There are many types of eczema, with atopic eczema (congenital, internal origin) being the most common in infancy and childhood. (Approximately 5-15% of the population suffers from some form of eczema.) Children with atopic eczema often also suffer from asthma and hay fever. eczema is a chronic, long-lasting condition, in which flare-ups are interspersed with symptom-free periods. eczema can be mild or it can be so severe that a sleeping child is disturbed by the itching.
Atopic eczema has a hereditary component. There is generally someone in the family who has eczema, or who suffers from hay fever or asthma. This, however, is not a rule.
Where do the symptoms of eczema occur?
Symptoms of eczema change with age, but they are likely to be found on the arms, legs, face and neck. It is important to note that the itching and the dry skin are always present.
What causes eczema?
The exact cause of infantile (childhood) eczema is not known, but we do know that that skin of children with eczema is excessively sensitive to external and internal factors. The most frequently occurring root cause is contact with irritants (soaps, perfumes, cosmetics, detergents, rinses), clothing (e.g., wool), extreme temperatures and humidity, certain foodstuffs, airborne allergens (mold, hair, dustmites).
The allergic tests of children with eczema are often positive, even though they are not truly oversensitive. Bloodtests carried out during the course of treatment are not very helpful.
Can infantile eczema be outgrown over time?
In most cases, the symptoms of eczema improve over time. In the case of eczema which appears in infancy, three years’ age, five years’ age and teenage years are milestones in the evolution of the disease. eczema sometimes persists into adulthood.
The care and treatment of eczema
The appropriate physician-parent-patient relationship is of primary importance in the treatment of eczema. A one-time cure does not exist for eczema, but symptoms can be restricted to the minimum level, the frequency of flare-ups reduced and the patient can be maintained in remission for various periods of time.
Bathing and eczema
Bathing is important even in the case of eczema, but baths which are too hot or too long must be avoided, taking the dry skin into consideration (the temperature of water should not exceed 34° and the bath should take less than 10 minutes). Bubble bath and soap should not be used because they irritate the skin. A child’s eczematous skin should only be washed with a soap-free cleanser. This should be followed by gentle blotting with a towel and immediate use of a hydrating emollient while the skin is still damp.
What are emollients?
Emollients are hydrating products which are indispensable due to the dry skin associated with eczema. These products maintain the hydration of the child’s skin, while decreasing the tightness and itching. Emollients contain a low level of skin irritants and preservatives. Emollients should be used during the symptom-free periods because they help prevent flare-ups, lengthen the symptom-free periods and decrease symptoms during flare-ups. During symptom-free periods, the child’s skin should be covered with emollient two or three times daily. This should occur not only on the eczematous skin but also on the areas where there is no inflammation, since the entire skin tends to be dry. In the case of mild or moderate eczema, the use of emollients alone may be effective enough. In the case of severe eczema or when symptoms are intensifying, a so-called active anti-inflammatory product should also be used. Only those hydrating products should be used which are recommended by the physician. Lipobase and Locobase Repair are excellent emollients which were developed explicitly for the daily care of dry, eczematous skin and which are safe to use in the long-term.
Steroid-containing creams are effective in reducing inflammation and the itching during acute flare-ups, but they are not recommended for long-term use due to their side effects. These preparations must be prescribed by a physician. They are to be used only once daily along with the emollients.
Local kalcineurin inhibitors
A new treatment is available for atopic eczema. These are non-steroid preparations which reduce inflammation of the skin and the itching. Acute flare-ups may take longer to quiet down; on the other hand, long-term use is safe.
Treatment of eczema with medication
Antihistamines are used to alleviate itching. The traditional antihistamines induce sleepiness, these are used at night. Modern antihistamine medications do not cause drowsiness, therefore they can also be taken in the morning. The use of antibiotics may be indicated in case of bacterial secondary infections.
Practical advice regarding eczema
- Clothing and bedding should be made of cotton
- Feather pillows should not be used
- Living quarters should be ventilated frequently
- Nails should be cut short, excessive heat and perspiration should be avoided
- Pets should not be kept in the vicinity of the eczematous child
- Attention should be diverted from the itching
- Special washing and neutral hydrating creams should be used by the child at school
- If classmates and friends understand the problems of eczema, they will assist the eczematous child