Identifying and controlling this common skin problem in children – guidelines from the National Eczema Society

‘Eczema’ comes from the ancient Greek, meaning ‘to boil over’ - a good way to describe how children feel when they have this skin condition. Commonly known as dermatitis, eczema in its mildest form produces itchy dry skin. In severe cases, it affects the whole body, causing irritation, inflammation, flaking and sometimes blisters, which weep and form a crust. Children want to scratch the hot, itchy areas of skin and if it is broken there’s a risk of infection, although eczema itself is not infectious or contagious.

It’s an increasing problem affecting 1 in 8 children. The good news is that most children have mild forms of eczema which can be treated and it often clears as they grow older: 60-70% of children are clear of skin inflammation by their mid-teens.

Types of eczema.

There are many distinct types of eczema. The most common include:

• Atopic eczema: It first appears in infancy and is largely confined to childhood. Atopic eczema is inherited and strongly linked with asthma and hayfever.
• Allergic contact dermatitis: caused when the skin comes into contact with a substance which causes an allergic reaction. Common allergens include nickel, chromate, rubber, glues, resins, preservatives in ointments and cosmetics or even plants.
• Seborrhoeic eczema: often starts with an itchy, scaly scalp and severe dandruff and spreads into a facial rash. Infantile seborrhoeic eczema or cradle cap usually develops during the first year of a baby's life. It takes the form of a greasy, scaly scalp. Although it looks unpleasant, this type of eczema does not appear to trouble the baby and often clears up on its own.

Unfortunately, there is no known cure for most forms of eczema. There are various treatments and some have risks or disadvantages associated with them.

Emollients

Using emollients regularly is the most important factor in preventing eczema. Emollients are mixtures of oils, fats and water which help to restore the oil and moisture content of the skin. They are available from pharmacists or on prescription, in the form of creams, ointments, soap substitutes, lotions and medicinal bath oils.
Risks:take care when bathing. The creams and oils make the bath and the child slippery.

Bathing

Frequent bathing is essential. Add special emulsifying oils to counteract the drying effects and have the water warm, not too hot.

Topical steroids

Topical steroids (steroids that are applied directly to the skin) are anti-inflammatory treatments to bring eczema under control quickly, to reduce the risk of infection. They should only be used under the supervision of a doctor and it is essential to use the appropriate strength and quantity.
Only one topical steroid can be bought from a pharmacist without a prescription. This is hydrocortisone and is sold as a cream or ointment. It can be used to treat mild eczema but it should not be used on the eyes, face or other sensitive areas of the body.
Risks:From time to time steroids receive adverse publicity and are branded as potentially dangerous medications. It is important not to confuse topical steroids with those used illegally for body building or those used in the contraceptive pill; they are completely different. If they are correctly used under the supervision of a GP, topical steroids are a safe and effective treatment for eczema. The likelihood of side effects (thinning of the skin, increase of fine hair growth) is related to the potency of the preparation, where it is being used and the condition of the skin. There is also a risk that topical steroids could be absorbed into the blood through the skin. This could slow growth in children by suppressing the adrenal gland. It is for this reason that strong steroids will only be prescribed for short periods of time for young children. Fear of side effects can mean that parents under-treat children with eczema by stopping treatment too soon or not using the preparation at all. This can make the condition worse and mean that a stronger preparation will be needed to bring the eczema under control. It is important to bear in the mind that steroids are only used to control flare ups of eczema. Emollients are the crucial part of daily care to keep the skin moisturised and protected.

Antihistamines

These are sometimes prescribed to aid sleep and relieve itching. A doctor should always be consulting before giving antihistamines to children.
Risks:Very occasionally, antihistamines can cause children to become over-active.

Evening Primrose Oil

A number of studies have looked at the effect of evening primrose oil in treating eczema. Unfortunately, the results have not been conclusive - some trials have seen an overall improvement in the eczema of those patients studied, while others have not. Evening primrose oil is available on prescription for the treatment of atopic eczema under the brand name EPOGAM™.
Risks: This form of treatment is not suitable for children with epilepsy.

Managing your child’s eczema.

The pain and constant itching can distress children and disturb their sleep. Severe eczema prevents some children from attending school. It can also affect them psychologically. They often have low self esteem and if they feel self conscious about their appearance, may avoid social situations.

When children are troubled by their eczema you need to develop a daily routine to keep the condition under control. It’s important to apply treatments such as emollients and steroids regularly.

Making some changes around the home will also limit the sources of irritation that trigger your child’s eczema:

• Over-heating is a particular problem, particularly at night. Use cool, light bedding
• Try using 100% cotton bedding and clothing when possible. It can be more comfortable against the skin.
• Experiment with different washing powders/liquids - some make eczema worse.
• If your child has eczema try to avoid pets – contact with fur and feathers can irritate the skin.
• Keep fingernails short and if necessary, us cotton gloves or mittens at night to prevent scratching during sleep.
• Some children are sensitive to the droppings of house-dust mites. Using specialist vacuum cleaners can control these microscopic creatures. Having hard floors and washing bedding frequently at high temperatures can also help.
• Changes to diet may be effective for some children, if food has been identified as a trigger factor. Only do this with advice from your doctor or a dietician.

  You can get more information from The National Eczema Societywebsite or their helpline on 0870 241 3604