Atopic Eczema

What exactly is eczema?

Eczema is a group of medical conditions that cause the skin to be itchy, shiny or red and irritated. It may sometimes blister or peel. The commonest type is known as atopic eczema which affects 10-20% of children. Most of these children outgrow atopic eczema by the time they are 10 years old although a few live with it into adulthood.

What are the symptoms of atopic eczema?

This type of eczema commonly affects the arms, elbows, legs, knees, hands and face. You will notice that:-

  • The affected area may look and feel dry
  • Your child will itch this place/ seem irritable for the smaller ones that cannot itch
  • The skin will look scaly or start peeling
  • the skin will looks shiny and/or red depending on the child`s pigmentation (complexion)
  • It may also ooze fluid or crust out if scratched.
  • Eczema occasionally irritates the child so much that it may affect their sleep.

What causes atopic eczema?

Atopic eczema commonly but not always follows a genetic pattern. Children from families whose parents or siblings have eczema are likely to suffer the same. It is also common in children with other allergic conditions including asthma.

What are the common things that cause eczema to flare ups?

Every child is different, but a list of common foods and items that cause flare-ups include:-

  1. Various Soaps and cosmetics that your child may react to
  2. Pollen
  3. Weather changes especially to humid places like Mombasa or Kisumu
  4. Foods like cow’s milk and its products, eggs, peanuts, soy, wheat products among many others. Do not attempt to eliminate all these foods from your child`s diet without the assistance of a medical specialist or nutritionist as your child may suffer nutritional deficiencies.

Is atopic eczema contagious?

No, atopic eczema is not an infection and thereby cannot be passed by contact.  Other skin infections that occur together with eczema like bacterial skin infections may on the other hand be transmitted by contact.

How is atopic eczema treated?

It is advisable to consult a dermatologist to confirm the diagnosis before trying to treat eczema over the counter. There are many skin conditions that may match the above description.

Eczema may be treated by an allergy specialist (link), dermatologist or a general paediatrician.

On your consultation, the doctor may do the following:-

  1. Ask questions about your child`s rash or skin condition. It is worthwhile to have information on exactly when it started and any associated triggers you may have noted in terms of foods eaten or places visited. In case you do not regularly bathe or critically examine your child on a daily basis, it is advisable to clarify this information with your child`s nanny or other carer before your appointment.
  2. Examine the different affected skin areas
  3. May or may not run some tests. These include allergy panels for common triggers. (laboratory allergy testing)
  4. The doctor may recommend elimination diets. These cut down on common trigger foods one at a time to figure out specific items. This should be done on regular follow-up clinics under the guidance of a dermatologist or allergy specialist to avoid malnutrition. They may also collaborate with the nutritionist.
  5. The doctor will recommend ointments and moisturizers. These may ease mild eczema. Different moisturising creams respond differently to various skin types.
  6. Steroidal creams and other applied medications are prescribed for the moderate to severe types of eczema. These MUST be used after a registered medical doctor, specialist paediatrician or dermatologist has examined your child and written you a prescription.
  7. If the atopic eczema skin area has an added infection the doctor may add an antibiotic or antifungal targeting the specific infection. These are not used routinely for eczema and you should avoid mixed ointments purchased over the counter.

Why should I avoid self-prescribing topical steroids for my child?

You may be tempted to go over the counter and purchase a cream that relieved your child`s symptoms in the past but this is not advisable medically. This is because steroids are a complex group of drugs. There are many types of steroids and they have different strengths (potency levels). They are also packaged in different concentrations (percentages). Some come in the forms of creams and others in the form of ointments. When applied to the skin wrongly they may cause skin thinning, change your child`s skin pigmentation and leave permanent stretch marks. They also leave your child’s skin vulnerable to bacterial infections. Though applied to the skin, a small amount may be absorbed and makes its way to the bloodstream. If dosed wrongly this may tamper with the child`s growth.

Your doctor will prescribe the right type of steroid, right amount, in the appropriate form and for the correct duration after examining your child`s unique and specific case. He/she will also monitor how your child`s skin and growth is fairing on. It is important to keep these appointments even though this condition may last for months or years.

How can I help my child when they start itching so much?

In severe cases your child may start to itch uncontrollably especially at night.

Take a clean piece of cloth (like your child`s bathing towel), place it in cold or Luke-warm water and press over the itchy skin area. This is known as a cold/Luke-warm compress.

Avoid over the counter anti-histamines especially in children below 2 years of age.

Make an appointment to see a doctor at the allergy clinic or dermatology clinic at the earliest available date. If you feel you cannot wait until your appointment seek medical advice from any of the general paediatric outpatient clinics.

How can I participate in my child`s eczema care as a parent?

Keep an investigative eye to understand the triggers that cause flare-ups in your child. You may record these in your diary.

Keep your child’s skin clean, properly dried and then moisturised always.

Keep your child’s fingernails short to avoid bruising when they itch.

Use non-scented and non-medicated mild soaps to clean your child`s skin. Every child`s skin is different and in most cases harsh cleansers can irritate your child`s skin.

Dress your child in soft, loose fitting and absorbent clothes during the day and at night. This is more important when the weather is humid or your child travels to different environments.

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