Eczema is really common in young children. In fact, around 20% of children get eczema, which can be a big stress for parents. Eczema causes itching and scratching that can be a big source of misery and sleepless nights.
Genevieve Osborne, Dermatologist for Bupa UK, shares the most common questions she gets asked by parents and the advice she gives them.
What is causing or worsening my child's eczema?
The majority of children with eczema have what is called 'Atopic Eczema'. This condition (together with a tendency to develop asthma and hay fever) runs in families. However, it often skips generations. Research has shown that a significant number of individuals with atopic eczema have a biologically altered skin surface. This gives the skin less resistance to many irritants like excessive water exposure and detergents - all factors that are known to make eczema worse.
Other factors that are known to irritate eczema include sweating and overheating. Dry air (centrally heated air and dry climates) can also aggravate it.
Unless eczema is mild, it can be very itchy and scratching makes it worse, which starts a 'vicious cycle'. Itching generally increases in more severe eczema, but individuals also vary in how much they scratch.
Over-scratching is common behavior in children suffering from eczema. It can become an automatic habit, especially during the night time. Sometimes stress increases scratching, which most parents will have observed.
Skin infections from a specific bacteria or cold-sore virus can also trigger eczema to get considerably worse. It's very important for parents to recognise the signs of infected eczema in order to seek appropriate treatment.
Could allergy (such as a food) be the main cause of their eczema?
Specific environmental factors, known as allergens, can sometimes make eczema worse but these are never the main cause. These allergies may come from things in the air (like pet fur and pollens), in cosmetics (fragrances) or sometimes be found in a food.
If you suspect an allergy may be contributing to bad eczema flare ups, look for signs of it getting worse within 48 hours of being exposed to it, and for improvement when it's taken away. Allergies are rarely a trigger for mild cases of eczema, and are more likely to be a contributing factor in more severe cases in children under the age of 1.
Will my child grow out of it?
The good news is that in a lot of cases, children do grow out of eczema, especially if they develop it as a baby. It's really important that if you have a child suffering from eczema, you don't cut out foods from their diet without speaking to a doctor first. Whilst your child is at a young age and their body is developing, it can be harmful to remove certain foods needed for a balanced diet, so it's crucial to get a medical opinion before taking any action.
What can I do to prevent it from getting worse?
Trying the following are ways you might be able to limit flare ups:
• Reduce how often they bath - this is important because skin with eczema has a reduced resistance to water, similar to when lips get chapped from being licked too much, this can make eczema worse. Infants can be 'top and tail' washed daily, but it can be helpful to avoid bathing the whole body. (The exception to this would be if the eczema has become infected, regular bathing helps to remove crusts)
• Avoid using soaps when bathing, especially in infants. A moisturising soap substitute may be used in older children. Avoid bubble baths too, as these tend to contain things that can irritate the skin.
• Try to keep them at a comfortable, cool temperature through wearing breathable fabrics (for example, cotton not nylon) and not over-heating their bedroom.
• Try to limit dust exposure by reducing cushions and soft toys on their bed and consider using protective pillow and mattress cases
• Regularly use an 'emolient' (also called a moisturiser) on your child's skin, apply this all over several times a day. This important measure can help eczema by increasing its resistance to irritants through improving the skin's barrier.
How do I know if my child's eczema is infected? What symptoms should I look out for?
If your child is showing any of these symptoms, their eczema might be infected so it's important you see a doctor as soon as possible so they can get the right treatment.
• They have any: open sores, blisters, pus spots, yellow /brown crusts
• Their eczema has recently got dramatically worse
• Their eczema has become bright red and wet in areas, weeping a clear or yellow liquid
• They have become unwell, tired or feverish
Is there a cure for eczema?
No but in most cases, children gradually grow out of it.
What treatments should I be considering to help my child's eczema?
Start with a regular emollient; more effective versions tend to contain more oil or wax and work better for protecting very dry skin.
To help monitor and manage triggers, it can be a good idea to keep a diary of the things that make your child's eczema flare up, for later discussion with your doctor
When you visit your doctor, they will determine whether there is a significant allergic or other avoidable contributing factor that is making the eczema worse, and they will advise accordingly. They'll recommend an emollient; to be used regularly (at least 1-2 times a day) even when the eczema isn't particularly red or itchy, to maintain the skin's state and increase its resistance to active eczema.
If an emollient isn't working then your doctor will probably recommend applying a steroid ointment for a short period to reduce inflammation and relieve itching. Some steroid creams can be bought over the counter, but more potent ones will need to be prescribed. If the eczema has become infected, they might also prescribe a course of antibiotic. Then they will provide you with advice on the day to day management of your child's eczema for improved longer term control.