What is eczema?
The word eczema comes from ancient Greek meaning to “boil over”. Skin becomes infamed, red, itchy and often blisters. Over the past 40 years there has been a huge rise in eczema with about one in fve children in the UK affected. Atopic eczema is common. “About 50% of children will grow
out of eczema as a signifcant problem by the age of fve, and by 16–18 years of age, less than 5% continue to have eczema as an ongoing problem,” says Prof John Harper, Professor of Paediatric Dermatology at Great Ormond Street Hospital for Children NHS Foundation Trust and also at The Portland Hospital. Other genetic patterns of eczema include discoid (circular/oval patches), contact dermatitis (usually on contact with a substance) and seborrhoeic eczema (affects nose, eyebrows, ears and scalp).
What causes it?
Some children are born with a susceptibility to develop eczema. “Atopic eczema is essentially a genetic disorder and often there’s someone else in the family with eczema, asthma or hay fever,” explains Prof Harper. Atopic eczema is not caused by a specifc allergy. However, children with eczema have hypersensitive skin and are therefore more prone to allergic reactions and this can make their eczema worse. Known “triggers” for eczema include different environmental allergens such as house mite dust, grass pollen, cat and dog fur. Allergy tests are not necessary in all cases but should be considered if your child has ongoing troublesome eczema, which doesn’t respond to frst-line treatment. Foods can also trigger eczema, especially in infants, but they are not the primary cause of eczema (see Diet).
There is no one cure-all eczema treatment but the good news
is that if you stick to a DAILY regime, you can keep eczema in check. Keeping skin moisturised
is the number-one rule. “It’s now recognised that children with eczema have a defect in the outmost part of their skin, which causes dry, sensitive skin, which is more susceptible to infection and allergy,” says Prof Harper.
Emollients are products which moisturise and soften the skin. They help to restore the skin barrier, improve suppleness
and reduce itching. “Moisturise, moisture, moisturise to stop the itch, scratch cycle,” says Boots Pharmacist, Angela Chalmers. Use emollients in oil form as a soap substitute. “Avoid heavy greasy ointments as they can aggravate eczema by limiting sweating and heat loss. The best moisturisers are oily creams which contain some water,” says Prof Harper.
“Bathing daily or even twice daily is the single most important thing you can do if your child has atopic eczema,” says Prof Harper. It washes away bacteria and allergens. Plus, if you use an oil bath additive it will help to sooth the skin.
Fabrics and Laundry
Avoid synthetic or woollen fabrics that don’t allow the skin to breathe. Instead dress your child in clothes made from cotton/ bamboo fbres. For excellent tried and tested clothing and products try everythingforeczema.com.
Avoid biological washing detergent in favour of non-bio and cut out fabric conditioner all together. You could also consider using natural detergents and doing an extra rinse at the end of the wash cycle to remove as much of the detergent as possible.
A word on dust mites
House dust mites sound revolting but rest assured every home has plenty of them! These microscopic creatures are found in old mattresses, within the dust on carpets and other surfaces. When scratched into the skin they will worsen eczema. You won’t get rid of them but you can cut numbers. “Air bedrooms and living rooms daily, vacuuming and dusting with a damp cloth regularly, says Margaret Cox, CEO of the National Eczema Society. “If possible ft mattress, pillow and duvets with barrier covers. Vacuum mattresses and wash bedding at at least 60C° once a week,” she advises. You could also consider freezing cuddly toys in a bag overnight, then washing and drying to kill off dust mites. Finally, keep pets out of bedrooms. See allergyuk.org for a list of approved products from vacuum cleaners to bedding.
Children with eczema are susceptible to skin infections because of the scratching and splitting of the skin. Eczema seems to attract certain bacteria, in particular Staphyloccocus aureus. It has been suggested that children with eczema may be allergic to some bacteria and that this may aggravate the condition. Infected skin looks infamed and weepy, and usually requires treatment with antibiotics. The National Eczema Society runs a helpline 0800 089 1122 plus its website eczema.org has lots of useful information.
Night time is tricky because when children get hot in bed they tend to itch more. My eldest daughter used to scratch herself so badly at night that we ended up putting gloves on her and bandages on the worst areas so she couldn’t damage the skin. Our GP advised giving her a sedative antihistamine before bed when her eczema was at its worst, and this defnitely helped us all sleep!
Andrea Grace, bedtime specialist, health visitor and nurse as well as a mother of four, says, “Using cotton bedding and sleepwear, removing toys and keeping the bedroom cool will all help aid a good night’s sleep.” Long-sleeved pyjamas, keeping nails short or mittens for little ones, can also help reduce the temptation to scratch. “There may be times when your child cannot help scratching. So teach them to tap or gently pinch the skin until the itch has gone,” suggests Andrea.
We still don’t know enough about the role of diet in eczema. Many parents worry that their child’s eczema is caused by something their child is eating. There is, however, no reason to put your child on an exclusion diet as it’s rarely diet alone that triggers eczema, warns Prof Harper. “Often parents have already tried soya milk and this should not be encouraged,” says Harper, explaining that a signifcant proportion of babies who are allergic to cows’ milk are also allergic to soya milk. “Diets should be reserved for the very young with severe eczema who haven’t responded to standard treatment and for those who have a clear history of specifc food allergy or tolerance,” says Prof Harper.
In about 10% of cases eczema is aggravated by foods including milk, eggs, citrus fruit, chocolate, peanuts and colourings, according to NHS Choices nhs.uk. “Keeping an accurate diary of what your child eats and of the condition of the eczema can be useful but always consult a doctor or dietician before you make any changes, especially long term, to a child’s diet,” says Margaret Cox.
Keep the bath temperature as close to the air temperature as you can. ideal soaking time is 10–20 minutes max. to wash hair, use a shampoo especially designed for children with sensitive skin. Best to shampoo out of the bath. pat dry and avoid ruBBing the skin. Cuddledry have great towels for babies and toddlers made with cotton and bamboo fbres. cuddledry.com. if your child has a steriod treatment cream, apply at this point. apply an emollient moisturiser (one hour later or straight way if no treatment cream is used). “You should always use an emollient moisturiser even when the eczema is clear as it can really help keep fare-ups at bay,” suggests Prof Harper.
When my daughter’s eczema was really bad, moisturising alone didn’t help and I found only a steroid cream would clear it. Many parents worry that steroids will thin the skin but Prof Harper says that used correctly steroid creams are both safe and effective. “Only apply to the areas of infammation (red or pink) immediately after a bath, and not at the same time as the moisturiser,” advises Prof Harper. Most children with mild eczema will respond to a weak steroid cream. However, if this does not work then it is far better to use a stronger cream to clear the eczema quickly rather than use one that is ineffective over a longer period, advises Harper.
Creams, such as Protopic and Elidel, suppress the immune or allergic response and do not thin the skin like topical steroids. These are, however, second-line treatments. Concern has been expressed about their long-term safety: “Clinical trials have shown them to be effective treatments for eczema and safe in the short to medium term,” says Prof Harper.