Eczema - causes and treatment

Eczema (or atopic dermatitis) is a chronic (long-term) condition affecting about one-third of all children. It appears as dry, red and bumpy skin that is very itchy. It can appear on one or many areas of the body. Babies often have eczema on their face while older children tend to get it in the creases of elbows and knees, ankles and wrists. Over time affected areas can become thickened from scratching. Eczema is not contagious.

There is no cure for eczema, but nearly 80 percent of children will grow out of it. There are many ways to keep your child’s eczema well managed. effective treatments to control symptoms in the meantime.

Eczema can change and at times will be considered mild or non-existent (in remission) while at other times it may flare up and become worse.

What causes eczema?

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 (from the outside environment) and moisture loss. Eczema is frequently associated with a personal or family history of asthma, and/or allergic rhinitis (hay fever).

Things that can trigger eczema include:

• Being overheated. Remove jumpers when entering indoors or during physical activity.
• Dry skin. Keeping the skin moist is an important part of eczema management.
• Environmental irritants such as pet fur or dander, pollens, grasses, and dust mites.
• Physical irritants (things contacting the skin): prickly fabrics, dirt/sand caught in socks, soap, bubble baths, antiseptic washes (except for prescribed bleach baths or Condy’s Crystals baths).
• Saliva and foods contacting skin (causes flares around mouth, neck, and upper chest). Wipe away irritant with water and apply barrier cream (Sudocrem) to the skin to protect it from further irritation.
• It’s important to recognise the signs of infection early (very red, weepy, and or yellow crusted areas), start regular antimicrobial baths (Bleach Baths or Condy’s Crystals) and see your GP.

For most eczema sufferers there is not just one trigger. The condition can flare up as frequently as 2-3 times per month).

How is it treated?

Baths

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. See our fact How to bathe a child with eczema for more information.

Moisturisers

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. 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.

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 a day, head to toe. The best time to apply moisturiser is after a bath.

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. When used intermittently with flares of eczema, there are no risks in using these medicines.

Corticosteroids come in different strengths for different parts of the body and for degrees of severity of the eczema flare. Your doctor will prescribe the right one for your child.

Corticosteroids 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 corticosteroids on their child and sometimes do not use enough to reduce the inflammation. There is no need to be concerned about skin thinning if the treatment is properly supervised.

Which cortisone should I use?

The skin on your face, neck and genitals is thinner than the skin on the rest of your body, therefore a mild cortisone is used on these areas, and a moderate to potent corticosteroid is used on the body where the skin is thicker.

When applying topical cortisone, it is important to use the fingertip unit application. One adult finger-tip unit is equivalent for 2 adult hand sizes of redness.

Other treatments

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 cool the skin and help the corticosteroid ointment work better and to hydrate the skin. See our Eczema: wet wraps fact sheet for more information.

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.

Infections

Bacterial or viral infections are common in children with eczema. The signs of infection include an increase in redness, weeping, and or yellow crusting in the eczema. Sometimes blisters filled with pus may be present. Treat with daily bleach baths or Condy’s Crystals Baths and see your GP who might prescribe a course of oral antibiotics to treat the infection.

Food allergies and eczema

Some children with eczema may also have a food allergy. A food allergy appears usually within 2 hours and up to 4 hours after ingesting a food. The symptoms of a food allergy are one or more of the following symptoms within 4 hours of ingesting a food:

• hives (urticaria),
• swelling of the lips, face or general swelling,
• stomach pains and/or
• vomiting, itching of the throat, difficulty breathing, wheezing and/or persistent cough.

If your child experiences any of these symptoms, seek medical attention immediately. For more information about food allergies, see our Food allergies fact sheet.

Eczema myths and facts

• FACT: Eczema improves after a beach holiday
  Some studies have shown that salt water may have an anti-inflammatory effect. Also vitamin D from sunlight has been suggested to help children with eczema.
• MYTH: Bathing is bad for eczema.
  A daily bath helps rehydrate the skin.
• MYTH: Swimming pools are bad for eczema.
  Swimming pools are a stronger version of a bleach and salt bath. Just be sure your child showers straight after finishing in the pool and apply moisturising cream as the concentration of chlorine can dry the skin.
• MYTH: Corticosteroids are dangerous and should be used sparingly.
  On the contrary, if you don’t use enough corticosteroid 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.

When to seek help

See your GP if your child has any common symptoms, including:

• signs of skin infection (increased oozing and yellow crusting in the eczema, a fever).
• signs of food allergy (hives (urticaria), swelling of the lips, face or general swelling, stomach pains and/of vomiting, itching of the throat, difficulty breathing, wheezing and/or persistent cough).

In an emergency, call Triple Zero (000) and ask for an ambulance.

If you're not sure whether to go to an emergency department, call 13 HEALTH (13 43 25 84) and speak to a registered nurse.

For more information

• Eczema - bathing your child
• Eczema - using wet wraps

Developed by the Dermatology Service, Queensland Children’s Hospital. We acknowledge the input of consumers and carers.

Resource ID: FS109. Reviewed: June 2022.

Disclaimer: This information has been produced by healthcare professionals as a guideline only and is intended to support, not replace, discussion with your child’s doctor or healthcare professionals. Information is updated regularly, so please check you are referring to the most recent version. Seek medical advice, as appropriate, for concerns regarding your child’s health.