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Eczema

Disclaimer: This fact sheet is for education purposes only. Please consult with your doctor or other health professional to make sure this information is right for your child.

Eczema is often called dermatitis or atopic dermatitis, but all of these terms mean the same thing. Eczema is an itchy skin condition which often occurs in families. The child or other family members may also have asthma or hay fever.

How do you recognise eczema?

• The skin is generally dry.
• The skin is itchy.
• Some areas of the skin are inflamed - the skin is red and cracked, and may be oozing or weeping.

Certain areas are particularly affected

• Babies: the face.
• Toddlers: the fronts of knees and ankles and the inside of wrists.
• Older children and adults: the folds of elbows and knees.
• In some people, the rash is all over the body.

Is eczema caused by an allergy?

It is often thought that eczema is due to an allergy to something, and that if this can be removed, the condition will be cured. In fact, very few people have eczema caused by an allergy. However, the same people who have eczema may also have allergies which give them different symptoms.

What is important in all people is that the skin is dry and easily irritated and is not a good barrier.

A person with a tendency to eczema is born with a dry, irritable skin. This type of skin needs special care to prevent eczema developing.

What can you do to deal with dryness?

• Various moisturisers can be used. Sorbolene cream with ten per cent glycerine is usually the cheapest option but sometimes it stings. It is available from chemists or supermarkets in a large jar and you do not need a prescription. It should be applied all over, at least twice a day. Sometimes this irritates the skin, so you may need to try alternatives such as Eucerinä ointment and emulsifying ointment. Avoid creams containing urea, which will sting broken skin.
• Bath oils eg. QV™ or Alpha Keri™, also available from chemists.

What can irritate the skin?

Be aware of these things which can irritate the skin and try to avoid them:

• Some materials, especially wool and acrylic (carpets, furniture, car seats and stroller covers as well as clothes).  House dust mite in carpets can irritate some children.
• Sand.
• Perfumed and 'medicated' products.
• Bubble baths.
• Using soap - for the most soiled areas, sorbolene cream can be used as a soap substitute.
• Chlorine in pools.
• Rapid changes of temperature and active exercise to the point of sweating.
• Food allergies.
• Dry air eg. heated rooms in winter, air conditioning in summer.

Not all these will irritate all children with eczema, but if you know what can cause trouble then you can avoid it.

Food allergy

If any foods seem to provoke a reaction, it may have to be taken out of the diet. It is best to check with a dietitian to make sure your child is not missing out on essential vitamins and minerals for growth.

What can be done if eczema develops?

If eczema develops, continue regular moisturising and avoid anything which irritates the skin.

Cortisone preparations will be prescribed to deal with the areas of eczema. These are safe as long as they are used as directed, and only used sparingly on areas of eczema. It is alright to apply them to broken skin. You can stop using them when the eczema settles down.

Most cortisone creams are best used twice a day on the affected areas. Some stronger preparations, which are rarely required, are used only once a day.  It is important to follow the instructions carefully.  In general, cortisone creams are better used in ointment bases (clear, greasy) than in cream bases (white) because the ointments are more moisturising.  Some formulations are not suitable for the face or the nappy area.

If the eczema is very severe and is not responding to treatment at home, a period of intensive treatment in hospital with wet dressings will usually bring the condition under control.  Cortisone tablets should not be used.

Is infection a risk?

Children with eczema often develop severe infections from the herpes simplex virus - the same virus that causes cold sores. People with cold sores should not be allowed to kiss your child.  There is no special problem with other viruses and the usual childhood immunisations are safe.

Impetigo, a bacterial infection, can occur on top of the eczema. This will need antibiotic medicine. Do not use disinfectants - they will only irritate the skin.

• Eczema cannot be cured but it can usually be controlled.
• Avoid things which irritate the skin.

The Children's Hospital at Westmead Tel: (02) 9845 3585 Fax: (02) 9845 3562 www.chw.edu.au	Sydney Children's Hospital, Randwick Tel: (02) 9382 1688 Fax: (02) 9382 1451 www.sch.edu.au	Kaleidoscope, Hunter Children's Health Network Tel: (02) 4921 3670 Fax: (02) 4921 3599 www.kaleidoscope.org.au