What is eczema, how common is it, and what are the risk factors for getting it?

Eczema is a very common skin condition also known as atopic dermatitis ("atopic" means being sensitive to allergens, and "dermatitis" inflammation of the skin). It generally presents in childhood, before the age of five, with very dry and itchy skin. The skin can also be red and hot, and can have cracked or broken down areas. In the long term, if not treated properly, the skin can become thickened and rough; it can also change in colour, becoming darker for lighter skins or lighter for darker skins. All parts of the body may be affected by eczema, but the typical areas are behind the knees, the crooks of the elbow, the wrists, the neck/nape and the face.

But just remember: if it does not itch it is very unlikely to be eczema.

Although eczema may be continuous, it is usually characterised by flare-ups followed by periods of remission. As mentioned before, through the dryness and the cracks, there is breakdown of the skin's natural barrier - this makes the skin more vulnerable to irritants, allergens and germs that may cause infection.

Eczema can very much vary in its spectrum of severity, from mild (few patches of occasionally dry itchy skin) to very severe, where the whole body is affected. Most cases lie in between of course, and although it is a relatively simple medical diagnosis it can have a big impact on quality of life.

The look of the skin can be embarrassing for children at school, the necessity for regular treatment (several times a day) can be a nuisance and the constant itchiness can strongly interfere with quality of sleep at night and levels concentration during the day.

So who gets eczema?

As mentioned before eczema is very common, and infact is on the rise: it affects 15-20% of school children and about 2-10% of adults. Of the children affected about 80% are under five.

No one really knows the absolute reason for developing eczema but there is known a genetic component - having it in the family is a known risk factor. Other risk factors include a history of asthma or hay fever, use of certain detergents and soaps, fabrics such as wool (itchy) or synthetics (sweaty), extremes of temperature, and inhaled allergens (dust mite, pollen). Dietary factors (such as dairy or egg) can worsen eczema in about 10% of children (this is unusual in adults). Having excess skin bacteria (especially Staphylococcus Aureus) can also increase the risk of a flare-up, and it is known that eczema sufferers do carry larger quantities of organisms on their skin.

What are the principles of treatment?

The ruling principles of eczema treatment are MOISTURE, MOISTURE, MOISTURE followed by control of inflammation. This is undertaken in a step-wise progression, upping treatment needed.

Here is initial guide to how to manage your child's eczema as part of your daily routine:

In the bath: add emollient (moisturising) oil to the bathwater and let you child soak in the water for about 10mns. There are several products out there such as E45 bath oil, Oilatum, Balneum or Balneum Plus (good for really itchy skin). NEVER use bubble baths or other scented products: wherever there is fragrance there is alcohol and this will dry the skin.

To wash: use a soap substitute such as plain Aqueous Cream to wash with. There are other products such as Dermol 500 that are like Aqueous Cream but with antiseptic properties for more inflamed skin. To wash hair find a shampoo that is suitable for eczema and try and avoid washing hair in the bath.

To moisturise: this, as said before, is super important. There are many emollients and creams out there, all with varying grease/water contents. Again make sure they are fragrance free and colour free. The higher the grease content the higher the moisturising ability. Good ones that are easily available are Diprobase, Doublebase, Epaderm or Cetraben. There are of course much greasier products such as White Soft Paraffin 50:50, but these tend to be necessary in much more severe eczema. Apply these liberally to the while body if necessary, or particularly to affected areas of skin. Make sure you moisturise at least twice a day if not more.

If you need steroids to help control a flare-up, your doctor should advise you on which strength to use. The idea is to treat the flare-up and then stop the steroid - treatment is therefore always temporary and relatively short-term. Even if you see a pretty immediate effect (within a couple of days), do not stop the treatment until you have finished the course prescribed by your doctor - this will only lead to a rapid recurrence fo the flare up and more steroid use in the long term.

Steroids come in different strengths classified from mild (Hydrocortisone), moderately potent (Betnovate, Eumovate), potent (Elocon), and very potent (Temovate). They are given for short courses between 5 and 14 days depending on the level of severity and thickenss of skin. Certain areas of the body will require milder steroids - the face for example, where the skin is more delicate.

It is also important to apply the correct amount, and this is done by Finger Tip Units (FTUs). An FTU of cream or ointment is measured on an adult index finger before being rubbed onto a child. Again, one FTU is used to treat an area of skin on a child equivalent to twice the size of the flat of an adult's hand with the fingers together. Steroids are applied once or twice a day only.

Sometimes, when skin is very irritated, excoriated and inflamed, it may be infected. As mentioned before, eczema sufferers do carry more bacteria on their skin and, with the break in the skin barrier, are more vulnerable to infection. It can be beneficial to treat this with oral antibiotics such as Flucloxacillin for a week (this will cover Staphylococcus Aureus, the main skin bacteria).

Finally, consider the use of antihistamines, especially at night. These can be very useful in allowing your child to get a comfortable night's sleep without itching, therefore allowing her to feel rested and happier the next day. This may have a significant positive impact on behaviour and school performance.

However, If despite your best efforts with all of the above, your child still suffers from severe eczema, there are other treatment options available. By now though, you should be in the capable hands of a dermatologist. These treatments may involve very specialised creams and ointments, medicines taken by mouth that may modify the immune system, dry-bandaging/wet-wrapping, and phototherapy. Dietary modification may also be considered with exclusion of certain foods if these are considered to be a contributing factor.

As always, if you think your child may have eczema and that this is becoming a real nuisance, do not hesitate to discuss it with your doctor - relief is at hand!

For more advice on your child's health, click here

Visit www.eczema.org

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