Eczema

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Eczema and dermatitis are terms that refer to an itchy skin rash that often occurs in families. Atopic dermatitis is the most common form of eczema/dermatitis seen in infants and children. The child or other family members may also have asthma or hay fever.

How do you recognise eczema?

  • The skin is generally dry
  • The skin is itchy
  • Some areas of the skin appear red & cracked. In some severe cases the affected areas weep fluid

Certain areas are particularly affected

  • Babies: the face
  • Toddlers: the fronts of knees and ankles and the inside of wrists
  • Older children and adults: the folds of elbows and knees
  • In some people, the rash is all over the body

Is eczema caused by an allergy?

It is often thought that eczema is due to an allergy and that if the cause of the allergy is removed, the eczema will be cured. In fact, very few people have eczema caused by an allergy. However, the same people who have eczema may also have allergies that cause other symptoms.

What is important to know, is that the skin in all people affected with eczema is dry and easily irritated and therefore is not a good barrier to infection.

A child with a tendency for eczema is generally born with dry, easily irritated skin, which needs special care to prevent eczema developing.

What can you do to reduce the dryness?

Various moisturisers can be used. Sorbolene cream (which sometimes stings) or emulsifying ointment, are available from chemists or supermarkets. They are cheap and you do not need a prescription. It should be applied all over, at least once a day. Avoid creams containing urea, which can sting broken skin. Adding bath oils e.g. QVä or Alpha Keriä , into the bath water can help reduce the drying effect of the water.

What can irritate the skin?

Be aware of ‘things’ which may irritate the skin. Try to avoid:

  • wool and rough fabrics (e.g. carpets, seams and lace on clothes)
  • house dust mite in carpets can irritate some children
  • sand
  • perfumed and 'medicated' products
  • bubble baths and hot baths
  • using soap. Sorbolene cream can be used instead of soap
  • chlorine in pools
  • rapid changes of temperature and being hot in car seats or in bed
  • active exercise to the point of sweating
  • dry airflow e.g. heated rooms in winter, air conditioning in summer.

Not all these ‘things’ will irritate all children with eczema, but try to become aware of what can cause irritation for your child’s skin. That way you can avoid it, and avoid a ‘flair up’.

Food allergy

If any foods seem to trigger a reaction, keep a food diary and the reactions, and show your doctor.

What can be done if eczema develops?

If eczema develops, continue regular moisturising and avoid anything that further irritates the skin. Smooth cotton clothes can prevent irritation from itchy fabrics and reduce sweating.

Cortisone preparations (prescription strength) may be prescribed by your doctor to treat areas of eczema. These are safe and should be used only on those areas affected by eczema. It is all right to apply them to broken skin. You can stop using them when the eczema settles down in any particular area. Your doctor will explain how often to use these cortisone ointments or creams.

It is important to follow the instructions carefully. In general, cortisone ointment bases (clear, greasy) are better than cream bases (white) because the ointments are more moisturizing and sting less. Some formulations are not suitable for the face or the nappy area. Read all labels carefully.

If the eczema is very severe and is not responding to treatment, a period of intensive treatment in hospital or at home with wet dressings will usually ease the condition.

Is infection a risk?

Children with eczema may develop severe infections from the herpes simplex virus - the same virus that causes cold sores. People with cold sores should not be allowed to kiss your child. There is no special problem with other viruses and childhood immunisations are safe.

Impetigo, a bacterial infection, can occur on top of the eczema and you will notice your child’s rash change and your child may be itchier than normal.

Eczema can easily become infected from your child scratching. If you think your child’s eczema is infected you need to see your local doctor.

Remember

  • Eczema cannot be cured but it can usually be controlled 
  • Avoid things which irritate the skin 
  • See your doctor if there are signs of an infection 
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The Children's Hospital at Westmead
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Sydney Children's Hospital, Randwick
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Hunter New England Kids Health
www.hnekidshealth.nsw.gov.au

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