What is Atopic Dermatitis?
Atopic dermatitis or eczema is an itchy, dry, inflammation of the skin. It is the commonest type of skin disease in children. It is not an infectious disease. The child with atopic dermatitis has sensitive skin which is irritated easily.
Why does my child have atopic eczema?
Atopic eczema is a genetic disorder associated with a sensitive skin. The condition is often associated with a family history of eczema, asthma or hay fever. There are many external factors which may aggravate the eczema.
What are the clinical presentations of atopic eczema?
Most patients present with eczema (redness, scaling and swelling) on the face (Fig. 1), limbs (Fig. 2) and trunk. The flexures may be more severely affected. The condition is very itchy.
Figure 1 Atopic Eczema & Infection.
Figure 2 Atopic Dermatitis involving the wrists.
Crusting may be present when the eczema becomes infected (Figs. 3 & 4).
Figure 3 Atopic dermatitis involving the elbow creases.
Figure 4 Atopic dermatitis involving the back of the knee
What are the aggravating factors in eczema?
How to avoid them?
Aggravating factors include:
- Sudden changes of room temperature, strenuous exercise and hot, humid weather.
- Synthetic or woollen clothings. Children should be dressed in cotton.
- Emotional upsets
- Frequent use of soaps, bubble bath, hot water. Use mild soaps or soap substitutes like emulsifying ointment. The temperature of the bath water should be cool.
- Cigarette smoke. In an enclosed room, smokes and fumes will irritate the skin. It is best to ban smoking within the house.
- Dogs and cats danders. All furry pets will aggravate eczema. Avoid keeping cats and dogs in the house.
- Irritant foods and saliva. Acidic juice in citrus fruits eg. oranges and vegetables eg. tomatoes can cause eczema around the mouth. This is often made worse by lip licking and dribbling.
Will my child 'grow out' of eczema?
The tendency for sensitive skin will remain with your child even into teenage years. However, your child's eczema will gradually improve as they get older and only a few continue to have troublesome eczema in adult life.
Is eczema due to an allergy?
No, eczema is usually not caused by any specific allergy. Children with atopic eczema have a hypersensitive skin which reacts to many materials which come in contact with the skin surface. Although many people believe that allergy causes atopic eczema, they are simply beliefs and have not been verified by scientific studies.
Will allergy tests help my child's eczema?
No. Children with atopic eczema usually demonstrate multiple positive reactions on skin tests, which are of little relevance in treatment. Blood allergy tests are generally not helpful in the management of atopic eczema.
Is swimming contraindicated in a child with eczema?
There is no contraindication to swimming in the sea in patients with atopic eczema. In swimming pools, the chlorinated pool water may irritate the skin.
Treatment of your child's atopic eczema
There is no single medication which will cure eczema. It is possible to control eczema effectively by using a simple treatment plan.
These are products which moisturize and soften the skin. They help to reduce the itching and scratching, are safe and should be used frequently.
- Topical steroid cream
The use of an appropriate topical steroid is safe and an essential part of treatment. Your doctor will advise you on the appropriate cream to use.
- Anti-itch (antihistamine) medication
Given an hour before bed, this will help the child settle and have a comfortable night's sleep.
Skin with eczema seems to attract certain bacteria to the skin. Antibiotics remove these bacteria and may improve the eczema. Your doctor will advise you on whether antibiotics are needed.
In addition to the above, nails should be kept short to prevent excoriation.
DEDICATED TO EXCELLENCE IN DERMATOLOGY
By National Skin Centre (Singapore)
Copyright (C) 1995 - National Skin Centre (Singapore)