Eczema in children: an expert’s guide

There has been a dramatic rise in allergic diseases in the Western world over the last 40 years, and almost 20% of children today are thought to have either allergic or atopic eczema. So, what is eczema, what can trigger flare-ups and how can we treat it. Dr Adam Fox, a leading paediatric allergist explains.

What is eczema?

Atopic eczema (a.k.a. atopic dermatitis) is a chronic skin condition characterised by patches of dry, itchy skin, which periodically flares up with no apparent cause. It usually starts in early childhood and fortunately, it is usually mild, albeit irritating. However, for some children, it can be more severe, with soreness, peeling skin, and rash-like symptoms, and it can be continuous, severely impacting the child’s life, as well as the lives of their parents or caregivers.

What is the best way to treat eczema?

Emollients (moisturisers) and bath oils are often used regularly on babies and children with eczema to keep the skin hydrated; however, these measures do little to calm down sore, enflamed patches and are no guarantee of preventing them either. These active areas of eczema are most effectively countered with anti-inflammatory measures, such as steroid creams.

The idea of using steroid creams on children can make some parents nervous due to the possibility of side-effects. This leads to many cases where eczema is under-treated and the child suffers skin damage as a result. The fact is, with the direction of a doctor, steroid creams are largely safe and usually very effective at treating eczema.

If a bacterial infection has caused the flare-up, antibiotics may also be required.

Why does eczema flare up?

Eczema may flare up due to:

• Skin infections
• Contact with irritants
• Abrasive clothing
• Sweating
• Viruses

One possible but controversial factor could be that of diet. Some parents try to change their child’s diet to improve their eczema, but many doctors remain sceptical of the value of this, not least because it could mean that the child is missing out on important nutrients, which could affect their health in other ways.

However, as our understanding of food allergies improves, it is becoming clear that at least in a small proportion of children, excluding certain foods does indeed seem to have an impact on the child’s eczema. Establishing if food is a factor with the particular child and identifying the problem foods is not easy – if you think you have spotted a connection, take your child to see their family doctor or a specialist allergist rather than experimenting yourself.