What is Eczema?

Eczema is a common skin condition in which the skin becomes dry, itchy and red. It can make the skin crack, weep and bleed and more prone to bacterial infection, especially if a lot of scratching occurs.  Approximately 30% of children in Australia are affected by eczema but a large proportion of these children will grow out of it by the time they are a teenager. It can have a large impact on families with sleepless nights, irritability and frequent visits to the doctor or chemist.

What causes Eczema?

It is unknown what causes eczema but it seems to run in families and is associated with other allergy type conditions such as asthma and hayfever.  It is essentially an issue with the skin’s protective barrier so it isn’t very good at maintaining moisture, is prone to drying out and is sensitive to various triggers. These triggers can include overheating,  infection, irritants such as soap and detergents, dry skin and allergens in the environment such as animal fur, dust mites and pollen.

Symptoms of Eczema

Eczema is characterised by a red, dry and itchy rash on the skin. The locations of the rash usually varies depending on the age of the child. Infants less than 6 months usually get eczema on the face, cheeks, chin, forehead, scalp and nappy region. Crawlers between 6 – 12 months tend to get eczema on the outside of their elbows and knees. Toddlers and older children are usually affected in the creases of their elbows and knees, wrists, mouth and eye lids. In some children the whole body can be affected.  Due to the loss of the skin’s protective barrier the skin can get infected and becomes weepy and crusty (especially with lots of scratching!).  The severity of eczema can vary for each child – sometimes it can be quite mild and other times it can get very severe  and distressing for the child which is why it is so important to manage it well.

How to treat eczema

The aim of eczema management is to try and maintain the moisture of the skin,  avoid triggers that can flare up eczema and stop the itch scratch cycle.  A large proportion of children with eczema can be managed with the below simple measures.  

1. Avoid Triggers
   • Minimise the things that irritate the skin such as grass, sand, carpet, chlorine and salt water (e.g. by rinsing off after swimming), synthetic clothing, baby wipes, overheating, fragrances, bubbles baths and soaps. Saliva and and some foods can also be very irritating around the mouth area.
2. Moisturise
   • Use soap free washes (there is a large range found in the eczema section of the chemist) Avoid bubble baths and fragrant washes as they dry out the skin. Bath oils are very moisturising.
   • Short baths – we recommend less than 5 minutes and make sure it isn’t too hot. The aim is to preserve natural skin oils and long showers or baths can dry out the skin.
   • Moisturisers – when treating childhood eczema it is important to know the difference between lotions , creams and ointment.
     • Lotions – contains more water in it and less oil, so they are less moisturising for kids with eczema. It contains more preservatives so more likely to sting
     • Creams – contain 50% oil and are white. They are thicker than lotions but more moisturising so good for maintenance treatment for eczema. They can sting if the skin has active eczema so ointment better for flare ups
     • Ointments – contains 80% oil, they are clear and more greasy. They are better for flare ups and doesn’t sting as much.
3. Treat Flare ups

Sometimes eczema does not respond to the simple measures as above and your doctor may recommend the following.  

• Steroid creams – help reduce the itch and the redness and are very effective at treating eczema flare ups. They are very safe when used correctly so please discuss with your doctor which steroid cream or ointment is better for your child.
• Wet dressings can be soothing for children with flare ups especially before bed. They can increase the absorption of topical steroids three times and are usually only needed for a few nights. The Royal Children’s Hospital Melbourne has some good resources online on how to do wet dressings.
• Bleach Baths – this is often a difficult sell when I suggest this to patients! This discovery came about when it was observed that kids with eczema that swam in chlorinated pools had less flare ups of eczema. Studies conducted showed that by adding a bit of bleach to a bath that children with eczema had less flare ups, used less steroid cream, had less infections, required less antibiotics use and less itch due to its anti-septic and anti-inflammatory properties on the skin. Using ¼ cup plain white king in a ½ filled adult bath for approximately 5 minutes is safe concentration for children.
• Antibiotics – if your child is showing signs of infection such as weeping and crusting of the skin they may need antibiotics.

Food Allergy and Eczema

Parents often ask if their child’s eczema is because of a food allergy. Children with eczema are more likely to suffer from food allergies  but usually their food allergies are not related to their eczema (it  is more of an association rather than cause). Care must be taken with dietary eliminations as this can lead to nutritional deficiencies and food aversions. The best way to check is once the eczema is clear, try reintroducing food – if a rash appears within 30 minutes to 1 hr after eating, a food allergy may be the cause. Please talk to your doctor if you suspect a food allergy. Also be aware that some foods act as an irritant around the mouth (just like saliva) , so take care with acidic foods during flare ups such as orange juice, watermelon, and tomato sauce.

What if my child keeps getting flare ups of eczema?

All of the above can be very time consuming and as busy parents it is hard to stick religiously to the eczema management regime. Once your child’s eczema has cleared it is important to continue ‘maintenance measures’ such as moisturising and to try and avoid or minimise triggers. You don’t have to  wrap them in cotton wool but it might be after a morning at the beach – make sure they rinse off the sand and apply some moisturiser afterwards to help protect the skins barrier. If you are still struggling to break your child’s ‘itch scratch cycle’ please see your GP.

Resources – https://www.rch.org.au/uploadedFiles/Main/Content/derm/knowing-your-childs-eczema-booklet(1).pdf