. Ointments, like petroleum jelly, are more hydrating than creams and won’t burn on open areas of skin. They create a barrier to protect the skin. Some ointments may contain lanolin which is a common allergen. Switch to pure petroleum jelly if symptoms are worsening or not improving.

• Talk to your healthcare provider about how often and how long to bathe in warm water.

• Pat the skin dry after bathing.

• Use a moisturizing product immediately after every bath or shower.

Control itching

• Keep affected skin covered with clothing to prevent scratching.

• Keep your child’s fingernails short and clean.

• The best way to help itching is to moisturize consistently and treat with topical medicines when needed. 

Treat inflammation

• Sometimes, eczema cannot be controlled with moisturizers alone. Your provider may prescribe a medicated cream or ointment to use on the affected area.

• Apply a thin layer of medicated cream or ointment to the affected area as prescribed. Do not apply to healthy skin.

• Wait 15-30 minutes, then apply a layer of moisturizer over the medicine.

• Continue to use moisturizers 2-3 times a day while taking the medicine.

• Stop using the medicine as directed by your healthcare provider.

Follow the eczema action plan that matches your skin condition:

You are in the Red Zone if your skin is still itchy, red, or dry, or if you are taking an oral steroid (prednisone, prednisolone, dexamethasone).

• Every day, moisturize at least 2 times a day and within 3 minutes of bathing.

• Apply red zone prescribed topical steroids to affected areas 2 times a day for up to 2 weeks.

• Call your provider if there is no improvement in 3-5 days.

You are in the Green Zone if your itching and dryness is well-controlled with your skin care routine.

• Every day, moisturize at least 2 times a day and within 3 minutes of bathing.

• For areas with flare, do one of the following:

  • Apply green zone prescribed topical medicine 1-2 times a week, OR

  • Apply petroleum jelly mixed with green zone prescribed topical steroid.

Instructions for additional eczema treatments:

Wet wrap therapy (WWT):

Wet wrap therapy provides additional hydration. Follow these instructions if your healthcare provider recommended this treatment. You will do the wet wrap procedure 3-5 times each week for 1-2 weeks. After that, you will do the wet wraps 1-3 times a week or as instructed by your provider. 

1. Give your child a bath at night in lukewarm water for 5 minutes.

2. Pat the skin dry after the bath and immediately apply petroleum jelly or prescribed steroid ointment to the affected areas.

3. Wet a pair of tight-fitting cotton pajamas or long-johns and wring them out until damp. Put the wet pajamas on your child. If only a small area of skin is affected, then only wet those areas of the pajamas. Instead of wet pajamas, you may also use damp rolls of gauze (Kling® or Kerlix®) or a tubular dressing such as Tubifast® to wrap arms and legs.

4. Put a pair of dry cotton pajamas over the wet pajamas.

5. Keep your child warm and comfortable.

6. Leave the wet pajamas/dressings on for 1-2 hours. Remove the pajamas. Apply petroleum jelly as directed. Dress your child in appropriate clothing. 

Dilute bleach baths:

The bath may be helpful for moderate to severe eczema with frequent infection.

• Talk to your healthcare provider before using dilute bleach baths.

• These baths are for the body only.

• Follow these instructions.

Call your healthcare provider with any questions or concerns, or if: 

• There is extreme redness, swelling, or pus beyond the patches of eczema.

• The itching keeps your child awake at night.

• The rash is not improving with the above treatment.

• Your child has developed pus bumps or blisters

• Your child has been using medicine for longer than 2 weeks.

• Your child develops a fever. 

Go to the emergency department if: 

• Your child appears ill.

• The whole body looks very red and feels hot.

Reviewed December 2024 by Kim Nguyen, MD