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Eczema

Eczema is a common skin condition that usually begins before your baby is 12 months old. The affected skin is dry, red, and itchy. Sometimes these areas of skin can become cracked, weepy and then scab over.

Eczema can be well controlled and there are ways you can help your child's eczema feel more comfortable. For many children, appropriate skin care and cortisone treatment will need to be continued for many years.

Eczema is not contagious.

Signs and symptoms

• Babies usually have a red, dry rash on their face. The rash is sometimes on their scalp, behind their ears, on their body and arms and legs. The rash is very itchy.
• In toddlers and older children, the rash is often in the skin creases around the knees, wrists, elbows and ankles.
• Eczema can involve any part of the surface of the skin and in some children the rash can cover the entire skin.

You will notice that at times your child's skin is well controlled and at other times it gets worse. It is common for the eczema to fluctuate, which is why it is important to manage the eczema effectively and control it as soon as it flares up.

Causes

The cause of eczema is not known. If a member of your family has eczema, asthma or hay fever then it is more likely that your child will have it. Some children with eczema also develop asthma or hay fever.

Eczema can be brought on or triggered by a number of different things such as:

• Over heating your child.
• Dryness of the skin.
• Irritation from soaps, detergents, fabrics and other chemicals.
• Food allergies or intolerances.
• Allergies to dust mites, plant pollens or animal fur.
• Viruses and other infections.

Care at home

Eczema can be well controlled in most children by:

• Avoiding the main triggers, such as overheating and skin irritants.
• Looking after your child's skin by keeping it well moisturised to avoid dryness.
• Reducing the itching by using wet dressings and cool compresses.

Avoid things which irritate the skin

Each child may react to different things and it may take a while to work out what is irritating your child's skin.

Here are some common things that can irritate the skin:

• Dummies, dribbling or food around the mouth. Apply an ointment prior to eating.
• Prickly materials such as woollen or acrylic clothing, bedding and car seat covers.
• Detergents, soaps, bubble baths, antiseptics.
• Contact with animal fur.

Keep the skin moisturised

A good quality moisturiser (purchased from a pharmacy) can be used as often as necessary. Some children will require moisturiser application once or twice a day, while others will need it applied several times a day. Common moisturising creams are Sorbolene, Aquasol and Paraffin. Thicker creams and ointments are more effective than lotions. 

Moisturisers, bath oils and soap free body wash should be used instead of soap in the bath. These products are very effective in cleansing your child's skin.

Cortisone treatment

Despite avoiding triggers that irritate the skin and using a regular moisturiser, the itch and redness may remain. As a result, your doctor may prescribe a cortisone-based cream or ointment. Cortisone is a natural hormone that is produced by the body. Cortisones are very effective in controlling the eczema. They are safe if used as directed.

Weaker cortisones are used on the face and stronger cortisones are used for the body. It is important to apply the correct cortisone to all areas of eczema, even if the skin is open. Use all medicines, creams and ointments as prescribed by your doctor.

Control your child's itching

Try and control the itching as scratching makes the eczema worse and can cause infection. Avoid saying "Stop" to your child when they are scratching. Instead try these ideas:

• Apply a soft, cool wet towel to the itchy area for immediate relief and leave on for 5-10 minutes. Remove the wet dressing and apply a thick layer of moisturiser post. 
• Distract your child when he/she is scratching.
• Avoid overheating your child, particularly in bed, or on long car trips.
• Use moisturising cream regularly throughout the day.
• Keep your child's fingernails short and clean.
• Wet dressings are very effective and should be applied to the limbs at bedtime. Particularly if the eczema is not controlled within 24-48 hours of starting the cortisone treatment. Wet dressings should be stopped when the eczema is cleared and restarted again if it flares up.
• A wet T-shirt or singlet (apply a thin layer of cotton clothing over this) is a good way to reduce the itch and redness on the trunk (body). This can be applied throughout the day and night until the itch and redness subside.

Heat is the most common trigger for eczema. Therefore it is important to keep your child cool at all times. You can do this by:

Eczema and diet

• Most children with eczema do not have any reactions to food. However, in some children, food allergy/ies may be the main trigger.
• Food allergy needs to be considered in babies with very widespread eczema. Sometimes older children can be intolerant to acidic foods and preservatives leading to eczema breakouts around the mouth.
• All foods should be considered 'innocent until proven guilty'. Diets that restrict certain foods should not be undertaken unless your child is advised by an allergist or dietician.

Treatment by a doctor

• If your child's eczema flares up or does not respond to the regular treatment, then you should see a doctor.
• Sometimes patches of eczema will get infected by bacteria or a virus and your child may need antibiotics. A person with a cold sore on their lip should not kiss a child with eczema as this may cause the rash to get infected with the cold sore virus.
• Very occasionally, if your child has a severe infected rash, they may need to be treated in hospital.
• If the eczema becomes weepy or scabby, it is extremely important that the scabs are removed as soon as possible. The easiest way to do this is to bathe your child in a cool bath for 30mins to soften the scabs, then before getting them out of the bath wipe the crusts off with a soft, water soaked towel. Once the scabs are removed the eczema treatment plan should be followed again.

Common questions about eczema

Will the treatments cure eczema?

No. Eczema can be well controlled in most children by looking after the skin as suggested. This does not mean the eczema is cured. For many children, adequate skin care including cortisone treatment will need to be continued for many years.

Can my child have all the usual vaccinations?

Virtually all children with eczema may have all their vaccinations in the normal way (including measles). This includes children who have not eaten egg and children who have a family member with an egg allergy. Occassionally, the eczema may flare up after immunisations.

Can my child go swimming?

Yes. If the eczema is not flaring up. Prior to swimming, apply a layer of moisturiser from top to toe. Soon after swimming wash the skin thoroughly in a cool shower or bath with some bath oil then reapply the moisturiser. If the eczema flares that night, apply a wet dressing just before your child goes to bed.

Key points to remember about eczema

• Remove scabs as soon as possible.
• Keep your child cool at all times.
• Eczema leads to the skin becoming dry and easily irritated.
• The severity of the rash varies from day to day.
• Keep your child away from things that irritate the skin.
• There is no cure for eczema but it can be well controlled.
• Use moisturiser regularly, from top to toe.
• If your child's eczema gets worse and doesn't improve in a few days, see your doctor.
• Children with eczema need to be immunised, in the same way as all children.
• Ask your doctor to complete an eczema treatment plan for your child.

Remember to go to your doctor if you are concerned about your child's health.

For more information

• Dermatology: Knowing your child's eczema
• Individual eczema management plan (requires Acrobat Reader, 88KB)
• Wet dressing instructions (requires Acrobat Reader, 161KB)
• Eczema workshops are run at RCH by the Dermatology Nurse Consultants.  At these 3 hour workshops your child will receive assessment, education and management plans. Your doctor needs to send a referral for you to attend this workshop.
• Eczema Association of Australasia Inc.

Individual instructions