Eczema; atopic; dermatitis; skin; itch; rashes; allergy; rash; itch;
Eczema (also called atopic dermatitis) is a skin rash which is common in babies and young children, but which tends to get better as they get older. The skin is very itchy and it can be quite distressing to the child. It can usually be controlled and the child helped to feel more comfortable.
If a child's eczema suddenly gets worse, it may be due to an infection. See your doctor as extra treatment may be needed.
- Babies with eczema have a pinkish-red, scaly rash which is very itchy. This is often on their faces, scalp, behind the ears, over the body and on the arms and legs. The rash can get lumpy, weep and crust.
- As children grow, the eczema tends to clear from the face and scalp, and be mostly in the elbows, behind the knees, on wrists and hands.
- Eczema may get better as the child grows older and it may be gone by adolescence or adulthood. Some forms of eczema start in adult life.
What causes eczema?
- Children who are born into families where there are allergies are more likely to develop atopic (allergy-type) diseases such as asthma, hay fever and eczema.
- The child's skin has less body oils that usually keep skin supple and intact.
- The skin barrier is usually damaged, although you may not be able to clearly see this.
- When the skin is damaged and the barrier is impaired, moisture evaporates from the skin, cells shrink and this causes cracks.
- Allergens and other irritants can get in and lead to a reaction that causes the skin to feel itchy. The rash is made worse by rubbing and scratching.
- The rash of eczema can be triggered by many things including virus infections, irritation, teething or infection. The child may be allergic to some foods, or to substances in the air such as pollens and the droppings of house-dust mites.
- Often there is no obvious cause for a flare up of the rash at a particular time.
- The rash tends to come and go no matter how well it is treated. There are days and weeks when the child has more rash than usual, then there will be times when it is better.
About 40% of babies who get eczema go on to get asthma and/or hay fever when they get older.
- See your doctor to be sure the rash is due to eczema and to talk about ways to treat it.
- There is information in this pamphlet 'Eczema - how to manage it' which has been published by the Women's and Children's Hospital, South Australia.
- Children who get eczema need special care of their skin all of the time, plus extra treatments when the rash flares up.
- Reducing the dryness and irritation of the skin is a very important part of treating eczema.
- Even when the eczema is under control use a moisturing cream containing gylcerine and mineral oils several times a day. Talk with your pharmacist about which creams to use.
- If the skin feels dry even if you use the cream more than 4 times a day - use a thick cream containing white and/or soft paraffin several times a day. Again, check with your pharmacist about what to use. Sometimes you will need to use greasy creams (such as Dermeze, Epaderm or QV intensive).
- Any product that causes bubbles can irritate the skin.
- Bath the baby only about once a day in warm (not hot) water.
- Avoid using soaps and any shampoo.
- Use sorbolene cream, sorbolene and glycerine cream or bath oils instead of soap.
- After drying the child (pat, don't rub) put more moisturiser cream on dry parts of the skin.
- Dress your child in soft clothes. Use cotton (or cotton and polyester mix) against the skin. Put cotton trousers on crawling babies so their legs don't rub on carpet.
- Keep your child cool. Avoid hot baths, hot rooms and over dressing.
- Avoid contact with wool, including lambskins. (Parents may also need to avoid wearing wool, so that their baby's skin does not become irritated when they cuddle). They also harbour house dust mites.
- The skin of a child with eczema is very sensitive. If any moisturiser or oil you are using seems to make the skin worse, change to another one. Perfumed creams and creams which have plant extracts such as tea tree oil, pawpaw and aloevera can irritate the skin.
- Giving the baby a massage with a natural vegetable oil or mineral oil can be great for dry skin if the child is not sensitive to the oil.
- If swimming in chlorinated water, moisturise the child's skin before going into the water. After swimming rinse off and apply more moisturiser
- Sea water seems OK, but again apply moisturiser to your child's skin before going into the sea as the salt water may sting sensitive skin.
- As well as keeping all of the skin healthy and comfortable (see below), a corticosteroid cream or ointment may be needed to treat reddened parts of the skin when the eczema flares up.
- Steroid creams or ointments are safe to use in the way that your doctor tells you, and when they are needed (when the child has a rash) but when the rash settles, the steroid creams can usually be stopped. Often the rash returns and cream or ointment will be needed again.
- Hydrocortisone cream is the mildest form of steroid and the one to use on the face. For babies this may be all they need on the body also. Older children and babies with more severe eczema, may need to have a stronger cream prescribed for a while.
- Sometimes antibiotics will also be used if an infection is part of the problem.
- Antihistamine medicines may be helpful in controlling the itching and especially in helping the child sleep at night.
Treatment does not 'cure' eczema. The aim is to keep the child as comfortable as possible.
How to manage eczema
(brochure from the Women's and Children's Hospital, South Australia)
problems with eczema
- If eczema is more severe and doesn't get better with the treatments that have been suggested, go back to your doctor.
- There may be an infection which needs treatment.
- Allergies may be making the eczema worse (see below).
- Treatment in hospital is sometimes needed if the rash is severe and covers a large part of the baby's or child's body.
with allergic triggers
- In most cases, removing things that irritate the skin and treating the skin (as above) is enough to control the eczema.
- If this does not work it may help to find out if the child is allergic to something, which you can then avoid. These investigations should be undertaken by a trained allergy specialist as natural practitioners may undertake costly tests that have no scientific basis (ASCIA 2015).
- House dust mites droppings or animal fur (cats or dogs) may cause problems. Control measures and suggestions can be found at the Australasian Society of Clinical Immunology and Allergy (ASCIA) website.
- A few babies may be allergic to foods they eat or drink, or if breastfed, to foods their mothers eat.
- Cows' milk, eggs and peanuts are the most common foods causing allergies but many others are possible triggers.
- Some foods cause a rash around the mouth when eaten, but don't affect the rest of the body.
- Skin prick tests can be done to help work out what the problem is if the problem seems to be due to an allergy. Your doctor can refer you to an allergy specialist with specialist training to help sort this out.
- Don't change or restrict your child's diet without checking with a trained medical doctor or accredited practicing dietitian to be sure the diet is still healthy. Natural pratitioners who carry out unorthodox tests may suggest restricting hildren's diets which may cause harmful effects when foods are re-introduced. (ASCIA 2015)
Australian Society of Clincial Immunology and Allergy Inc
Dermnet New Zealand
Eczema Association of Australasia
National Eczema Association (USA)
National Eczema Society (UK)
Women's and Children's Hospital, SA Health
Eczema - how to manage it (brochure)
British Dermatological Nursing Group (2012b) 'Dermatology Nursing Competencies: Developing Dermatology Nurses from Novice to Expert. Retrieved from http://www.bdng.org.uk/ documents/EmollientBPG.pdf on 16 June 2015.
Danby SG, Al-Enezi T, Sultan A, Chittock J, Kennedy K, Cork MJ British. 2011 The effect of aqueous cream BP on the skin barrier in volunteers with a previous history of atopic dermatitis. British Journal Dermatology
165(2):329-34. doi: 10.1111/j.1365-2133.2011.10395.x. Epub 2011 Jul 11.
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The information on this site should not be used as an alternative to professional care. If you have a particular problem, see a doctor, or ring the Parent Helpline on 1300 364 100 (local call cost from anywhere in South Australia).
This topic may use 'he' and 'she' in turn - please change to suit your child's sex.