Eczema is an itchy red rash which comes and goes. It affects one in five children in the UK. One in 20 will have severe disease. In young children it is common on the face, while in older children the elbows, wrists, knees, and ankles. It usually starts in the first year of life and improves with time. Children may also develop asthma or hay fever.
The diagnosis is made on the symptoms and appearance, rather than tests. Some conditions may mimic eczema, for example scabies.
Eczema is due to a leaky skin barrier. Water leaks out making it dry. Dirt and dust get in leading to it becoming red and inflamed.
Healthy skin Eczematous skin
with leaky skin barrier
Allergy tests are not helpful as they only test for immediate allergic reactions and not those delayed by many hours, as with eczema. Inappropriate use of allergy tests often leads to with unnecessary avoidance of foods, which can be harmful and promote new allergies.
Moisturisers: Moisturisers are the mainstay of treatment. They help to restore the skin barrier and reduce itching and scratching. Use the moisturiser your child is most comfortable with. They are safe and should be applied regularly at least four times a day even when the skin looks clear. Ointments are preferred as they contain less chemicals than creams.
Bath lotions are no longer recommended for children with eczema.
Garments / wraps: Cotton garments act as a “second skin” and help protect against damage from scratching. Although wet wraps may help to control severe eczema, they can promote skin infections.
Topical steroids and calcineurin inhibitors e.g. tacrolimus: These anti-inflammatory medications reduce itching and redness. Many people are concerned that steroids thin the skin. 1% hydrocortisone ointment is a mild steroid that can be used regularly long-term without causing this side-effect. Advice should be sought before using stronger steroids.
Tacrolimus ointment is an alternative to steroids. It won’t thin the skin. It is used by specialists if mild strength steroids don’t work.
No. Antihistamines do not relieve the itch in eczema. Sedative antihistamines help with sleep. Avoid in children less than six months old, and for long periods. The effect can last for a day and can affect a child’s ability to concentrate at school.
Infection is one of the most common reasons. If the skin barrier is damaged, there is a risk of infection, particularly the staphylococcus bacteria. If infected, the skin becomes painful and starts to weep. There may be yellow crusted blisters / pustules (impetigo). Topical antiseptics or bath antiseptics help prevent infections. A course of antibiotic such as flucloxacillin may be required for up to two weeks.
Less commonly but importantly, eczema may sometimes be infected with the herpes cold sore virus. It appearances as a crop of small blisters [photo]. Later there may be “punched-out” lesions about 2mm in size. A doctor should be consulted as soon as possible as there is a risk the virus may cause more serious illness.
Don’t take foods out of children’s diets without advice from your doctor or dietitian. Removing foods can lead to poor growth and nutrition and in the longer term may lead to more troublesome allergies.
In children with severe eczema where a specific food consistently causes eczema to flare, see your doctor or dietitian. This is particularly important before removing dairy and wheat, which are very important for a balanced diet.