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Q&A On Eczema With Professor John Harper, Consultant in Paediatric Dermatology

Visit your GP or dermatologist for expert advice

Q&A On Eczema With Professor John Harper, Consultant in Paediatric Dermatology

WHAT IS ECZEMA?

Eczema is a chronic inflammatory skin reaction affecting around 15% of children. Eczema is not caused by a specific allergy; however, children with eczema are more prone to allergic reactions and this may make the eczema worse.


IS ECZEMA HEREDITARY?

Yes, it is a genetic disorder often associated with asthma and hay fever.


WHAT CAUSES ECZEMA?

There is now strong evidence that eczema is a primary disorder of the outermost cells of the skin, which interface with the external environment, referred to as the “skin barrier”. This is based on genetic studies, which have highlighted subtle defects in the protein structure and function of the “skin barrier” in children with eczema.


HOW SHOULD I MANAGE ECZEMA?

  1. Addressing the barrier defect

Emollients

Emollients are used to try and restore the skin barrier. They are products which moisturise and soften the skin. They help prevent a flare of eczema. It is important to have regular daily baths with an oily bath additive and to use a moisturising cream with a high water content.

 

  1. Treating the inflammation

Topical steroids

A topical steroid is the recommended first line treatment. The potency of the topical steroid is tailored to the severity of the eczema, the age of the child and the site affected. Antihistamines

Antihistamines do not help the itch of eczema; however, a  long acting sedative antihistamine is often useful at night. A non-sedative antihistamine taken on a regular daily basis is indicated for allergy to aero-allergens, especially grass and tree pollen in the summer months.

 

ARE STEROID CREAMS SAFE TO USE?

Topical steroids are highly effective and the intermittent use of a mild or moderately strong topical steroid is safe, but the child needs to be regularly monitored. Parents are often anxious about the use of topical steroids, but these worries stem from the misuse of the very strong steroids, which may cause problems, such as thinning of the skin, and should not be used to routinely treat children. On the face of the very young, topical steroids should be used with caution and, when necessary, only for a limited period of time.

 

ARE THERE ANY AGGRAVATING FACTORS FOR ECZEMA?

Eczema can be aggravated by an associated food or inhalant allergy. Cow’s milk allergy may be an issue in some infants. As the child gets older inhalant allergies become more of an issue, in particular exposure to house dust mites in the home, especially in an old mattress or carpeting, and outdoors to grass and tree pollen.

Other aggravating factors include: the irritant effect of certain foods, such citrus fruits and tomatoes, which  can cause eczema around the mouth;  getting too hot and sweating; dry air in the home related to central heating; contact with synthetic or woollen fabrics, the use of biological detergents and fabric conditioners; and cigarette smoke fumes (avoid anyone smoking in the home).