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Eczema

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.

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Alert!

If a child's eczema suddenly gets worse, it may be due to an infection. See your doctor as extra treatment may be needed.

What does eczema look like?

  • 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.
  • When the skin is damaged, moisture evaporates from the skin, cells shrink and this cause 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 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.

What you can do

  • See your doctor to be sure the rash is due to eczema and to talk about ways to treat it.
  • 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 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 or QV intensive).
  • Bathing
    • 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.
    • 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).
  • 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.
  • Avoid swimming in chlorinated water. Sea water seems OK. 

Additional treatments

  • As well as keeping all of the skin healthy and comfortable (see below), a corticosteroid cream or ointment may be needed to treat 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.

PDF documentHow to manage eczema  (brochure)

Further 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.

Allergic eczema

  • 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.
    • House dust mites droppings or animal fur (cats or dogs) may cause problems.
    • 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 to help sort this out.
  • Don't change or restrict your child's diet without checking with a doctor or dietitian to be sure the diet is still healthy.

Resources

Australian Society of Clincial Immunology and Allergy Inc
http://www.allergy.org.au/ 

Dermnet New Zealand
http://dermnetnz.org/ 

Eczema Association of Australasia 
http://www.eczema.org.au

National Eczema Association (USA)
http://www.nationaleczema.org

National Eczema Society (UK)
http://www.eczema.org

Women's and Children's Hospital, SA Health
PDF documentHow to manage eczema  (brochure)

References

Australian Society of Clincial Immunology and Allergy Inc
'Care Plan for eczema' and 'Action Plan for eczema' (see above).

Eczema Association of Australasia 'Information about eczema' 
http://www.eczema.org.au

Gold MS, Kemp AS, 'Atopic disease in childhood' Medical Journal of Australia 2005; 182 (6): 298-304

Psaila SH 'Atopic Dermatitis' in Garfunkel et al (Eds) Pediatric Clinical Advisor' Mosby 2007

Ross T, Ross G, Varigos G 'Eczema: practical management issues' Australian Family Physician Vol 34, No 5, May 2005 p319-324

**Any products referred to in our health topics are usually well-known brands readily available in Australia. The brand names are given as examples only, and do not necessarily represent the best products, nor the full range of effective products on the market.

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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.

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