Why Winter Is So Hard on Kids With Eczema — and What Actually Helps

Dareen Siri, M.D., FAAAAI, FACAAI

Credit: SIU Medicine

For many families, atopic dermatitis (AD) can feel like the first domino to fall, soon followed by food allergies, asthma symptoms and a growing list of questions about what comes next. Parents are often told these conditions are connected, but understanding why they occur together and how to manage them, especially as seasons change, can feel overwhelming.

In this interview, Dareen Siri, M.D., FAAAAI, FACAAI, an allergist-immunologist with Midwest Allergy Sinus Asthma and assistant professor at Southern Illinois University School of Medicine, breaks down what families need to know about the “atopic march.” From why winter weather can make eczema worse to how early skin care may influence long-term allergy and asthma risk, Siri shares practical guidance, evidence-based reassurance and insights into today’s evolving treatment options, including steroid-free therapies for children.

Many parents hear that eczema, allergies and asthma often go together. Can you explain why these conditions are connected and what families should watch for as children grow?

Dareen Siri, M.D., FAAAAI, FACAAI: It’s true — AD (also known as eczema), allergies and asthma often travel together, in a pattern we sometimes call the “atopic march.” A child’s skin, immune system and airways are all connected. When the skin barrier is impaired, as in AD, it allows irritants and allergens to penetrate more easily. In my practice, I’ve seen this early immune activation can increase a child’s risk of developing food allergies and, later, asthma. The risk of developing asthma increases with AD severity, as more than 50% of children with severe eczema also develop asthma. As for what families should watch out for:

• Skin changes: Persistent dryness, itching or red patches — especially if they worsen in the winter or with certain triggers or foods — can be a sign of eczema.
• Food reactions: Hives, itchy eyes, swelling, vomiting, rash around the mouth, food refusals or even a sudden worsening of eczema after a new food may indicate a developing food allergy.
• Breathing symptoms: Nighttime cough (especially a dry cough in the absence of any obvious infection), shortness of breath with activity or a musical “wheeze” when your child exhales can be early signs of asthma.

These conditions are highly treatable, and early recognition can change a child’s long-term health trajectory. If you notice new or worsening symptoms, especially during growth spurts or seasonal changes, it’s worthwhile to check in with your child’s pediatrician or a board-certified allergist and immunologist. We can help sort out what’s allergy-driven, what’s inflammatory and help to identify triggers.

Why does colder weather make eczema flare, and what simple steps can help protect kids’ skin during this season?

DS: Winter is one of the toughest seasons for children with eczema. The cold, dry outdoor air and the dry heat indoors both strip moisture from the skin. For kids whose skin barrier is already fragile, this rapid loss of hydration can trigger inflammation, itching and flare-ups.

The good news is that small, consistent habits make a big difference. A few evidence-based strategies I recommend to families:

• Keep baths short and warm — not hot. Hot water feels soothing in the moment but actually worsens dryness and irritation.
• Use gentle, fragrance-free cleansers. Harsh soaps can disrupt the skin barrier even further.
• Moisturize immediately after bathing. Applying a thick cream or ointment within a few minutes of patting the skin dry helps lock in moisture.
• Dress kids in soft, breathable layers. Cotton layers are ideal; wool or rough fabrics can trigger itching.
• Run a humidifier if your home feels very dry. Restoring moisture to the environment helps protect the skin barrier overnight. Be careful not to over-humidify, as this can encourage mold and dust mite growth in the home.
• Use gentle, fragrance-free skin care products and simplify your laundry routine. Wash clothes with less detergent, add an extra rinse cycle, and skip fabric softeners and dryer sheets. These steps reduce residue and help minimize irritation for sensitive, eczema-prone skin.

Are there specific lifestyle or environmental changes parents can make now to help prevent flare-ups as the weather shifts?

DS: Yes! Families often hear conflicting advice about bathing, especially the idea that children with eczema should avoid baths, especially in the winter. In reality, evidence strongly supports the opposite approach when bathing is done correctly.

Short, lukewarm baths followed by immediate moisturization help the skin — not hurt it. Studies and national guidelines (American Academy of Dermatology, American Academy of Allergy, Asthma & Immunology, and American College of Allergy Asthma and Immunology) consistently show that brief, tepid baths hydrate the skin when paired with the “soak and seal” method: pat dry and apply a thick cream or ointment within three minutes to lock moisture in. This improves skin hydration, reduces itching and strengthens the skin barrier.

Infrequent bathing is not beneficial for most children with eczema. Older advice to avoid baths has been disproven. When kids bathe rarely, sweat, allergens and bacteria (including Staphylococcus aureus) accumulate on the skin, which can worsen irritation and flares. Regular bathing helps remove these triggers and keeps the skin cleaner and calmer.

With the right skin care routine, most children can get through winter with far fewer flares. And if the eczema still feels hard to control, an allergist or dermatologist can help tailor a treatment plan to keep skin calm and comfortable all season long.

What are the current treatment options, including steroid-free choices, and how do they fit into an eczema care plan?

DS: When eczema becomes bothersome, we now have a wide range of effective and safe treatments — including several steroid-free options. One option is VTAMA (tapinarof) cream, 1%, a steroid-free prescription topical approved by the U.S. Food and Drug Administration (FDA) to treat eczema in children as young as 2 years old, as well as in adults. VTAMA is applied once daily and has no label restrictions on duration of use or on locations of topical use, meaning it can be applied everywhere on the skin — even on sensitive areas in kids like the face or neck. Remember that VTAMA cream is for use on the skin (topical use) only. VTAMA cream should not be used in the eyes, mouth or vagina. VTAMA can be used for mild, moderate or severe eczema, which makes it a helpful treatment option for patients, regardless of disease severity.

Many of my patients also appreciate that VTAMA is nongreasy and that its once-daily application can make it easy to incorporate into their daily routines.

It’s important to note that VTAMA cream can cause side effects. The most common side effects in people with eczema treated with VTAMA cream were upper and lower respiratory tract infections, red raised bumps around the hair pores (folliculitis), headache, asthma, vomiting, ear infection, pain in extremity and stomach-area (abdominal) pain.

For families feeling overwhelmed by frequent flare-ups or multiple diagnoses, what message of reassurance would you want them to hear?

DS: I want families to know that they are not alone — and that eczema, allergies and asthma are all highly manageable conditions. These flare-ups can feel relentless, especially when they disrupt our daily routines, but with the right care plan, most children can experience significant improvements.

What I emphasize to parents is this: your child’s immune system is not “broken.” It is simply reacting in ways we understand well and can treat effectively. We now have better tools than ever — from advanced moisturizers to topical therapies, including some steroid-free medications — and we build care plans step by step, so they feel realistic, doable and tailored to the patient’s need, since effective eczema and allergy care is not one-size-fits all. You don’t have to navigate this journey on your own. Partnering with a specialist who is certified in allergy and immunology can help bring clarity, reduce stress and get your child back to feeling like themselves. Our goal is always the same as yours: fewer flares, better comfort and a child who can thrive.

Note: You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA’s MedWatch or call 1-800-FDA-1088. Please read the Prescribing and Patient Information for more information on VTAMA cream.