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Eczema (children)

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Eczema (children)


Eczema is a form of dermatitis, a condition where areas of the skin become inflamed, itchy and red. The most common form of eczema is called atopic eczema which tends to run in families who have a history of other allergic conditions such as hayfever and asthma.

Atopic eczema may begin to develop in babies from about 3 months of age, and so is sometimes called infantile eczema. About 5% to 15% of children in the UK will be affected by eczema by the age of seven. In about 65 % of children the eczema will go by the time they are 7 years old and in about 74% of children the eczema will go by the time they are 16 years old. It is not possible to determine which children will grow out of their eczema, but in some, particularly those with more severe forms of eczema, it will continue into adult life.

Another common type of eczema is irritant contact dermatitis, where the skin becomes inflamed because of direct contact with a substance that irritates the skin. The hands are particularly vulnerable as these are the areas of the body that are most likely to come into contact with irritant substances. If repeated exposure to the irritant occurs, a person may develop allergic contact dermatitis. In this case, future contact with only very small amounts of the irritant will be sufficient to trigger an allergic skin reaction.
Atopic eczema is not an infectious or contagious condition. Instead, it appears that there is a genetic reason for being highly sensitive to
substances in the environment that trigger an allergic reaction, causing the skin to become red and inflamed. A large number of substances or allergens can trigger the allergic reaction, but the most common are house dust mite, animal fur, soaps, detergents and over-heating.

In atopic eczema, it appears that the skin does not produce as much fats and oils as normal skin. Therefore it is less able to retain water and less able to act as a protective barrier. Soaps and detergents can make the condition worse by removing natural oils from the skin. The skin becomes dry, loses its suppleness and cracks. It no longer provides an effective barrier against irritant substances and so quickly becomes red and inflamed. Cracking of the skin also allows bacteria to enter, causing an infection.
In its mildest form, atopic eczema appears as itchy, dry skin. In more severe cases, the skin becomes very red and intensively itchy. Scratching of the skin, in an attempt to relieve the itch, makes the condition worse. The skin becomes more swollen, it may crack, weep, bleed and blisters may form. Eventually the skin may become infected. Constant scratching of the skin causes it to become scaly and cracked. Symptoms may suddenly flare up after long periods of being under control. In babies, symptoms often appear on the face, scalp, arms, legs and body. In older children they tend to appear in the skin creases, behind the knees, on the neck, wrists and in front of the elbows.

The signs of irritation and redness are similar in contact dermatitis except that they tend to be localised to the area where the irritant has been in contact with the skin, for example around the neck if a nickel necklace has been worn, or around the wrist if a nickel bangle has been worn.
Atopic eczema
There is no known cure for atopic eczema, but regular treatments can be effective at managing the condition. The main treatments are emollients and topical steroids, which are applied directly to the skin.

Emollients are mixtures of oils, fats and water which keep the skin moisturised and prevent it from cracking. They are available in the form of lotions, creams, ointments, soap substitutes and bath oils. Used regularly, emollients will help prevent atopic eczema.

Topical steroids are anti-inflammatory medicines, which are used to bring eczema under control quickly. They help reduce the inflammation and so ease the redness and itchiness of the skin. There are a number of topical steroids available in different strengths in the form of creams, ointments and lotions. They should be used for short periods of time in the lowest strength that will control symptoms.

Pimecrolimus and tacrolimus are known as immunomodulators as they help reduce the immune response that leads to inflammation. Topical pimecrolimus is recommended for moderate atopic eczema on the face and neck of children aged 2-16 years. Topical tacrolimus is recommended for moderate to severe atopic eczema in children over 2 years. They are used when topical steroids have failed to control symptoms or there is a risk of side effects from using topical steroids; for example thinning of the skin if topical steroids are used for long periods on the face and neck.

Antibiotics, taken orally or applied directly to the skin, may be used to treat eczema that has become infected. Other treatments include wet wrapping with bandages and light treatment.

Contact dermatitis
Prevention is the best way of controlling contact dermatitis. When working with materials that are likely to cause irritation protective clothing should be worn or barrier creams should be applied to avoid the materials coming into contact with the skin. If symptoms do appear, mild topical steroid creams will help.
When to consult your pharmacist
Your pharmacist will be able to give advice on atopic eczema and contact dermatitis and their treatment. There is a wide variety of emollients available to help moisturise the skin, and the pharmacist will be able to recommend a product that is suitable for your child and will describe how to use it. Mild topical steroids containing up to 1% hydrocortisone may also be obtained from your local pharmacy without a prescription, and are suitable to use if symptoms flare up. If your pharmacist thinks that symptoms are too severe to be managed by over the counter medicines then you will be advised to see your doctor.

Let your pharmacist know if you think that any of the products you have been using to treat eczema, whether prescribed by your doctor or bought over the counter, are not working. Creams, ointments and lotions contain a large number of different ingredients and it is possible that some of these ingredients are making symptoms worse. Your pharmacist will be able to identify which of the ingredients may be causing the problem and will advise you to change to an alternative.
When to consult your doctor
Seek help if you suspect your child has eczema. Any worsening of symptoms needs attention. Consult your doctor if the skin is weeping and fails to heal or if an infection is suspected.
Useful Tips
  • Avoid wool and synthetic fabrics - 100 per cent cotton bedding and clothing are more comfortable against the skin
  • Over-heating can make eczema worse - layer clothes and bedding so that the temperature can be adjusted
  • Use non-biological washing products as biological washing products contain enzymes, which may make skin problems worse
  • Try to identify what is triggering your child's eczema and make changes to try and remove these triggers from the home
  • Special sprays, vacuum cleaners or filters and bedding systems may control irritation caused by house dust mite droppings. Regular damp dusting and washing of bedding at high temperatures can help to keep level of house dust mites down
Based on information supplied by: The National Eczema Society

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