Eczema

Your child may display these symptoms of eczema for months or longer:

• Crusted spots
• Dryness
• Intense itching
• Redness
• Scaly or flaky skin

Eczema may occur at the inner elbows, behind the knees, the neck, and the face. In infants, eczema can occur at the cheeks, scalp, and the front of their arms and legs.

If your child scratches the affected areas excessively, they may cause them to become infected. The spots will appear as painful red oozing spots which may develop pus or yellow crusting.

It is common for the severity of your child’s eczema to change. Your child’s eczema may worsen from time to time. It is important to know when to step up treatment and effectively manage these flares at the start so that they do not worsen.

The specific cause of eczema is not known. Underlying genetic factors are known to play a part. If a member of your family has eczema, allergic rhinitis or asthma, it is more likely that your child may have eczema.

Common triggers which are known to worsen eczema include:

• Environmental allergies such as dust mite or pet dander in older children
• Food allergies in young babies
• High bacterial skin load
• Inadequate skin moisturising
• Irritation due to synthetic or woollen clothes
• Irritation from soaps, fragrances, detergents and other chemicals
• Stress
• Sweat
• Viruses and other common infections

Moisturising your child and avoiding common triggers are important in caring for your child’s skin.

Choose a thick plain fragrance-free moisturising cream rather than a lotion and apply to all areas off your child’s skin to protect it. It should be used regularly, at least once to twice a day or more often as necessary even when their skin is clear. Soap-free body washes or bath oils should be used for baths and showers. Do not use washes or creams with food or plant-based ingredients especially in young children as they may develop sensitisation to these foods through the skin. Pat your child dry with a soft towel after bath instead of rubbing the skin.

Keep your child cool and comfortable to reduce sweat. Dress them  in light cotton clothing and keep the room well-ventilated. Aim for an ambient room temperature of 25 degrees Celsius. Use a moist towel to wipe down any sweat instead of allowing it to dry up on your child’s skin.

Avoid other irritants such as detergents, harsh soaps and bubble baths. Avoid wool or acrylic materials for clothing or bedding.

In young children/babies, drool and saliva often cause irritation around the mouth or neck. Apply a thick layer of moisturiser to these areas often to act as a barrier and protect the skin. Wipe off any drool with a clean moist towel.

As eczema is itchy, it will be common for your child to scratch if the eczema is poorly controlled. Scratching can worsen eczema and cause skin infections. Ensure your child’s fingernails are kept clean and trimmed. Store your moisturising cream in the fridge and use the cool cream on the skin with massaging motions to reduce itch and provide comfort. You can also use cool compresses over areas of itchy skin. Wet wraps can be used overnight and for short periods in the day to provide relief. Try distracting your child with a favourite game or activity. In severe cases, your child may require a sedating antihistamine for a short period of time to allow them to sleep comfortably without itch.

Reducing Staphylococcus bacterial load on the skin may help to reduce severe eczema episodes in your child. Use diluted bleach baths or antiseptic washes 3 times a week to keep the skin bacterial load low.

Most children with eczema do not have reactions to food. However in young children/babies with severe eczema and are not responding to treatment, it may be necessary to explore food allergy as a potential trigger. If you are worried about a food allergy, do visit your allergist to confirm any food allergies. You do not have to restrict your child’s diet unnecessarily.

Work together with your doctor for a detailed eczema care plan for your child so that you can effectively manage flares. It may be necessary to apply topical steroid creams for short courses as advised by your doctor to help reduce skin inflammation during flare episodes. Do not rely on over-the-counter creams without seeking proper medical advice and follow-up.

You should bring your child to a doctor if they display any of the following symptoms:

• Your child’s eczema is not getting better after 2 days of regular treatment
• Your child’s skin is showing signs of infection that is weeping, oozing or yellow crusting of the affected areas
• Your child develops fevers with worsening eczema symptoms

There is no cure for eczema but flares of eczema can be controlled well in most children with good skin care and avoidance of triggers. In certain cases of severe eczema, your doctor may advise on long-term oral immunosuppressive medications to control the chronic inflammation.