Eczema

What is eczema?

Eczema is a dry, itchy skin condition that affects somewhere between 15 and 20 per cent of children at some point. It usually appears for the first time before your child is two. The good news is that most children who have eczema will grow out of the condition by the time they are in their teens. Eczema can't be cured, but it can be controlled with the right treatments.

Eczema is also known as atopic eczema or dermatitis. Atopic means the tendency to develop conditions such as eczema, asthma and hayfever. The end result is the same: dry, itchy, red and cracked skin, which can sometimes ooze fluid and bleed. The areas most affected in babies are the hands, face, neck, elbows and backs of the knees.

Eczema means that the skin's barrier doesn't work as well as it should. This can make your baby's skin is more easily prone to infections and allergies which can make the condition worse.

What causes eczema?

We don't know what causes eczema but it often runs in families. Allergic conditions including eczema, asthma and hayfever are on the increase but no-one is completely sure why.

Eczema affects the skin in "flares" or "flare-ups". Your baby's skin may have red and itchy patches of skin most of the time, but during flare-ups these areas worsen and may need more intensive treatment.

Eczema flare-ups can be triggered by skin irritation caused by chemicals, such as the detergents in bubble baths, shampoos, washing powders and fabric softeners. This is called contact eczema. A child with atopic eczema could develop contact eczema as well, so the two types sometimes occur together. Use bath emollient rather than soaps and detergents in the bath and you could also try changing your washing powder to see if this improves your baby's eczema.

It is also possible to have allergic contact eczema. This is usually a reaction to a specific substance such as the nickel in jewellery. However, the allergic reaction may spread to affect other areas of skin.

Eczema can be extremely distressing in babies because they find it very difficult not to scratch, which can lead to infections. In some cases eczema can disturb your child's sleep and affect his confidence, which can have an effect on his quality of life.

What is the treatment for eczema?

The treatment of eczema depends on its severity. If your child has mild eczema with only a few red and itchy areas, you may simply be advised to use an emollient lotion, cream or ointment, sometimes combined with a short course of a low-strength steroid cream.

It is known that dryness of the skin makes eczema worse and so preventing flare-ups by moisturising the skin is crucial. All children with eczema need to use liberal quantities of an emollient several times a day to stop their skin from drying out.

There are a huge variety of moisturisers or emollients available and you may have to try several to find the one that suits your child best. These are available as creams, ointments, lotions and bath additives. Aqueous cream is a cheap emollient that is often prescribed for eczema, but is best avoided as it contains detergents that may irritate your baby's skin.

You may have to use large quantities of emollient on a regular basis. Your doctor should regularly offer repeat prescriptions once you know which one works best. It is also a good idea to ask for extra quantities of emollient to keep at your child's preschool or nursery.

Will using steroids harm my child?

Doctors will often recommend that babies with atopic eczema use steroid creams from time to time. Many parents have heard about side effects from overuse of steroids, and are reluctant to use them, particularly on babies and young children. However, steroids are very safe if used appropriately. Their main side effect is thinning of the skin if they are used for long periods of time, but there is no evidence that this is permanent.

It is very important to use the correct strength of steroid cream, depending on the severity of the eczema, so steroids should always be used under the supervision of your doctor.

When using steroid cream, keep usage to a minimum by only using on the affected areas, no more than twice a day, and remember always to use plenty of emollient cream - it's impossible to use too much emollient.

What other treatments are available?

Oral antihistamines are sometimes prescribed if your child's eczema is very itchy and if it is disturbing his sleep, but they aren't used routinely to treat eczema. The ones normally available for young children often cause drowsiness and so will tend to be used at night. You should seek your doctor's advice before giving young children antihistamines.

If your baby has more severe eczema he may need stronger steroid creams from time to time. If his eczema isn't responding to treatment, he may need to be referred to a specialist dermatologist for other treatments.

Other treatments which might help severe cases of eczema include dry bandages and a technique known as wet wrapping - where bandages are soaked in emollient or steroid cream and then dry bandages are wrapped on top. This helps the treatments to soak into the skin.

What alternative treatments can I try?

Some parents find that homoeopathy and other complementary therapies can sometimes be helpful in treating eczema although it important to remember there is no firm evidence that they are effective.

Chinese herbs have been shown to help in some cases, but it is essential that you visit a qualified, experienced and registered practitioner as some Chinese herbs may have toxic effects on the liver.

What happens if the eczema becomes infected?

Eczema can be complicated by skin infections which are often caused by scratching until the skin is broken. If your baby's eczema becomes infected it may bleed, crust over or weep fluid and will need antibiotics to clear up the infection. If only a small area is infected, your baby will probably be prescribed an antibiotic cream but if a large area is infected he will need to take some antibiotic medicine by mouth .

Can I do anything to prevent my child getting eczema in the first place?

Here's what we know:

• Breastfeeding exclusively for at least four months may help to protect against eczema and other allergies. The Health Ministry recommends exclusive breastfeeding for six months.

• Some children who develop eczema may be allergic to cow's milk but it's important to talk to your doctor before removing cow's milk (or cow's milk formula) from your child's diet. If your child is formula fed your doctor may recommend a trial of a hydrolysed protein formula. Soya-based formulas and goats' milk formula are not recommended.

• There isn't any firm evidence that avoiding certain foods while you are breastfeeding or during pregnancy will prevent your child from getting eczema, but it is worth talking to your doctor if you are breastfeeding and eating a certain food seems to cause a reaction in your child. Don't alter your diet unless you have discussed it with your doctor first.

• There is some evidence that taking probiotics (either in the form of a supplement or food such as yoghurt) during pregnancy may reduce the chance of your child developing eczema, but more research is needed.

Is there anything else I can do to help?

There are other self-help measures you can try:

• It might be worth keeping a diary to see if you can identify what triggers your child's eczema and discussing it with your doctor.

• Some experts believe that exposure to some foods can aggravate eczema. Reactions to individual foods can obviously be helped by avoiding that food, but don't change your child's diet drastically without talking to your doctor. A review of studies found that excluding certain foods such as egg and milk only helped the eczema of those children with a suspected food allergy. Only about 10 per cent of children with eczema are affected by foods.

• Some doctors believe that house dust mites trigger some cases of eczema although there is no firm evidence that this is the case. You can try to reduce the amount of dust moving around your house by using a damp cloth rather than a dry duster for cleaning. Weekly washing of cotton bedding at a high temperature (50 degrees C or higher) is thought to help, as is airing your child's bedroom once a day and vacuuming the mattress once a week. However it is impossible to eradicate dust mites completely and many doctors believe it is better to concentrate on treating eczema.

• Cotton clothing may help, whereas woollen and synthetic fibres may make it worse.

• Overheating can make eczema more severe, so keep bedding and clothing light and layered, so that you can adjust your baby's temperature easily. Read more about how to keep your sleeping baby cool in hot weather.

• Keep your baby's nails short to help prevent skin irritation from scratching.