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ECZEMA : ATOPIC - CHILDHOOD ECZEMA

What is Atopic Eczema ?

Atopy is the word which describes the linked conditions of asthma, eczema and hay fever. Atopic eczema is the commonest form of eczema affecting children. An atopic child may have one or any combination of these three conditions. The eczema is commonest around the age of 2 years. It can, however, appear for the first time at any stage in childhood from the age of two months and even in adult life. The eczema typically affects the skin creases the folds of the elbows and behind the knees. It can, however, affect all parts of the body. The skin is dry and very itchy. It is the itching that is most distressing to children, often keeping them awake at night. This form of eczema is very prone to infection. Bacterial infections of the skin are often responsible for a flare-up of the condition.

How does Atopic Eczema occur ?

Nobody knows exactly why atopic eczema develops. It is thought that in some children an allergy to dairy produce is important, particularly cow's milk. This is not so for all children and the importance of food allergy becomes less as the child becomes older. A number of factors make the eczema worse. These include irritants, temperature changes, infection and anxiety.

Why does Atopic Eczema occur ?

The atopic tendency is partly inherited and runs in families. Other members of the family often suffer from one or more of the atopic conditions mentioned above. In adults who have this form of eczema it may be triggered by jobs in which the skin is abused. People at risk include nurses, hairdressers and motor mechanics.

Treatment Involved for Atopic Eczema

With children who have atopic eczema there are three major problems: the skin is itchy, dry and prone to additional infection. Treatment is therefore directed towards these three main aspects. Irritants should be avoided. This includes all soaps, bubble baths and bath additives apart from those recommended by the doctor. Solvents and paints should be avoided, as these will tend to irritate the skin. Sudden changes of temperature need to be avoided, and the bedroom must be kept cool, particularly at night. This will help to reduce the itching and the general agitation of the child.

A number of creams or ointments can be used instead of soap for cleansing the skin. If emulsifying ointment is being used, it should first be whisked in boiling water in a bowl. This gives a fluffy ointment either to wash the skin or use as a moisturizer. Medical bath oils are useful in mild eczema. The main treatment for eczema is the use of steroid (cortisone-like) creams. In children, hydrocortisone is safe and has no long-term side-effects. Hydrocortisone is safe to use anywhere on the body, including the face. It should be used regularly in children with eczema as it is important to prevent them from damaging their skin. Continual scratching will often lead to permanent scars. If the skin becomes very thick, stronger creams may be necessary, but should only be used for a limited period of time. Steroid cream or ointment is often combined with an antibiotic.

This helps to control any additional infection in the skin. A severe flare-up of atopic eczema is often due to such infection. When this occurs, a course of antibiotic tablets is often prescribed. These should last for at least 2 weeks. It takes this length of time for the skin to clear properly. Syrups or tablets based on antihistamines can be used to control itching. Most of these preparations cause drowsiness and are best used at night to ensure a good night's sleep. In severe eczema, bandages may be used to cover the affected areas. In children with severe eczema, diets excluding dairy produce may be of value. These should never be started without the advice of a dietician. In children with very dry skin, evening primrose oil capsules are effective in some cases. The doctor can prescribe these. In particularly severe cases, special forms of sunlight treatment or certain drugs can be given. These should always be given under specialist supervision.

During Treatment for Atopic Eczema

Children and adults with atopic eczema should avoid contact with people with cold sores. This is because the virus that causes cold sores can cause a widespread infection of the skin if one has atopic eczema. Vaccination against smallpox can similarly cause a very widespread problem in the skin. Children with atopic eczema need constant reassurance and support from parents and brothers and sisters. The eczema makes them “different” from their friends because of the cosmetic effects of their condition, their continual irritation, and their need to use creams regularly.

After Treatment for Atopic Eczema

Even after the eczema subsides, the skin will tend to be very sensitive to irritants. You should avoid jobs that involve contact with water, detergents or oil.

If Atopic Eczema is Left Untreated

The eczema would generally become worse, with a high risk of infection. The skin would thicken because of the continual scratching and leave permanent scars. Eventually eczema will settle, but it is impossible to predict when. In some children, the eczema only lasts a few months. In others, it will last for years. In some people, it may persist through to adult life.

Effects on Family of Atopic Eczema

This is a familial condition and other members of the family may be affected. The psychological stresses on parents of affected children may be great, particularly if scratching disturbs the child's sleep. Parents thus need considerable support and reassurance.