Itching and inflammation of the skin, sometimes accompanied by scaling
- Can occur at any age but most commonly develops under 18 months
- Sometimes runs in families
- Exposure to irritants aggravates the condition
- Gender is not a significant factor
Eczema affects up to 1 in 5 children under school age in the UK. The condition may last for many years but usually disappears in late childhood. A child with eczema has red, inflamed, itchy skin that may make him or her irritable.
What are the causes?
The cause of eczema in children is not fully understood, but an allergic reaction to something in the child’s diet or environment may be a factor. Common allergens (substances that provoke an allergic reaction) include cows’ milk (see Cows’ milk protein allergy), soya, wheat, and eggs (see Food allergy). Affected children are also susceptible to allergic conditions such as hay fever (see Allergic rhinitis) and asthma (see Asthma in children). Close relatives sometimes have similar allergic disorders, suggesting that a genetic factor is involved.
What are the symptoms?
The symptoms of eczema vary in severity and usually affect particular areas of the body. Symptoms may include:
Red, scaly rash.
Gradual thickening of the skin.
In babies, the rash of eczema tends to occur on the face and neck and then on the knees and elbows as the children begin to crawl. In older children, the rash usually appears on the insides of the elbows and wrists and on the backs of the knees. The intense itching causes children to scratch the rash, which may break the skin and lead to bacterial infection. If an infection does occur, the inflammation becomes more severe, and weeping may occur.
A rare but serious complication of eczema is eczema herpeticum, which occurs if a child with eczema is also infected with a type of herpes simplex virus (see Herpes simplex infections). Eczema herpeticum produces a widespread rash with blisters and fever.
How is it diagnosed?
Your child’s doctor will probably diagnose eczema from the inflamed, itchy rash. In some cases, he or she may arrange for a blood test and a skin prick test to try to identify a specific food or substance to which your child is allergic. The doctor may also take swabs of the eczema rash to check for signs of bacterial infection.
What is the treatment?
Parents play a major part in treating children with eczema, mostly by preventing the affected skin from becoming dry (see Managing eczema in children). Your child’s doctor will advise you on day-to-day care and how to moisturize your child’s skin with unperfumed emollients, such as bath oils and creams (see Emollients and barrier preparations). He or she may prescribe a topical corticosteroid to reduce inflammation and oral antibiotics or antibiotic creams (see Preparations for skin infections and infestations) if the rash is infected. Your child may also be prescribed an oral antihistamine to take at night, which helps to reduce itching and also acts as a sedative.
In very rare cases, a child with severe eczema may be admitted to hospital. Treatment usually consists of applying a corticosteroid cream to the inflamed rash and wrapping the affected areas in bandages soaked in emollient cream.
If your child develops eczema herpeticum, he or she will be admitted to hospital and treated with intravenous antiviral drugs.
If the cause of eczema is found to be related to something your child eats, elimination of that food from the diet should improve the eczema. However, you should only give your child a special diet under medical supervision. In babies, breast-feeding can help to protect against future food allergies.
Since eczema is a long-term disorder with no reliable cure, you may wish to try alternative treatments. Before trying any such treatments, discuss them with your doctor, who may advise you on reliable sources and caution you against purchasing treatments that may have serious side effects.
What is the prognosis?
Eczema may last throughout childhood. Although there is no reliable cure, the symptoms of the condition can usually be controlled. Eczema usually disappears by adolescence without leaving scars, but in a few cases the rash continues to flare up (see Atopic eczema). Some affected children develop another allergic disorder later in life.
From the 2010 revision of the Complete Home Medical Guide © Dorling Kindersley Limited.
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