Eczema and your child’s skin. Dr A Bolin takes a look at some of the common types of childhood eczema and what you can do to help.

Does your child often get itchy skin?  Are there ever red patches which look inflamed?  The skin may be dry, cracked or could be irritated and slightly wet.  It might go through a cycle of getting better, flaring, then getting better again.  If you think this sounds like your child’s skin, you might consider booking an appointment with your healthcare provider for a formal diagnosis and tailor-made treatment plan.

What causes Eczema and how common is it?

No one can say for sure what causes eczema.  Eczema is believed to result from a combination of genetic factors as well as environmental triggers.  One in eight babies (with a family history positive for asthma, eczema or hayfever) may develop eczema. According to another study, 15 to 20 percent of all children may be affected by eczema.  Also, 80 percent of cases in children are diagnosed before the age of 5 years.

Are there many different types of eczema?

Yes, let’s discuss a few examples:

Atopic dermatitis is one very common type of eczema. Dermatitis means inflammation of the skin and atopy means that there is a bit of a hypersensitivity or allergic response (most likely determined by your genetics).

Have you heard of cradle cap (seborrhoeic eczema)?  This is when the skin on baby’s head, eyebrows, or other parts of the face is flaky, oily and may be have a yellowish crust.

Contact eczema or dermatitis is when the skin comes into contact with something which produces an allergic type of rash (an allergen, i.e. perfume, cleaning product, etc).

Nummular eczema is a small patch of skin that is rough, raised, inflamed, and may or may not have a wet, blistery surface (commonly mistaken for a fungal infection like tinea corporis or ‘ringworm’, so make sure to ask your doctor for a formal diagnosis and treatment plan).

There are other types of eczema that exist for example, after an insect bite there can be an inflammatory reaction, or some people have a delayed type hypersensitivity (i.e. nickel allergy) where your body’s immune system remembers being in contact with the allergen in the past.  Also, dyshidrotic eczema particularly affects palms of hands and small water-filled blisters often burst and are very itchy.

What makes eczema symptoms worse?

The symptoms of eczema are caused by the skin becoming overly dry.  Small children can have dry and flaky skin anywhere and as they get older the zones affected may be classically focused on face and eyelids, elbows, wrists, knees and elbows.  However, the affected skin could be in any distribution.  Understanding a few principles will help you take care of your child’s skin with the goal to decrease the severity and frequency of symptoms.

What about diet?

Diet is often one of the first ports-of-call for parents looking for solutions to their child’s eczema problems. Some people implement a dairy-free, gluten-free, or egg-free diet for their children, but is it a good idea?

That will depend on whether the child has an allergy or intolerance. If you are considering the above diets, it is best that you speak with your GP first in order to ensure that your baby or child has a balanced and nutritious diet for appropriate growth and development. He or she may recommend allergy testing so you can rule in or out any suspected allergens (and there are many- see below) so you can make an informed decision.

Some foods that are commonly involved in flare-ups include some fruits, especially more acidic ones including oranges, tomatoes, lemons and strawberries. Some foods including eggs, milk, peanuts, soybeans, fish and wheat may also trigger a reaction. Always talk to your doctor though before you exclude food groups from growing children’s diets.

Remember that most children will outgrow eczema.

With itchy skin, children tend to scratch… are they at increased risk for infection?

Yes.  Once your child starts scratching or rubbing the skin, it may crack and bleed.  Once the skin is open, it is easy for bacteria, viruses and fungi to cause an infection.  Examples of common infectious agents include Staphylococcus bacteria, molluscum contagiosum (a common vial infection that often affects people -mostly young children with atopic dermatitis – and causes clusters of small, shiny lumps to appear on the skin. It usually resolves over 6-18 months), herpes virus and tinea corporis.  If you notice pus, a yellowish discharge, or painful red skin, it is important to take your child to the GP to determine if it is an infection.

Steps to take: Things to avoid

• Seasonal allergens like pollen
• Dander -dust, dust mites and shedded skin.
• Excess heating (indoors during winter, too many layers of bedding, too heavy clothing) as it dries the skin
• Baths which are too hot. Heat makes the blood vessels dilate which can make symptoms worse
• Too much laundry detergent (can do an extra rinse cycle to remove excess soaps that might be an irritant in clothing)
• Excess soaps, perfumed body washes, bubble baths etc. for showers and bath
• Scratchy woollen, nylon, synthetic or clothing as they can be rough and trigger itch
• Stress, which can be a trigger. If you find your child has skin flares at times of emotional stress, anger, or fear, it would be worth looking into counselling and relaxation techniques as part of your health care plan.
• Allergy-inducing particles (allergens). If you think your child has a flare after exposure to an animal, specific food, pollen, trees, dust, preservative or additive etc., speak with your GP to decide if and when you might consider seeing an allergist for patch testing.  Bear in mind that many allergists prefer to wait until a child grows older before doing the test since it can be unpleasant for the child to have small scratches on their skin.  Also, most children will also outgrow their allergies.

If you suspect your child might have a skin infection do not delay in seeing your GP. Appropriate treatment early on is advisable.

Steps to take: Things to do

• Put emollients (moisturiser) on right after the shower or bath, preferably unscented. Reapply more than twice daily ideally for better outcomes.  Thicker ointments or cremes are better than lighter lotions.
• Steroid creams are appropriate to use in order to decrease inflammation. It is best to discuss with your GP, paediatrician or dermatologist which strength of cream or ointment to use.  Also, be certain to put the steroid cream sparingly on the affected area first before your moisturiser (as the other sequence could prevent the steroid from working as well).  Many people get scared by the term “steroid”, but it is important to know that they are safe and recommended as treatment as long as used in the right dose and application method.
• Use allergy covers on bedding and pillows if there is a senstitivity or suspected sensitivity to dust mites.
• Wash bedding in hot water (60C), as well as toys which may accumulate dust mites and their faeces.
• Talk to your doctor about using antihistamines (some may make your child drowsy, others are non drowsy, so check with your pharmacist or GP for appropriate dose and medication choice) to decrease the release of histamines which contributes to itch.
• Consider wet dressings if directed by healthcare provider (which helps keep in the steroid or emollient, and prevent drying out of the skin)
• Pay close attention to foods that might lead to a reaction and discuss these with your healthcare provider or allergist.

What more would a specialist recommend?

Depending on the severity of symptoms and the age of your child, a dermatologist or allergist might recommend other options such as oral steroids (short course), phototherapy (artificial UV light exposure), calcineurin inhibitors (an anti-inflammatory cream), or immune suppressing medications.

Useful links:

Allergy UK https://www.allergyuk.org/

http://www.mayoclinic.org/diseases-conditions/eczema/basics/definition/con-20032073

http://www.bad.org.uk/for-the-public/patient-information-leaflets/atopic-eczema

https://nationaleczema.org/eczema/child-eczema/)