Eczema

Dermatology patient

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:

Emollients

Emollients or moisturisers are extremely important in the treatment of eczema. There are many types of emollients available ranging from thick greasy ointments to thinner creams or lotions. They are widely used and replenish and improve the damaged skin barrier. They are known to calm and soothe eczema skin and when used regularly can reduce the need for stronger topical steroids to be used.

It is very important to use enough. Emollients may be used five to six times a day all over the body. A minimum of twice a day would be recommended. A 500g pump dispenser of your preferred emollient should only last one to two weeks if skin is dry.

With the help of your dermatology nurse or doctor you should be able to find one or two which suit your child. An important factor will be how the skin care regime fits in with your busy lifestyle and how to get the most benefit from your emollients.

Very often these products are underused but are an essential part of treating eczema and dry skin.

Remember not to run out and ensure you have a supply handy if you are out and about or on holiday.

Please note that some of the heavier paraffin based products are flammable if in contact with a naked flame.

Bath oils and soap substitutes

As well as using emollients you will have to find an alternative to soap and bubble bath. There are various options to choose from and some contain antibacterial ingredients which can be helpful when eczema is regularly infected.

Shampoos are kinder for eczema if they are unscented and non-coloured. This goes for nappy wipes, nappy creams and sun creams. The dermatology team can advise you of your options with these too.

Topical steroids

These continue to be the main treatment for inflammatory skin conditions including eczema. There have been some negative opinions of topical corticosteroids over the years but if used appropriately for monitored lengths of time they are very useful in reducing the red itchy symptoms associated with eczema and helping your child to become more comfortable.

The dermatology team will show you exactly how much to apply as it is common for parents to underuse a course of steroids and good control of the eczema. The term ‘use thinly’ is not helpful as it often leads to very little being used.

Steroids come in four different potencies. Mild, moderately potent and very potent. Children are mostly prescribed mild to moderate options with potent steroids reserved for acute flare ups. Very potent steroids may be used but only in very well monitored situations for eczema which is very bad. Potent and very potent steroids are rarely used on faces.

Always check if you are unsure. It is good practice to leave a gap between steroids and emollients of around 30 mins if possible. Applying steroid and emollient together for quickness is not advised as it will dilute the potency of the steroid and make it less effective.

Apply all creams, both emollients and steroids in a downward fashion and do not rub in vigorously. This will only make your child’s skin itchier.

Antihistamines may help some children. The ones with a sedative effect can help at night but even then you may still notice your child scratches in their sleep. For short periods of time they are useful. Observe for any grogginess or tiredness this next day, particularly in school age children.

Non-sedating antihistamines generally have limited effects on eczema symptoms.

Wet wraps

This is a simple technique your dermatology nurse can teach you if your child’s skin is not infected. It tends to work best on itchy dry skin which is inflamed.

Used mainly at night, it consists of one special eczema garment being applied damp to well moisturised skin then a second garment applied straight after to seal in the moisture. Topical steroids are not used as the air and water tight properties of the bandages will enhance potential side effects.

Wet wraps are useful when a child is very itchy at night although they can be used during the day if re-moisturised at least once more.

Paste bandages are also a good treatment for non-infected eczema, particularly if it is dry and thickened. More chronic eczema of the limbs does well with this option although it does take time to do and is messier than wet wraps.

Your dermatology nurse can discuss bandages in more depth with you as they are an effective treatment for some children and young people.

Immunomodulators

These are topical creams or ointments which work similarly to steroids in reducing skin inflammation and redness. While steroids are safe to use under supervision, these drugs differ as their side effects are less, particularly skin thinning.

They are therefore a suitable option for facial and eyelid eczema or to use as a maintenance option following on from a prescribed course of topical steroids.

Many children use them as a ‘weekend’ therapy just twice a week to reduce eczema flaring.

They are available in different strengths but generally not useful when eczema is acutely infected.

 

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.

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