Atopic eczema often starts early in life, it can develop from birth but usually at around 3-6 months of age, and in the toddler years. Having a baby or child with atopic eczema can cause great concern. Eczema can be a long-term problem. In most cases it tends to wax and wane, but sometimes it can be active for months or even years or may finally disappear – often for no apparent reason. The tendency to have atopic eczema is often inherited, which means it may run in families. Almost one-third of the population may have the ability to develop atopic eczema, so it is very common. Having atopic eczema can be linked with having asthma and hay fever. Some family members may have all these conditions, others may only have one, or brothers and sisters may not be affected at all.
Atopic eczema causes dry, reddened and itchy skin. It may also be weepy, cracked and scaly. There is often a pattern of the skin flaring up and then calming down for a time, but the skin tends to be dry and itchy, even in between flare-ups. Even before a baby is able to scratch, it will rub its face against the cot to try to relieve ‘the itch’. In babies, atopic eczema can occur in a few small patches or all over the body. In children, atopic eczema often affects the creases of body joints, such as the backs of knees or insides of elbows. Constant scratching will split the skin, causing it to weep, bleed and open up to infection.
The itchiness of eczema can be unbearable, leading to sleep loss, frustration, stress and depression – this can affect whole families, not just the person with eczema. Even before a baby is able to scratch, it will rub its face against the cot to try to relieve ‘the itch’. Although there is no immediate cure for atopic eczema at present, there are ways to maintain it and keep it under control. Atopic eczema can, however, flare up spontaneously for no apparent reason. Spontaneous flare-ups are often the result of triggers. Triggers are not the same for everyone, but there are a number of common ones:
• Skin infection (bacterial and viral)
• House-dust mites and their droppings
• Animal dander (fur, hair, saliva)
• Sometimes diet
Learning what triggers your baby’s or child’s atopic eczema can help you maintain their condition successfully, but there will be times when the trigger factors are maybe not obvious and the eczema may flare for no particular reason.
Successful eczema treatment begins with an understanding of what eczema is, followed by information about management and treatment; and the complications associated with eczema, such as infection and triggers. The basics of treatment for childhood atopic eczema are emollients and topical steroids. Follow your health care professional’s advice on what treatment is appropriate to use, when and how to use it and how much to use. If in doubt, ask your doctor, nurse or pharmacist to go through your treatments with you.
Keeping skin well moisturised is the most important thing you can do to make your baby or child’s skin more comfortable. Emollients prevent dry skin and help to keep skin moist and supple. They should replace all soaps and be used for washing and moisturising the skin on a daily basis. They soften the skin, reducing inflammation and irritation. If you have eczema it is advisable to use emollients (medical moisturisers) instead of ordinary moisturisers, soaps and bath products, all of which can irritate and dry out the skin. The most important thing is choosing emollients that your baby or child’s skin and fits in with your lifestyle, for example a light cream for during the day and a greasier one for evenings. It is the frequency of reapplication that is essential to prevent skin drying, so generally they need to be used liberally and several times a day.
Apply moisturisers in gentle downward sweeps following the direction of the hairs on the skin. Never rub in the emollient, as this is likely to set up ‘the itch’. You need to use a soap substitute for washing your child and you may need to put medicinal bath oil or an emollient in the bath. Most emollients are available on prescription and can also be bought over the counter at the chemist, ask your pharmacist for advice. Try any new product on a small patch of skin unaffected by eczema and check that your child does not react to it before using it all over their body.
Topical steroids are prescribed to treat eczema flares. There are four strengths of steroids, which come in cream, ointment and lotion forms. The doctor who prescribes the topical steroid will take into account the age of the child, where the steroid is being applied. and the severity of the child’s severity. Hydrocortisone is usually all that is needed for babies and children with mild eczema. Children who have moderate to severe eczema may need a stronger steroid or may have steroid strength increased, if Hydrocortisone does not clear the eczema. The doctor may also prefer to ‘hit’ the eczema with a moderate or potent steroid first, and then once the eczema is under control move down to a weaker strength. Steroids are usually applied to the eczema once or twice a day; your doctor, nurse or pharmacist will advise you on application. Remember to leave a 20 minute gap in between applying emollients and steroids. It is much kinder to control a severe flare-up quickly, using an appropriate topical steroid recommended by the doctor, than to allow it to drag on indefinitely because you are afraid to use a topical steroid, and therefore cause considerable distress to your child.
Some people worry about the side effects of topical steroids, such as thinning of the skin. Side effects can occur, but are usually due to incorrect use and are often reversible. Applied appropriately with advice about how to apply from your doctor, nurse, topical steroids are a safe and effective treatment for eczema.
If your child or babies eczema is not getting better, they may have a skin infection, especially if their skin is weepy and itchy. There are a number of other treatments available to treating more severe eczema. You should always return to your health care professional to discuss worries and concerns; they will in turn advise you further on your baby or child’s eczema management
The National Eczema Society
The National Eczema Society aims, to provide people with independent and practical advice about treating and managing
eczema; and raise awareness of the needs of those with eczema. The National Eczema Society provides a wealth of information, which can be found at www.eczema.org
An eczema helpline operates 08.00-20.00hrs on 0800 089 1122 and is the first point of contact for anyone affected by eczema. It provides support and guidance on eczema management and treatment.
Please call the helpline for a copy of the National Eczema Society Childhood Atopic Eczema booklet.