Southern Peninsula Paediatric Allergy strives to provide education and understanding to parents and children to enable them to better manage their medical problems.
Eczema is an inflammatory condition of the skin and is part of a sensitive skin disorder. Children who have sensitive skin have a number of characteristics to the skin which includes a greater ability to become dry, hot and itchy as well as infected. Tendency to eczema is strongly genetic or inherited through a group of sensitivities which includes eczema, hay fever, asthma, sinus problems and food allergies.
The younger the child with eczema at presentation and the more severe the eczema, then the more likely that foods are implicated. Testing for foods can be done at any age, depending on whether a child has enough clear skin to carry out skin prick testing, which is the preferred method. If there is no clear skin, then testing for food antibodies (sensitivities) can be done via a blood test.
A child with eczema has inflammation in their skin which, in turn, is likely to make the skin more sensitive, and therefore it is very important to identify and remove as many triggers as possible, some of which can be determined by allergy testing and others by association, such as soaps and detergents, wool and other skin irritants. Many children will have problems with their skin if exposed to chlorine, sand, dirt and even sunscreens and some moisturisers.
It is important to reduce the inflammation of the eczema and treat the eczema, particularly in young children, very aggressively. Many children, unfortunately, will continue on with their eczema through fear of certain treatments, particularly topical steroids (steroid phobia) and their eczema will become chronic and more difficult to treat as they get older.
Control of eczema is possible and early, aggressive treatment and understanding of the process occurring in the skin is vital if long term control is to be achieved.
Attention needs to be paid to all aspects of the skin problems including dryness with the use of moisturisers, keeping the skin cool, reducing the itch and in particular, if the child is scratching vigorously and excoriating themselves, then reducing the excoriations by cutting and filing the nails can make a major difference.
Controlling the eczema with an appropriate topical steroid in the first instance is very important. Many children will respond to mild steroids, which can be purchased over the counter but if a mild steroid is not satisfactory, then a moderate strength steroid, available on a script from your doctor, needs to be employed and for some children, they may even need intermittent courses of higher strength topical steroids.
Infection is a common problem in children with chronic eczema and this is usually from a bacteria called Staphyloccus aureus (Staph for short) that often produces a toxin that can irritate the skin and create more eczema, but also cause the skin to become less sensitive or resistant to the effect of the topical steroids. Many children need to have attention paid to the possibility or the reality of infection before their skin will clear up and some will require oral antibiotics while others benefit from reduction of the bacteria on their skin with the use of preparations such as Microshield T or QV Flare-Up in the bath. Even regular washing can reduce the Staph n the skin.
Once control has been achieved of the eczema, it is important to maintain it as relapses occur frequently, but if over time the skin can be maintained with good control, then the outlook for most children with eczema is extremely good.