Many parents know firsthand the anxiety that arises when unexplained skin changes appear on their child, leaving parents wondering whether it’s something minor or a sign of a bigger issue. And, while childhood eczema is common, its symptoms can vary, making it sometimes difficult to recognize in its early stages. To clear things up, in this interview, Irina Dawson, MD, a Board-Certified Allergist and Immunologist at Allergy Partners of Fredericksburg, offers guidance on identifying and managing symptoms, assessing severity, and knowing when to seek specialized care.

Can you briefly share your background and experience working with children and families affected by eczema?

I am a board-certified allergist and immunologist and have been practicing at Allergy Partners of Fredericksburg for the past 5½ years. A large part of my practice is caring for children with eczema and their families. Eczema is a special area of interest for me because it affects not just the skin, but sleep, school performance, emotional health, and family life. I work closely with parents to create realistic, long-term plans that help children stay comfortable and confident.

 Irina Dawson, MD, a Board-Certified Allergist and Immunologist at Allergy Partners of Fredericksburg

For parents who are new to this topic, how would you explain eczema in simple terms?

Eczema is a chronic skin condition where the skin’s “protective barrier” does not work as well as it should.

This means the skin:

• Loses moisture easily

• Becomes dry, itchy, and inflamed

• Is more sensitive to irritants and allergens

It is not contagious, and it is not caused by poor hygiene or something parents did wrong.

How common is eczema in children, and at what ages does it most often appear?

Eczema is very common:

• About 1 in 5 children will develop eczema.

• Most cases start in infancy or early childhood.

• Around 60% of children show symptoms before age 1.

• Nearly 85% develop it before age 5.

Some children outgrow it, while others continue to have flares into adolescence or adulthood.

What are the most common signs and symptoms parents should watch for?

• Dry, rough, or scaly skin

• Red or darkened patches

• Intense itching (often worse at night)

• Crusting, oozing, or thickened skin in chronic areas

• Scratches or open areas from rubbing

Itching is the hallmark symptom—if your child is constantly scratching, eczema should be considered.

Where on the body does eczema usually show up at different stages of childhood?

Infants (0-2 years):

• Cheeks

• Scalp

• Trunk

• Outer arms and legs

Toddlers and young children:

• Elbow creases

• Behind the knees

• Wrists and ankles

• Neck

Older children and teens:

• Hands

• Feet

• Eyelids

• Elbows and knees

What are the most common triggers you see in young patients?

• Dry air or cold weather

• Heat and sweating

• Fragranced soaps, detergents, and lotions

• Rough fabrics (especially wool)

• Environmental allergens (dust mites, pet dander, pollen)

• Stress

• Skin infections

• Sometimes foods (in a small subset of children)
  
  

Triggers vary from child to child.

What conditions are often mistaken for eczema?

• Ringworm (fungal infection)

• Psoriasis

• Contact dermatitis (reaction to soaps, metals, plants)

• Scabies

• Seborrheic dermatitis (“cradle cap”)

If a rash is spreading, painful, crusting, or not improving with basic care, a medical evaluation is important.

When should parents seek professional care instead of trying to manage symptoms at home?

Parents should see a specialist if:

• The rash is not improving with moisturizers

• Your child is losing sleep due to itching

• The skin looks infected (yellow crust, oozing, fever)

• Flares are frequent or severe

• You are unsure what is triggering symptoms

What are the most effective daily routines for managing childhood eczema?

Consistency is key.

• Daily lukewarm baths (5–10 minutes)

• Gentle, fragrance-free cleansers

• Apply thick moisturizer within 3 minutes of bathing (“soak and seal”)

• Use prescribed anti-inflammatory creams during flares

• Keep nails short to reduce skin damage from scratching

How safe and effective are prescription treatments, including topical steroids, for kids?

When used correctly, topical steroids are very safe and effective. They reduce inflammation quickly and prevent worsening.
The key is:

• Using the right strength

• Using them for the right length of time

• Applying only to affected skin

Avoiding treatment due to fear often leads to worse flares and skin infections.

How can families reduce flare-ups at home and school?

• Use fragrance-free laundry detergent

• Avoid dryer sheets and fabric softeners

• Dress children in soft cotton fabrics

• Keep skin moisturized daily

• Send a “skin care kit” to school or daycare

• Communicate with caregivers about triggers and routines

What is the most important message you want parents to remember?

The most important thing for parents to know is that eczema is a chronic condition, but it is very manageable—and your child can absolutely thrive. Eczema does not define your child, and it does not mean a lifetime of discomfort. With the right daily routine, early treatment of flares, and ongoing support, most children live happy, active lives.

Flares are a normal part of eczema and not a sign of failure. What matters most is recognizing them early and treating them quickly. Consistent skin care—especially daily moisturizing and using medications as prescribed—helps strengthen the skin barrier and reduces future flares.

Eczema affects more than just the skin. It can impact sleep, school, confidence, and family stress, so support and reassurance are just as important as medical treatment. And remember, care plans change as children grow—what works today may need adjusting tomorrow.

Most importantly, there is hope. New treatments continue to emerge, and we now have more options than ever before to help children feel better and live fully. With partnership, patience, and a proactive approach, eczema can become just one small part of your child’s story—not the whole story.

Parents interested in learning more or seeking support can visit https://www.allergypartners.com/.