Common concerns regarding atopic dermatitis in children
ATOPIC ECZEMA, ALSO known as atopic dermatitis, is the most common skin condition affecting children of all ages. It affects up to 20% of school-aged children in Singapore. Although symptoms begin for most patients during the first year of age, some children may only develop symptoms later in childhood or even during their teenage years. Atopic eczema is a recurrent and chronic itchy skin condition that may wax and wane throughout a patient’s lifetime. Although atopic eczema is usually mild in most patients, it can become more severe and extensive for some patients, leading to poor quality of life and significant psychosocial impairment.
What Causes Atopic Eczema?
Many patients or their family members may have other atopic diseases, e.g. allergic rhinitis (hay fever) or asthma. Many patients also have dry skin. This underlies the genetic basis of eczema. Environmental factors then play a role in triggering or worsening atopic eczema.
How does Atopic Eczema Present?
Atopic eczema presents as itchy, red, scaly bumps and patches. In babies, it commonly presents on the scalp and face. In older children, common sites of involvement include flexures (e.g. elbows and behind the knees), ankles, hands and feet. In more severely affected patients, eczema can affect more extensive areas of skin. In chronic patients who have been scratching persistently, the skin can become very thick and scaly. Secondary bacterial infection can occur in some patients after scratching, with eczema appearing more oozy and moist.
What can Worsen Atopic Eczema?
Environmental factors are important triggers of atopic eczema. These include extremes and changes in climate, excessive sweating and house dust mites, for example, dust mites in stuffed toys or carpets. Viral infections and secondary bacterial infection from a common skin bacterium, Staphylococcus aureus, can also worsen eczema. Scratching, stress and poor sleep cycles (e.g. sleeping late at nights) also play a major role in exacerbating eczema.
Does Food Worsen Atopic Eczema?
For most patients, food does not play a major role in worsening eczema. In small babies with severe eczema, it has been shown that milk allergy may worsen eczema, especially if the baby has poor growth as well as other symptoms, like diarrhoea. If you suspect a food allergy in your child, please consult a paediatric allergy specialist or dermatologist for allergy testing. Do not restrict your child’s diet unnecessarily without proper advice, as this may lead to poor growth and development in your child.
Children with atopic eczema should not be discouraged from exercise and swimming. However, if your child is experiencing a flare of the eczema, it would be best to avoid these activities until the skin improves with treatment. Swimming sessions should be limited to 45 to 60 minutes, as prolonged contact with water can remove the skin’s natural oil barrier. Swimming should be avoided during 10am to 4pm, as this is when the sun is the hottest. A good sunscreen should be used before swimming. Patients should have a quick shower and apply moisturisers immediately after coming out of the pool.
What General Measures are Recommended in the Treatment of Atopic Eczema?
Avoidance of triggers is important to prevent eczema flares. Taking five- to-10 minute baths or showers with cool or slightly warm water daily are important to prevent infections. A mild soap or soap substitute should be used by patients with eczema. Strong soaps and bubble baths should be avoided as these may irritate the skin. After a bath or shower, pat dry and apply a layer of moisturiser immediately over the entire skin surface. Moisturisers help to restore the skin barrier, which is damaged in skin affected by eczema. As there are many moisturisers available, the best moisturiser would be one that the patient feels comfortable applying, works best for the patient, and affordable. Moisturisers should be applied two to three times daily, even when the patient does not have a flare of eczema.
What Specific Creams are Recommended in the Treatment of Atopic Eczema?
Topical steroids are the mainstay of treatment in atopic eczema and help to decrease the redness and inflammation seen in skin affected by eczema. There is a range of potencies available, and the prescription is based on the age of the child and the site and severity of disease. Topical steroids should be applied one or two times daily on skin that is red, itchy and scaly. These should be continued until the skin is no longer red, itchy or scaly. If the use of topical steroid does not lead to improvement after two weeks, your child would need to see the doctor again for re-evaluation. Using topical steroids according to the instructions of your doctor will prevent and minimise the possibility of side effects, for example, skin thinning and stretch marks. A newer class of topicals used to treat inflammation in eczema is the topical calcineurin inhibitors (Elidel and Protopic). These are also prescribed by a doctor and should be applied in the same way as topical steroids.
Can Atopic Eczema be Cured?
There is as yet no cure for eczema. However, it can be well controlled by minimising triggers, daily use of moisturisers, and intermittent use of topical steroids or calcineurin inhibitors. Most children with eczema improve as they get older. However, the condition can recur after months or even years. With good control, many patients with eczema can lead healthy, active lives.
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