Childhood Eczema
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Eczema (also sometimes referred to as atopic dermatitis) is a chronic relapsing, remitting skin condition that can cause significant distress to both children and their parents but is manageable with good skin maintenance.
Eczema in children is common. Approximately 20% of children under the age of two develop eczema, typically in the first six months of life. Known as infantile eczema, this can affect any part of the body but tends to improve significantly between two and five years of age. Some children develop eczema between the ages of two and four, and typically experience redness, dryness and itch in the creases of the elbows, behind the knees, across the ankles and at times also involves the face ears and neck. This also typically improves with age.
Many infants with moderate to severe eczema will also have an allergy to food(s). Whilst these conditions may coexist, foods tend to be a trigger for eczema, but are rarely the cause. Removal of a food may sometimes result in improvement of symptoms, but will not cure the eczema, and may not make any difference at all. Removal of a particular food or foods should only ever be done with the guidance of a specialist allergist or dietitian.
Eczema Management:
The management of eczema involves five main steps:
1) Maintain and protect the skin every day
2) Avoid known triggers and irritants
3) Treat eczema flares or severe eczema
4) Control itch
5) Prevent and treat infection
In order to maintain and protect the skin on a daily basis:
Apply moisturiser to the face and body at least twice a day (avoid creams that contain food products)
Apply moisturisers directly to wet skin after bath/ shower if possible
Use a non-soap based wash or oil in the bath or shower
Avoid soap and bubbly products which dry out the skin
Known triggers and irritants should be avoided where possible. These include:
Scratching (consider night gloves & clipped fingernails in young children)
Swimming in chlorinated swimming pools (remove bathers and have a freshwater shower immediately after swimming)
Playing in sand
Sitting directly on carpets or grass
Irritants such as chemicals, woollen or synthetic fabrics (ideally choose cotton clothing)
Temperature changes, such as overly heated rooms, or long periods in air conditioning
Contact with animals or house dust mite allergen
Treat eczema flares or severe eczema:
Apply creams or ointments prescribed by your doctor, as soon as eczema starts to flare, as under-treatment of eczema can lead to a worsening of the condition by itching & scarring
Using topical steroids liberally during flares will often lead to less steroid use in the long run
Use topical steroids to actively treat redness and inflammation. Ensure that adequate amounts are used. As a guide, one fingertip unit (FTU) is the amount of cream or ointment from the first crease in the finger to the fingertip, which will cover an area equal to two adult hands.
Apply moisturiser after corticosteroid cream or ointment has been applied
Itching to areas of unaffected skin can rapidly cause eczema, so it is important to try to control itch:
Cold compresses and wet wraps may help reduce itch
Antihistamines may also help reduce itch, though non-sedating antihistamines (eg Claratyne) are preferable to sedating antihistamines in young children
Eczema is very prone to infection with bacteria like Staph aureus and viruses such as the cold sore virus or molluscum, so it is important to prevent and treat infection:
Maintaining good eczema control with daily protection and avoidance of triggers is key to avoiding infection
See your GP if you are concerned about a current skin infection, or if these infections seem to recur frequently
Websites for further information:
Eczema Association of Australasia
Please don’t hesitate to book an appointment with the doctor of your choice, to discuss whether your child may have eczema, and how to best manage it (including an Eczema Action Plan)
Written & collated by Dr Denise Ierino