Eczema is an inflamed condition of the skin that usually begins before babies are 12 months old. The affected skin is dry, red and itchy. Sometimes these areas of skin can become cracked, weepy and scab over.
Babies usually have it on their face. The rash can also sometimes appear on their scalp, behind their ears, on their body and arms and legs.
In toddlers and older children, the rash often appears in the creases of the knees, wrists, elbows and ankles.
Eczema often disappears by the teenage years, but can continue into adulthood.
Eczema is caused by a person’s inability to repair damage to the skin barrier. Once the skin barrier is disrupted, moisture leaves the skin and the skin become dry and scaly. Environmental allergens (irritants) can also enter the skin and activate the immune system, producing inflammation that makes the skin red and itchy.
This inability to repair the damaged skin barrier is thought to be genetic, as your child is more likely to get eczema if your family has a history of eczema or allergic conditions such as hay fever or asthma.
Eczema can be triggered by a number of things such as:
- Overheating your child
- Dryness of the skin
- Irritations from soaps, detergents, fabrics and other chemicals
- Allergies to dust mites, plant pollens or animal fur
Only rarely is eczema caused by a reaction to food. However it may be considered for babies with widespread eczema. Also some older children can be intolerant to acidic foods and preservatives leading to eczema breakout around the mouth. However, you should consult a doctor or dietician before restricting any food groups.
The treatment of eczema includes removing the cause, regular moisturising of the skin, relieving the itch, stopping inflammation, and treating and preventing any secondary skin infection.
Moisturisers
Moisturisers help relieve itch, prevent drying and cracking, and restore the skin’s protective role. A good quality moisturiser purchased from the pharmacy should be applied at least twice a day, especially after bathing. You may need to try several brands before you find the brand that works best for your child. Thicker creams and ointments are more effective than lotions. People with eczema should avoid scented products.
Moisturisers, bath oils and soap free body wash should be used instead of soap in the bath. These products are very effective in cleansing your child’s skin. Ask our pharmacists advice with choosing a product that best suits your needs.
Cortisone treatment
Despite avoiding triggers and using a regular moisturiser, the itch and redness (inflammation) may remain. Corticosteroids relieve these symptoms of inflammation. They come as creams, ointments and lotions and are available in different strengths and potencies. Some are available from the pharmacist and are suitable for use on the face and mild flare-ups on the body. Stronger ones require a prescription from your doctor. They are all safe if used as directed.
Antihistamines
Oral antihistamine liquids and tablets, available from the pharmacist, can relieve itching. Sedating antihistamines may be especially useful at night to help sleep. Sedating antihistamines cannot be given to children under 2 years of age.
It is important to control the itching as scratching makes the eczema worse and can cause infection. In addition to using antihistamines you can:
- Apply a soft, cool wet towel to the itchy area for 5-10 minutes, then use a moisturiser
- Moisturise regularly throughout the day
- Avoid overheating your child
- Keep your child’s fingernails short and clean
- Wet dressings are very effective, particularly if the eczema is not controlled within 24-48 hours of starting the cortisone treatment. Wet dressings should be stopped when the eczema is cleared and restarted again if it flares up. Ask our pharmacists how to create and apply a wet dressing
- A wet T-shirt or singlet (apply a thin layer of cotton clothing over this) is a good way to reduce the itch and redness on the body
Since heat is the most common trigger for eczema, it is important to keep your child cool at all times by:
- Dressing you child in 1-2 thin layers of cotton clothing. (Wool and some synthetic materials can be irritating)
- Baths should be lukewarm (<29oC)
- Do not use doonas or woolen blankets. Use a cotton blanket or sheet instead.
- Do not have the house hotter than 20oC during the day and 15oC during the night
- Educate carers eg.family, kinder, school to dress your child appropriately
Most people affected by eczema can manage the condition with moisturisers, topical creams and ointments, antihistamines and by avoiding the triggers already mentioned. In rare cases the eczema is resistant and oral immunosuppressants may be prescribed by the doctor. Because of the risks of side effects this treatment is only considered for severe cases that are difficult to control with other therapies. If your child’s eczema doesn’t respond to regular treatment, then you should see a doctor.
Sometimes patches of eczema can get infected by bacteria and your child may need antibiotics. A person with a cold sore on their lip should not kiss a child with eczema as this may cause the rash to get infected with the cold sore virus. If the eczema becomes weepy or scabby, it is extremely important that the scabs are removed as soon as possible. The easiest way is to bathe your child in a cool bath for 30minutes to soften the scabs, then before getting them out of the bath wipe the crusts of with a soft wet towel.
If you would like any more advice on products to treat your child’s eczema or would like us to create a treatment plan for your child, come and visit your friendly Community Pharmacy Pharmacist today
