Atopic eczema is one of the most common skin conditions in children, and how it looks differs with the child's age and skin tone. This article clearly summarises what atopic eczema looks like in children, how the symptoms change from infancy, when an infection may be present and when it is worth seeing a doctor.
The main symptom of atopic eczema in children is itching, together with dry, red and scaly skin; the condition alternately worsens (flares) and calms down. In babies it mainly affects the face (cheeks) and scalp, with the nappy area usually spared; as the child grows it moves to the creases of the elbows and knees, the neck, wrists and ankles. On darker skin the redness may be hard to see and the signs may be darker (brown, purple or grey). Atopic eczema is not contagious, is linked to atopy (asthma, hay fever) and an impaired skin barrier, and improves with age in many children. Weeping, crusting or blisters can signal an infection — in which case a doctor is needed.
Main symptoms in children
The leading symptom of atopic eczema is itching, accompanied by dry, red and scaly skin [1][3]. The condition is chronic and runs in episodes — periods of worsening (flares) alternate with calmer phases [4]. Itching and scratching often disrupt sleep and affect the quality of life of the child and family [4]. Atopic eczema is very common — it affects about one in five children, and in most of them it appears before the age of six [3][4].
How symptoms change with age
The distribution of the signs changes with the child's age [3]:
Babies — eczema usually begins in the first months of life on the face (especially the cheeks) and the scalp; it can also be more widespread, but the nappy area is usually spared thanks to the moisture under the nappy [2][3].
Toddlers and older children — as the child starts to crawl and walk, the signs move to the creases of the elbows and knees and to the neck, wrists and ankles [1][2][3].
Long-term scratching — in areas the child repeatedly scratches, the skin can thicken and toughen (lichenification) [2][3].
Most children "grow out" of atopic eczema — in a significant proportion it improves or clears by school age, although a tendency to dry and sensitive skin may persist [1][4].
How eczema looks on darker skin
Eczema looks different depending on skin tone. On lighter skin it is red during a flare; on darker skin the redness may be hard to see, and irritated areas more often appear darker (brown, purple or grey) [1][2]. In children from Asian, African or Afro-Caribbean families, eczema more often appears on the outer sides (extensors) instead of the creases and may have a discoid (circular) or follicular (around the hair follicles) pattern [3][4]. After the inflammation settles, the skin may be temporarily lighter or darker, and returning to its usual tone can take several months [2].
When it's a flare or an infection
During a flare, the skin is more noticeably red (or darker), itchy and irritated. Watch for signs of a secondary infection: weeping, small blisters, crusting or a persistent worsening can indicate a bacterial infection and are a reason to see a doctor [1][2]. A widespread outbreak of painful blisters, possibly with a fever, requires prompt medical assessment [1].
A diagnosis of atopic eczema in a child is always confirmed by a doctor. If you are unsure, if it worsens, or if there are signs of infection, consult a paediatrician or dermatologist [1][4].
The link with atopy and heredity
Atopic eczema is linked to atopy — an inherited tendency that often runs in families alongside asthma and hay fever [1][3]. Behind it is an impaired skin barrier; in about half of people with eczema a difference in the protein filaggrin, which is key to the barrier, plays a role [2]. Important for those around the child and for siblings: atopic eczema is not contagious — it cannot be caught or passed on by touch [1].
Everyday care for children's skin
The foundation of everyday care is gentle and frequent moisturising (emollients) and avoiding irritants such as soaps and fragranced products; nails should be kept short, and for babies cotton anti-scratch mittens help [1][2]. For children, always follow the advice of your paediatrician — especially with babies and during a flare or signs of infection [1][2]. From cosmetics for the everyday care of sensitive and dry children's skin, you might consider gentle, moisturising and dermatologically tested products from EPIDERMA® — for example the bioactive cream for eczema and the bioactive balm for eczema. Before using them on children, check the age suitability stated on the packaging and, if in doubt, consult a doctor. Cosmetics do not replace medical treatment.
Gentle, moisturising and dermatologically tested EPIDERMA® cosmetics for the everyday care of sensitive and dry skin (for children, check the age suitability on the packaging):
Bioactive cream for eczema 50 ml Bioactive balm for eczema 300 ml
Frequently asked questions
In babies, atopic eczema usually appears as dry, red and itchy areas on the face (mainly the cheeks) and the scalp, typically in the first months of life; the nappy area is usually spared [2][3]. The diagnosis is confirmed by a doctor.
Depending on age: in babies on the face and scalp, and in toddlers and older children in the creases of the elbows and knees, on the neck, wrists and ankles [1][3].
No. Atopic eczema is not contagious and is not passed on by touch. It is linked to an inherited tendency to atopy and to an impaired skin barrier [1][3].
If you are unsure of the diagnosis, if the eczema does not improve or is extensive, and especially if there are signs of infection — weeping, crusting, blisters or fever [1][2].
References
[1] NHS. Atopic eczema. nhs.uk/conditions/atopic-eczema
[2] National Eczema Society. Children and eczema. eczema.org
[3] DermNet. Atopic dermatitis. dermnetnz.org/topics/atopic-dermatitis
[4] NICE (CG57). Atopic eczema in under 12s: diagnosis and management. ncbi.nlm.nih.gov/books/NBK571009
MUDr. Jiří Skalický
Founder of EPIDERMA®
This article is for educational purposes and does not replace medical consultation. Always discuss any skin changes on your child with a paediatrician or dermatologist.