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Wednesday, July 2, 2014

Childhood Eczema

Eczema (atopic dermatitis) is a chronic condition caused by inflammation of the skin. It's a component of the "atopic march" which includes asthma, hay fever, and food allergy. Though the exact cause is unknown, the risk of developing eczema is higher in children with dry skin (xerosis) and those with immune dysfunction. 

Additionally, possible triggers reported include:
  • irritants (wool, soaps and chemicals)
  • contact allergens (latex, metals, perfumes)
  • food allergens (cow's milk, eggs nuts, soy, wheat and shellfish)
  • house allergens (tobacco smoke, hard water, dust mites, animal dander)
  • other irritants (extreme changes in humidity, pollens, molds)

Eczema is most common in children younger than 5 years old. Studies show that 66% of patients first experienced eczema before 7 years of age. The amount of children affected by eczema varies by country and, in the United States, from state to state. Numbers reported are from 1 to as high as 22% of children younger than 18. Studies also show that preterm infants (<37 weeks gestation at birth) have a higher risk of developing the condition. 

Possible risk factors include atopy (positive reaction to at least one skin prick allergen), not breast feeding, immunosuppressants and stress.

Children with eczema are at an increased risk of skin infections caused by staph, strep, herpes simplex 1 and various fungi. Chronic itching may lead to scarring and sleep disturbances. 

The pediatrician will make the diagnosis based on physical examination. It's important to rule out conditions such as parasitic infections (scabies), fungal infections (tinea), metabolic conditions (zinc deficiency), immunological deficiencies (Wiskott-Aldrich Syndrome, dermatitis herpetiformis, lupus, HIV dermatitis), systemic disease (primary biliary cirrhosis, polycythemia vera and renal failure) and other skin conditions (contact dermatitis, ichthyosis, psoriasis and seborrheic dermatitis).

Most cases of childhood eczema improve with age, and up to 70% of cases clear by teenage years. 

The secret to managing eczema lies in both controlling the dryness of the skin and minimizing any inflammation. This includes:
  • Use moisturizing soap (Dove brand preferable) at very END of bath to avoid irritation
  • Moisturizing cream (such as Vaseline or Eucerin) applied immediately after bath (while still damp) to affected areas 
  • An anti-inflammatory (steroid cream such as triamcinolone) may be prescribed. Use twice a day.
  • Avoiding irritants or triggers


Atopic dermatitis. Dynamed database. Updated January 21 2014. Accessed July 2, 2014.