In this section
The onset of eczema is usually before 12 months. Infants
initially develop facial eczema; flexures are affected later.
Eczema is a remitting and relapsing condition. 85% of children will
"grow out of" eczema before age 5.
Eczema is aggravated by heat, prickle (wool, nylon, seams,
labels), and dryness. Eczematous skin is prone to secondary
bacterial and viral infection. Infection should be considered when
eczema flares or fails to respond to treatment.
Characteristic clinical features:
Bacterial infection is suggested by flare of eczema,
particularly with crusts, weeping, erythema and increased itch. The
usual organism is Staphlyococcus aureus.
Herpes infection is characterised by vesicles (grouped), satellite
lesions, pustules, and erosions. It is often tender and not
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Differential diagnoses include miliaria, scabies, psoriasis or
occasionally zinc deficiency or histiocytosis. Consider
immunodeficiency if there is associated failure to thrive,
persistent diarrhoea or repeated infection.
Give a parent information leaflet and complete a
written management plan.
Ointments are preferred because they have emolient effects and
are less irritating. They should be applied thinly and not rubbed
in vigorously. Families should be reassured about the safety and
efficacy of topical steroids.
4-6 times per day eg. 50% soft, 50% liquid paraffin (Dermeze).
It should be stored in the fridge and applied over steroid creams.
Sorbolene may cause irritation. Care should be taken to avoid
contaminating cream remaining in the jar.
These rehydrate, reduce heat and itch, and protect from trauma
and friction. They should always be used if the child is not
sleeping well because of itch.
A short period of antihistamine treatment is sometimes useful to
If there is recurrent infection, consider nasal swabs and
elimination of nasal carriage with mupirocin ointment (Bactroban).
Skin carriage can be reduced with antiseptic preparations such as
benzalkonium chloride/triclosan/paraffin (Oilatum bath oil) or
triclosan cream (Microshield-T)
Refer children with troublesome eczema to medical outpatients