Parents and guardians
Eczema
What is eczema?
Eczema is a common skin condition which usually first presents in childhood, affecting 1 in 5 children in the UK. It often runs in families and can be associated with other allergic-type conditions (also known as atopic conditions) such as hayfever, food allergies and asthma. Eczema can be variable from person to person, affecting different parts of the body and with different levels of impact on the individual.
What causes eczema?
Your skin is a natural barrier which protects you from the outside world whilst also keeping the moisture in. In eczema, the barrier doesn’t work as well as it should, allowing moisture to seep out and things from the environment to get in. This results in skin which is dry, inflamed and itchy due to a loss of moisture and irritation from particles in the environment.
Click here to watch a video on what eczema is and its symptoms
The skin in eczema is usually itchy and dry, and if severe can cause difficulties with sleeping and participating in regular activities. Sometimes the skin will bleed due to scratching, and over time the skin can become thickened due to repeated scratching.
Often these symptoms fluctuate, with episodes called ‘flares’; sometimes flares occur due to exposure to a trigger, at other times there is no clear cause.
Eczema can affect anywhere on the body, but typically is found in the joint creases in children, for example the knees and elbows. In babies it often begins on the cheeks.
Common triggers
- Soaps
- Certain types of clothing – woolly clothes or synthetic materials which are warmer and cause sweating. Cotton, bamboo or silk clothing are useful alternatives which are cooler and less irritant
- Cold weather
- House dust mites
- Animal dander (shed skin, saliva and fur)
- Pollen
- Food allergies e.g. egg and milk in younger children
- Stress
- Swimming pool water
Diagnosis and treatment
Diagnosis
Eczema is diagnosed clinically, which means that a health professional can make the diagnosis based on the symptoms and appearance of the skin. They don’t usually need to do blood tests or any other investigations.
Treatment
Eczema is usually treated with a combination of
- Moisturisers or emollients
- Used daily to keep skin moisturised, feeling less itchy, and more protected from irritants
- Lots of different options
- Also come as soap substitutes for handwashing and bathing
Steroid creams
- Used during flares
- Used in very small quantities, in the weakest strength possible, to gain control of the flare
- Weaker steroids are often used on the face as the skin is more delicate
- Usually continued for 48 hours after a flare has stopped
Some children will require other treatments for eczema instead of steroid creams, for example if they are not managing to control their eczema, or if they experience problems with prolonged use of steroid creams. These are called topical calcineurin inhibitors, and are only used after discussion with specialist dermatology doctors.
Infected eczema
People with eczema are often prone to infections of the skin, due to the barrier being broken with repeated scratching. It is important to recognise if this happens so that your child can be reviewed by a medical professional, as antibiotics may be required.
Infected eczema is usually wet and oozing, and may be hot to touch. It often has a golden crust if it has been infected by common skin bugs like staphylococcus or streptococcus.
Eczema can also be infected by viruses. One important example is the cold sore virus, also known as herpes simplex. This looks slightly different to other types of infected eczema, as it is a blistering rash which often comes up very suddenly, is painful, and is associated with fevers and feeling generally unwell. Sometimes you will be aware that they have had a recent cold sore or been in contact with someone else who has, but not always. It is very important that if you have any concerns about a rash like this developing, you get your child seen immediately as early treatment is important.
Useful resources
https://www.eczemacareonline.org.uk
https://www.healthiertogether.nhs.uk
https://bspad.co.uk/eczema/ – for older children and teenagers
https://bspad.co.uk – for teenagers
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