Dr Emma Wedgeworth
Consultant Dermatologist and Spokesperson, British Skin Foundation
Eczema is extremely common, affecting up to 20% of children in the UK.
For most sufferers, eczema is mild, although, for some, eczema can be life altering and can have an impact on sleep, school and day-to-day family life.
Eczema occurs as dry, red, flaky, itchy patches, often in the creases of the elbows and knees, although it can appear anywhere on the skin. The itching of eczema can be incredibly uncomfortable and distressing.
Research over the past 20 years has given us a fascinating insight into the pathology of eczema and this is now translating into many different treatment options.
Eczema is particularly common in children, but the reasons for this are not entirely understood. By the age of 11, 60-70% of affected children will be relatively clear of eczema.
Why do children get eczema?
Eczema is a combination of skin dryness and a change in the skin’s immune system causing redness and itching (inflammation).
It commonly goes alongside other conditions such as asthma, food allergies and hay fever, and there is a strong genetic component. If one parent has eczema, asthma or hay fever, a baby has a 1 in 4 chance of getting eczema, if both parents have one of these conditions it’s a 1 in 2 chance.
One gene called filaggrin has been identified as being important in eczema, but it is not the only gene involved.
Certain environmental conditions may also affect eczema; cold weather, indoor heating and skincare are amongst some of the common culprits.
Food allergies co-exist in up to 40% of children with eczema, but usually aren’t the actual cause. Most food allergies present as immediate swelling of the lips and hives, whilst eczema is quite a different process.
In older children and adults, these reactions are often quite distinct from the eczema. However, occasionally food can influence eczema, particularly in very young babies.
How do you treat eczema?
Unfortunately, there is no one cure for eczema. However the vast majority of children can be well managed so that it doesn’t affect their life and there are many treatment options.
Medical moisturisers (emollients) are an essential daily step for treatment of eczema. They increase water levels in the surface of the skin, boosting the skin’s barrier function.
Eczema in children is very common and can significantly impact on the quality of life of affected children and their families.
Avoiding soaps, bubble baths and shower gels also helps, as these damage the skin barrier.
Moisturisers are key in targeting the dryness of eczema, but once redness and inflammation have developed, this needs to be treated with an anti-inflammatory.
Myth-busting steroid creams
Steroid creams can be very effective and safe in the management of eczema. People are often very worried about using steroids, fearing they may damage the skin or cause other side effects.
In fact, we see far more damage to the skin with untreated eczema than with steroid creams. Steroid creams are not the same as tablet or anabolic steroids.
Furthermore, thinning of the skin is only seen when steroid creams are used inappropriately.
For mild eczema, the steroid cream is just used as and when needed. If the eczema is more severe, the cream may be used for longer and followed up by a ‘proactive’ approach; using the creams twice weekly to prevent flare ups from happening.
Most children will be maintained effectively on moisturisers and intermittent use of steroid creams, however, other anti-inflammatory creams known as topical calcineurin inhibitors can be helpful for delicate areas such as the face.
In a very small percentage of eczema cases, creams won’t be effective enough. In those cases, children need to see a hospital specialist. Other options are light treatment (phototherapy), tablets or injections.
Eczema in children is very common and can significantly impact on the quality of life of affected children and their families.
Research over the past 20 years has given us a fascinating insight into the pathology of eczema and this is now translating into many different treatment options.