Eczema is a common skin condition that affects more than 1 million school-aged children in the United States. The most prevalent and long-lasting form of eczema is known as atopic dermatitis, and the terms are often used interchangeably to describe the chronic, immune-mediated, inflammatory disease. The physical symptoms associated with atopic dermatitis, including scaling, rashes, open sores, and severe pruritus, can lead to academic, social, and emotional challenges for students in school. School nurses can support students with eczema by raising awareness within the school community, educating faculty and staff, and working with parents and healthcare providers to develop plans for managing eczema at school. 

What to Know

The physical effects of eczema - red, weepy, crusty, flaky ovular or circular patches of skin - are visibly evident, and the symptoms can be distracting and uncomfortable for kids at school. Students with eczema frequently feel itchy and may struggle to focus in class or on schoolwork. When symptoms worsen, flare-ups occur, or students experience common side effects from their eczema medications, it often leads to missed school days, ultimately impacting academic performance and educational success. In addition, the visible nature of the disease, like many dermatologic conditions, can negatively impact self-confidence and limit students’ abilities or desires to participate in social activities.

While the physical effects of atopic dermatitis are typically observable, the psychological and emotional distress many children with eczema suffer can be considerably less obvious. A 2016 study by the National Eczema Association revealed that at least one in five students experienced bullying at school, during extracurricular activities, or with friends because of their eczema. Additional research indicates children with eczema have higher rates of anxiety, depression, behavioral challenges, and ADHD, and approximately 30% of children with eczema experience disrupted sleep most nights of the week, which can increase irritability, inattention, and moodiness.

The itch-scratch cycle is one of the worst and most frustrating aspects of atopic dermatitis. Rather than alleviating pruritus, scratching amplifies cutaneous erythema and edema. Scratching instigates the excitation of neural fibers, inciting additional pruritus and instigating a self-perpetuating cycle of scratching. Students with eczema may scratch themselves until they bleed, leading to further physical and emotional complications. 

How to Help

Every student with eczema has individual needs and triggers and should be under the care of a healthcare provider. Schools and school nurses should work to foster an understanding and empathetic environment for students with eczema by providing accommodations and support. Understanding students’ triggers and developing avoidance plans, providing opportunities to educate students and staff on what eczema is, and immediately addressing any bullying or teasing can promote a safe and healthy learning environment for students with eczema.

Additionally, some students may require the following:

• Time, space, privacy, and permission to apply prescribed creams or moisturizers throughout the day, as appropriate and necessary.
• Consideration for potential skin irritation from certain arts and crafts materials, which may require students to wear protective gloves or engage in alternative activities.
• Measures to address physical outdoor activities that could worsen any existing rash or itching, such as breaks, indoor play, or other modifiable forms of participation.
• Flexibility with uniform policies.
• Dietary accommodations for any food triggers.
• Accessibility to cool compresses and additional support to alleviate itching.

By spreading awareness and taking a proactive approach to eczema management, schools, and school nurses can help students with eczema to thrive academically, socially, and emotionally.