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Causes of eczema
Eczema has a genetic basis - this means it tends to run in families. Children with eczema often have other allergy-type conditions like asthma or hay fever.
Eczema might flare up:
- after contact with irritating chemicals like soaps or bubble baths, or irritating fabrics like wool and polyester
- after viral or bacterial infections
- after exposure to substances like dust mites or animal fur
- after exposure to foods that your child is allergic to
- when your child gets too hot
- when your child is stressed.
Often there's no obvious cause for a flare-up.
In a few children, diet can make eczema worse, although it's often hard to say which food is causing the problem.
Eczema is not contagious.
Children with eczema have very itchy, scaly, red patches of skin, usually on their cheeks, in their elbow creases and behind their knees. It might also appear on children's necks, bodies, hands and feet. Eczema locations change with time. For example, when children start to crawl you might see eczema coming up on the exposed skin of their lower legs.
Eczema can weep, develop cracks and even bleed, especially if your child scratches a lot because of the itch. Bacterial infections like Staphylococcus and viral infections like herpes can get into the skin through these cracks. This leads to light-brown crusts, blisters or pain.
Eczema usually comes and goes. In between flare-ups, the skin might look thickened and dry (this is called lichenification). When eczema is properly treated, the skin usually goes back to normal with no scarring.
Eczema usually starts in the first few months of life. At first, you might see it only on your child's face and scalp, or in the nappy region. Most children tend to 'grow out' of eczema by adolescence, but some people have eczema throughout their adult lives.
When to see your doctor about eczema
You should take your child to see your GP if:
- you think your child might have eczema for the first time
- your child seems itchy or uncomfortable
- your child's eczema is weeping or bleeding
- you've been treating your child's eczema as usual, but it hasn't improved much after a few days
- your child is having trouble sleeping because the rash is so itchy
- your child is generally unwell, in addition to the rash
- the eczema is painful or has developed pus
- you're not sure whether the rash is eczema.
Treatment for eczema
Eczema is chronic and can't be cured, but it can be managed. The key to preventing eczema flare-ups is to treat symptoms as soon as they appear.
If your child's skin is red and itchy, she'll probably need some corticosteroid ointment or cream. For mild eczema, you can buy mild corticosteroids over the counter at your pharmacy. For more serious eczema or if the over-the-counter products aren't working, you'll need to see your GP to get a prescription for a stronger corticosteroid.
You should apply the ointments or cream according to the pharmacist's or GP's instructions. It's usually once or twice a day to the affected areas.
Other eczema treatments include pimecrolimus, a non-steroidal cream. Doctors might prescribe this cream for children with mild to moderate eczema on the face and body folds.
If your child is scratching at her rash, you could ask your pharmacist or GP about using an antihistamine medication for a few days. Together with a corticosteroid cream, this might give your child some rest, and help the flare-up to settle.
If your child's eczema rash gets infected your doctor will prescribe a course of oral antibiotics.
Daily management at home
Eczema gets worse when skin is dry. Applying moisturising creams directly to your child's skin helps to stop the skin from drying out. Your child should use them every day, even when there's no eczema.
You can also try putting a wet dressing on the eczema.
At bath time, keep your child's baths short and use warm but not hot water. Bathe your child no more than once a day. You can add a simple, fragrance-free moisturising bath oil to baths. For your baby or toddler, you could wash his face and bottom rather than giving him a full bath, especially during winter.
Don't use soap on young children. They don't need it, and it dries out the skin and can make the eczema worse. Older children can use a soap-free wash under the armpits and around the genitals. They can also use a moisturising cream like sorbolene or a cream containing paraffin during and after washing - this will help stop the skin from drying out.
If your young child is scratching at her rash, try putting cotton mittens on her hands at night. Cut her nails short, and keep them clean.
If your child's eczema doesn't improve with this combination of medical treatment and daily management, you might want to talk with your doctor about taking your child to see a dermatologist.If your child uses any moisturisers and prescription ointments, take them with you when you're out. Put them on your child as soon as he starts to scratch. You can also ask anyone who cares for your child to put the treatments on your child if you're not around.
Prevention of eczema
The main way to prevent eczema in your child is to avoid things that irritate your child's skin:
- Dress your child in cotton underwear and clothes, rather than wool and polyester. Avoid too many layers.
- Keep your child cool, because overheating makes eczema worse, as do hot baths or showers. Don't have the heating on too high at home.
- Avoid the use of soaps and bubble bath.
- Give your child short baths or showers because water can dry out your child's skin. Bathe your child no more than once a day and less often in winter.
- Your child can swim in chlorinated water, but you should apply moisturiser all over before swimming. After swimming, wash the skin in a cool shower or bath and apply more moisturiser. Salt water might improve eczema.
If you think your child's eczema is caused by a food allergy, but you can't work out which food is the problem, you could talk with your GP about allergy testing.