Eczema (or atopic dermatitis) is a chronic condition affecting 10-15 percent of children. It appears as dry, red, itchy, thick, and sore skin on one or many areas of the body. Babies often have eczema on their face while older children tend to get it on the inside of the elbows, behind the knees and on the wrists, ankles and hands.
What causes eczema?
Eczema is frequently associated with a personal or family history of asthma, and/or allergic rhinitis (hay fever). The cause of eczema is unknown, but it is thought to be a genetic disorder that impairs the skin barrier, which leaves the skin susceptible to irritants and moisture loss. When the skin is dry, or exposed to irritants (such as pollens, animal skin and fur, feathers, soaps and sweat) it becomes itchy and inflamed and can sometimes get infected. For the vast majority of patients there is not just one “trigger”. It is an episodic disease of exacerbations (or flares, that can be as frequent as 2-3 times per month) and remissions.
While there is no cure for eczema, nearly 80 percent of children will grow out of it and there are effective treatments to control symptoms in the meantime.
What treatments work?
The best thing you can do for your child is apply plenty of moisturiser (emollients) to their skin. Moisturisers act by repairing the skin barrier, and reducing water loss. This in turn decreases the itch and can reduce the frequency of flares.
Moisturisers come as ointments, creams and lotions. Ointments and creams are best as they are more moisturising. You can use as much moisturiser as you like, but must use it at least twice per day, head to toe. The best time to apply moisturiser is after a bath.
You should bath your child once per day in a lukewarm bath for 10-15 minutes. Use bath oil in the bath and aqueous cream (rub on your child before bath then rinse off in bath) or soap free cleanser. Pat your child partially dry, and while the skin is still moist, apply moisturiser liberally.
Corticosteroid ointments and creams
Corticosteroid ointments and creams should be used on the red, oozing and inflamed areas to reduce inflammation and therefore itch. They are often called ‘cortisone’ or ‘steroids’ for short but they are not the same as the ‘steroids’ athletes and body builders may take. Corticosteroids are similar to the chemicals your body makes naturally to fight inflammation.
Corticosteroids come in different strengths for different parts of the body and for severity of eczema flare. Your doctor will prescribe the right one for your child.
Cortisone applications work for nearly everyone who uses them. Use as directed by your doctor until the redness and inflammation has gone. Typically people are afraid of using cortisone on their child and therefore do not use enough to reduce the inflammation. There is unnecessary concern about skin thinning which is highly unlikely if the treatment is properly supervised.
Which cortisone should I use?
The skin on your face is thinner than the skin on the rest of your body, therefore a mild cortisone is
used on the face and a moderate to potent cortisone is used on the body where the skin is thicker.
Face: Sigmacort, Dermaid, hydrocortisone.
Body: Advantan Fatty Ointment, Diprosone, Elocon
Sometimes your child’s eczema may get infected and they may need antibiotics. This looks like increased oozing and yellow crusting in the eczema. Sometimes blisters filled with pus may be present. The cortisone applications do not work when there is infection so your doctor may prescribe a course of oral antibiotics to treat the infection.
You may be told to apply wet dressings to the body or apply cool compresses to your child’s face when your child is having a flare-up. They are used to help the cortisone ointment and moisturiser soak into the skin and keep the skin cool.
Often it is useful for your child to have an antihistamine (anti-itch) medicine, especially at night. Some can make your child a bit sleepy too so they may help with sleep.
Topical calcineurin inhibitors (TCIs) such as picrelimus and tacrolimus are a second-line therapy for eczema, and are usually prescribed by a dermatologist. Talk to your GP about a referral to see one.
Things to avoid
- Do not let your child overheat. Help keep them cool by dressing them in cotton clothing, and remove their jacket/jumper when inside. You can use cool compresses to face/neck and wet dressings when the eczema is flaring. Remember you cannot catch a “cold” from being cold.
- Avoid prickle/irritation by wearing cotton, no wool/prickly fibres, avoid dry air from central heating, and remove irritants such as sand and dirt caught in socks after playing outside
Eczema myths and facts
- FACT: My child’s eczema improves after a beach holiday
Some studies have shown that salt may have an anti-inflammatory effect. Also vitamin D from sunlight has been suggested to help children with eczema.
- MYTH: Bathing is bad for my child
- MYTH: Swimming pools are bad for my child.
Just be sure your child showers straight after finishing in the pool and apply moisturizing cream.
- MYTH: Corticosteroids are dangerous and should be used sparingly.
On the contrary, if you don’t use enough cortisone you won’t get your child’s eczema under control.
- MYTH: Moisturisers with “natural” plant or animal extracts are better for my child.
Often plant or animal extracts can be more irritating for the skin. Also, these products are often more expensive and are an unnecessary expense.
Lady Cilento Children’s Hospital
501 Stanley Street, South Brisbane
t: 07 3068 1400
t: 07 3068 1111 (general enquiries)
e: DermatologyCN_LCCH@health.qld.gov.au (for non-urgent enquiries)
In an emergency, always call 000.
If it’s not an emergency but you have any concerns, contact 13 Health (13 43 2584). Qualified staff will give you advice on who to talk to and how quickly you should do it. You can phone 24 hours a day, seven days a week.