skin conditions – and also one of the most uncomfortable. Around one in five children
is affected, suffering itchy, irritable skin on a regular basis. Lucy Jolin has answers
to all your questions
Eczema is a skin condition that makes the skin red, flaky, itchy and irritable. Nobody
really knows what causes it, but it could have a genetic link. It’s also linked to
conditions such as asthma and hay fever. So, if you or your partner have any of these
conditions, your child has a higher risk of having them, too.
‘We are beginning to think that there are actually structural differences in the
skin of children who have eczema,’ says Helen Dennis, dermatology nurse specialist
and nurse advisor for the
National Eczema Society. ‘That means their skin has what we call impaired barrier
function, allowing airborne particles to actually enter the skin and trigger an immune
response which is inflammation, itching and redness.’
What are the signs?
It can start showing very early – almost from birth, says Helen Dennis. ‘Most children
develop it around three to six months or in the first year. We do hear of cases where
it doesn’t show until after the child turns four, but that’s quite rare. Parents
spot redness, dry patches of skin and inflammation. Children might also be noticeably
itching, so they might rub their bodies. It can appear all over the body, anywhere.
What is the treatment?
It’s essential to get a proper diagnosis. Most children will be treated by their
GP. Childen whose eczema is very severe will be referred to a specialist.
Treatment depends on the severity of the eczema. All children with eczema will need
to have an emollient regularly applied to moisturise the skin and create a barrier.
This can come in the form of a cream, an ointment or a lotion. The ointments have
the highest oil content, followed by creams and then lotions. There are plenty on
the market and they can be bought over the counter. ‘I advise parents not to experiment
with too many, as they don’t vary that much,’ says Helen Dennis. ‘Just find one that
– as long as it does the job of adding moisture and restoring the barrier function,
If emollients aren’t enough, your GP may prescribe a steroid cream. ‘Topical steroids
are the fi rst line of active drug treatment, as emollients don’t contain drugs as
such. They are still the number
one choice, as they have the least side effects and are considered the safest of
the treatment options available,’ explains Helen Dennis. ‘They come in different
strengths. For children, mild topical corticosteroids are absolutely safe to use.
Some children will require the next strength up, which is moderate. If they require
something stronger, it’s probably appropriate to refer to a specialist.’ For more
severe cases, specialists can prescribe drugs called calcineurin inhibitors. Phototherapy
– treatment with a
special kind of light – is also an option.
‘His bed clothes would be covered in blood’
Lorna Parkes’ son Austin, now three, was born in Australia and showed no signs of
eczema. But when he was three months old, they returned to the UK, and Lorna noticed
what she thought was a rash –
inflamed, sore skin that Austin was trying to rub. ‘I took him to the GP, panicking
a bit, and he told me it was an eczema are-up,’ she says. ‘From then on, flare-ups
just kept happening.’
At first, Lorna’s GP recommended just an emollient, but that wasn’t enough to keep
the eczema under control. He then prescribed a steroid cream for Austin, which helped.
But flare-ups still happened. ‘He used to make himself bleed,’ recalls Laura. ‘I’d
go in in the morning and the bed clothes would be covered in blood. Funnily enough,
he never used to get that cranky with it, so luckily our sleep didn’t suffer. You
could see it was inflamed and red and bleeding but it didn’t
often make him cry.’
Lorna manages the eczema by ‘trial and error,’ she says, seeing what works and what
doesn’t. ‘We’ve tried mittens but he would pull them off. The ones that attach to
sleep suits and folded over were the best ones for him as a small baby. He has particularly
bad spots on his body – behind the neck and the wrists and the ankles. He used to
bleed from his ankles because from a very early age he learnt to rub his ankles on
carpets or the bed or anything where he could get some friction. We also tried strapping
his feet up using gauze at night, and that worked well, but only for his ankles.’
Austin’s eczema has improved over time. Lorna advises other parents to seek out the
products that work for their child as soon as possible. ‘It took quite a few months
for us to find an emollient that we felt really helped. We now use Aveeno, which
is great. We’ve been looking into things which might trigger the eczema and we are
pretty sure that cows’ milk doesn’t help but it’s very hard to pin it down. I also
try to use natural fabrics, such as merino and organic cottons, for items like pyjamas,
as they help the skin to breathe.’
What are the challenges?
Applying the emollient is the big one, particularly as your child gets more mobile.
Children will probably need to be creamed in the morning, then in the evening, followed
by an application of the emollient before bed. If the eczema is very severe, you
to apply the emollient several times a day and at night.
‘Babies are quite easy: you put a big towel on the fl oor and put them under their
baby gym,’ says Helen Dennis. ‘Once they are crawling, we’d recommend that you try
and contain them within the bathroom.’ Trying to stop children scratching is also
challenge, so keep their nails short to limit damage to skin and try putting mittens
on them at night time.
It’s likely that children will want to cream themselves when they start to develop
their own independence – Helen Dennis advises to let them get used to it. ‘You will
have to watch them make a mess, but there is huge value in being independent – and
they will get better at it, if you let them try.’
The itching can affect a child’s sleep, meaning that the whole family ends up tired.
‘If you’re finding it hard to cope, ask your GP if your child’s eczema is severe
enough to be referred to a specialist,’ suggests Helen Dennis. ‘The National Eczema
Society also has a helpline (see below) so please call us.’
How will nursery and school manage it?
When you’re looking round a nursery, ask them how they would cope with having to
look after a child with eczema, suggests Helen Dennis. ‘The nursery should meet their
needs but it does vary from place to place.
‘If they say they are short staffed and might not have time, then I would steer clear,’
adds Helen Dennis. ‘Schools
have an obligation to assist the child with their learning. It’s reasonable for the
child to be able to put cream on themselves when they get to school age. But they
need prompting and
reminding, and somewhere to do it.’
What does the future hold?
About 70 per cent of eczema will no longer be visible in the teen years, but around
a third of sufferers will have it into adulthood. It could also return during stressful
times in your child’s life. ‘The approach is to treat it in the early years so it’s
well controlled, even if that means being more aggressive with treatment,’ explains
Helen Dennis.‘If it’s managed well when children are little, the long
term prospects are better.’ For more info, visit www.eczema.org or call the society’s
helpline on 0800 089 1122.