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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 and dermatitis are terms that refer to an itchy skin rash which often occurs in families. Atopic dermatitis is the most common form of eczema/dermatitis seen in infants and children. 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 appear inflamed; red & cracked. In some severe cases the affected areas weep body fluid.

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 & that if the cause of the allergy is 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 an important fact though, is that - the skin in all people affected with eczema experience dry and easily irritated skin which is not a good barrier to infection.

A person with a tendency to eczema is generally born with dry, easily irritated skin, which 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 once a day. Sometimes this irritates the skin, so you may need to try alternatives such as Eucerin™ ointment and emulsifying ointment. Avoid creams containing urea, which can sting broken skin.
• Adding bath oils e.g. QV™ or Alpha Keri™, into the bath water can help moisturise the dry skin.

What can irritate the skin?

Be aware of 'things' which may irritate the skin.

Try to avoid these.

• 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 instead of soap.
• Chlorine in pools.
• Rapid changes of temperature.
• Active exercise to the point of sweating.
• Food allergies.
• Dry air eg. heated rooms in winter, air conditioning in summer.

Not all these 'things' will irritate all children with eczema, but try to become aware of what can cause irritation for your child's skin. That way you can avoid it, & avoid a 'flair up'.

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 further irritates the skin.

Cortisone preparations will be prescribed to treat affected areas of eczema. These are safe as long as they are used as directed, and only used sparingly on those areas affected. 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) rather than in cream bases (white) because the ointments are more moisturising. Some formulations are not suitable for the face or the nappy area. Read all labels carefully.

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 ease the condition. 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 further.

• 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