Eczema

Eczema, also known as atopic or childhood eczema, is the most common skin condition we see. In milder cases the skin is dry, red and itchy. In more serious cases there could be weeping, crusting and splitting of the skin. At this point it can become even more itchy and uncomfortable.

Approximately one in five children in the UK suffers with eczema. There is currently no cure but the good news is it can be controlled. Many children find it improves as they get older but it is worth bearing in mind that skin will have tendency to be sensitive for life.

Eczema flare ups may occur during adulthood even after years of being clear. Some children have more persistent eczema throughout their teens and into adulthood.

The National Ezcema Society (NES) estimates that one in twelve people will have adult eczema very often associated with hand dermatitis or contact dermatitis. This may be due to lifestyle or occupational factors.

Eczema is genetically inherited. In the majority of cases there will be other people within the family who suffer with it or have associated conditions such as asthma or hay fever. These are all known as atopic conditions.

Skin composition

Recent research has shown that the skin of eczema sufferers is fundamentally different from that of healthy skin which acts as an effective barrier between the environment and the inner body.

Defects in the way eczema skin is composed means it is not as effective as normal skin at acting as a barrier or producing much needed moisturising factors to lubricate and protect it.

It also means the skin is unable to fight off common skin bugs such as staphylococcus aureus. This is a bug which can make the skin worse and very itchy.

Severe itching is very common in eczema sufferers and it results in a vicious itch scratch cycle causing more discomfort and sleepless nights to the child and their family.

Treatment

Although there is no cure there are some very promising treatments on the horizon for children and adults with severe eczema. These are still in the trial stages but have shown consistently good results so far.

There are many other good treatment options for eczema and it is important to note that all children will be different. For that reason the Dermatology team will tailor make a plan to suit your child and their specific triggers and circumstances.

Different treatment types are explained in detail below:

Infection

If your child or baby is experiencing deterioration in their eczema and oozing or yellow crusting, it may be infected.

Bacterial infections, when bad, may need a course of oral antibiotics or a change in creams.

It is also possible for eczema to become infected with the cold sore virus. This is called eczema herpeticum and it can cause a child to become quite unwell. The classic signs are groups of little blisters which quickly breakdown into shallow ulcers and spread rapidly. Classically the child or baby will be unwell, off their food and may have a temperature. They may describe the lesions as more painful than itchy.

This type of infection always needs prompt medical attention and if widespread may require a hospital admission where the virus will be treated with intravenous drugs.

Topical steroid preparations are usually withheld for several days until the viral infection has settled.

Top tips

• Make sure you have a good stock of emollients and steroids so you don’t run out. A break in treatment can cause symptoms to flare.
• The emollient you have should be right for your child and their lifestyle. For example have a thinner less greasy one before school and a thicker one at night.
• Keep emollients somewhere warm like an airing cupboard. During winter months, cold emollients can unsettle younger children. In summer you can pop them in the fridge if your child benefits from cool applications.
• Find a ‘champion’ in the community to help you between hospital visits. This is so important. That health care professional could be your health visitor, GP or practice nurse who can help you monitor your child’s skin and give repeat prescriptions.
• Sheffield Children’s Hospital is very busy and does not have a drop-in dermatology service. For this reason it is good to have back up for your child’s condition in the community.

Support

It is worth remembering that eczema will naturally be prone to flare ups. This is not an indication you have done something wrong or missed something out.

Frustrating as it seems, you may be unable to pinpoint exactly why a flare up has happened. Having a child with any chronic illness is difficult for carers and families. In particular eczema can become overwhelming at times with the vast array of skin medications, bandages and antibiotics or the fact that these treatments can be time consuming and messy. It’s important to make time for yourself and other family members and ensure you are getting all the support you need.

Support websites

SkinSupport
The Skin Support website was developed by the British Association of Dermatologists (BAD) to support people in psychological distress due to skin conditions. It provides a wealth of information on various skin conditions, self-help materials and support services.

National Eczema Society
A registered charity in England, Wales and Scotland dedicated to improving the quality of life of people with eczema and their carers.

Eczema Parents in Sheffield
A Facebook group where parents and carers can ask questions and share tips. The group was organised by the mum of a child with eczema and our Clinical Nurse Specialist provides additional support.