Causes
Eczema has a genetic basis and tends to run in families.
It’s also often associated with other allergy-type conditions such as asthma or hay fever. In some children, diet seems to play a role in eczema, although it’s often hard to pinpoint the food that causes the problem.
Eczema might flare up:
- after contact with irritating chemicals, such as soaps or bubble baths, or other things like woollen or polyester garments
- after viral or bacterial infections
- after exposure to substances (for example, dust mite or animal fur)
- after exposure to foods that your child’s allergic to
- if your child gets too hot
- at times of stress.
Often there’s no obvious cause for a flare-up.
Eczema isn’t contagious.
Symptoms
Children with eczema have a very itchy, dry, red rash, which usually shows up in patches on the elbow creases and behind the knees. It might also appear on the face, neck, hands and feet.
The rash might develop cracks and weep or bleed, especially if your child scratches a lot because of the itch. This might cause an infection by bacteria, which enter the skin via the cracks.
Eczema usually comes and goes. In between flare-ups, the skin looks thickened and dry (this is called ‘lichenification’).
Eczema usually begins when your child’s a baby, often in the first few months of life. At first, you might see it only on the face and scalp, or in the nappy region. Most children tend to ‘grow out’ of eczema by adolescence, but in some it will stay throughout adult life.
When to see your doctor
You should see your doctor if:
- you think your child might have eczema for the first time
- your child’s rash is weeping or bleeding
- you’ve been treating your child’s eczema as usual, but there’s no significant improvement after a few days
- your child is having trouble sleeping because the rash is so itchy
- your child is generally unwell, in addition to the rash
- you have any doubts that the rash is caused by eczema.
Treatment
Eczema is chronic and can’t be cured. The key to preventing bad flare-ups is to treat symptoms as soon as they appear.
Eczema gets worse when skin’s dry. Applying oils and moisturising creams directly to your child’s skin is helpful. These help stop the skin from getting dry and should be used every day, even when there’s no flare-up of eczema.
If your child is scratching at his rash, try putting cotton mittens on his hands at night. Cut his nails short and keep them clean. If he’s scratching really hard, see your doctor to discuss the possibility of using an antihistamine medication for a few days. This might give your child some much-needed rest, and let the rash heal.
Another way to help soothe the itch is to apply a soft, cool, wet towel to the itchy area for 5-10 minutes, and then apply a thick layer of moisturizer over the area. If the rash gets infected, your doctor will probably recommend a short course of antibiotics.
Give your child short, warm baths (not hot). Bathe your child only once a day, and add a moisturising bath oil to the bath. You can buy these oils without a prescription.
Don’t use soap on young children. They don’t need it, and it can make eczema worse. Older children might use a mild soap under the armpits and around the anal and genital region. Apply a moisturising cream such as sorbolene or a cream containing paraffin after washing – this will help stop the skin from drying out.
Cortisone ointments and creams are the mainstay of eczema treatment. You can apply small amounts of these ointments several times a day to affected areas. Itching is always worse after hot baths and at night, so this is the time to apply the ointments and rub them in well. Carry the ointment with you if you go out anywhere with your child, and apply it if you see your child starting to scratch really hard. Leave some cream for your child’s carers to use if your child is likely to scratch when you’re not with her.
Use cortisone creams and ointments sparingly and under medical supervision, because overuse can lead to thinning of the skin. Try to use the weakest ointment that’s still effective – this is usually 0.5% hydrocortisone. If your child has eczema on his face, consult your doctor before using any steroid preparations.
Newer steroid creams are now being used on a once-daily basis. These can be easier to apply at night if your child won’t let you put cream on. Recently, new treatment for eczema (‘immunomodulators’) has come on the market. This is a non-steroidal cream, but its long-term effects are still uncertain, and it shouldn’t be used as a first-line treatment. Discuss this further with your doctor.
If your child’s eczema doesn’t improve despite all these measures, you might want to talk with your doctor about having your child referred to a skin specialist.
Prevention
The main way to prevent eczema in your child is to avoid things that irritate your child’s skin. It can be a good idea to remember the following:
- Cotton underwear and clothes will be more comfortable for your child than woollens and synthetics.
- Avoid the use of soaps and bath preparations.
- Keep your child cool, because overheating can make the itch worse, as can very hot baths or showers.
- Your child can go swimming in chlorinated water, but you should apply moisturiser all over before swimming. After swimming, wash the skin in a cool shower or bath, and apply more moisturiser.
If you think your child’s eczema is caused by a food allergy, but you can’t work out which food is the problem, discuss the possibility and value of allergy testing with your doctor.
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