 |
||
 |
      |
 |
 |
||
| >> Atopic Tell me more about EczemaWelcome to the Eczema Clinic. Here are some answers to some of the commonest questions that families ask us about eczema and its treatment. This is only a brief, simple introduction to eczema, which we hope you will find useful. It is intended to be supplemented by other more detailed information leaflets on particular aspects of eczema, as well as information directly from the eczema team and other agencies such as the National Eczema Society. What is eczema?Eczema is an inflammation of the skin which gives it a red, dry and flaky appearance. The hallmark of eczema is itching. This itching causes your child to scratch, and this in turn damages the skin further leading to more itching. This can be very miserable for the child and lead to poor sleep. In the UK, the word "eczema" in children really refers to atopic eczema, a particular type of inflammation of the skin, often associated with asthma and hayfever. What causes atopic eczema?There is no single cause to atopic eczema. We know that "genetic" (inherited) factors are important. These genetic factors probably make a child more susceptible to developing eczema, asthma or hay fever but there are a number of factors in the environment which will trigger off atopic eczema in a susceptible child. These triggers are not necessarily allergic in nature - in fact, non-specific irritation from ordinary soaps, wearing wool next to the skin, overheating at night and contact with water and dusty materials may be even more important in eczema than specific allergies to foods or house dust mite. One of the commonest reasons for eczema flaring up in childhood is secondary infection, and again, this is not usually allergic in nature. Will my child grow out of eczema?As you have probably discovered, eczema in childhood is a condition which tends to come and go. The good news is that the majority of children will "grow out of" eczema eventually. Around 60- 70% of children with eczema in the first few years of their lives are clear of it by the age of 11 but unfortunately, we cannot say exactly when your child will grow out of his/her eczema. Can we cure eczema?Unfortunately, no. A lot of research is currently being carried out to try and identify things that will prevent or "switch off" eczema for ever, but these are still in their experimental stages. We can however do a lot to control flare ups of eczema so that you child is happy and able to lead a normal life. These are outlined below under "general measures" and specific treatments. What general measures can I take to help my child's eczema?Avoid wool or rough clothing next to the skin - cotton is usually best. Keep your child's nails trimmed short so they cannot break the skin when scratching. Avoid using ordinary soaps and instead, use a soap substitute such as aqueous cream or emulsifying ointment. Use a moisturising cream, especially after bathing or swimming as this will keep the skin supple and possibly prevent further episodes of eczema. Keeping the bedroom cool at night by opening the window in the day and by using light cotton sheets or a lightweight synthetic continental quilt is also important. How can I identify to what my child is allergic?As we said earlier, many of the ups and downs in eczema are not caused by specific allergies but are due to irritation from a whole range of sources. In addition to these, there are 2 common factors to which your child may be allergic - house dust mite and certain foods. House dust mite allergy is extremely common in atopic eczema but unfortunately, it is very difficult to get rid of this mite completely from our homes. General measures such as keeping the bedroom cool and well aired, regular hoovering and avoiding too many carpeted and upholstered materials in the bedroom may be helpful. Food allergies are more difficult to recognise in a child and unfortunately, skin prick tests and blood tests do not help us very much in identifying which foods your child might be allergic to. If you think that your child's eczema gets worse after a particular food (e.g. eggs, dairy products, chocolate, fish, nuts, citrus fruits), then you should avoid that food completely for 6 weeks and have the courage to re-challenge your child again to see if it really does make his/her eczema worse. Don't experiment with suspected nut allergy, though - discuss this with us first. If you are going to put your child on a restricted dairy product free diet, then you should discuss your child's diet with your doctor or dietician so that your child has adequate calories, protein and calcium. Does my child need to use a moisturiser?Undoubtedly, yes. These moisturisers help to dampen down inflammation, protect against infection and may prevent some irritant and allergic substances from upsetting your child's eczema. These emollients need to be used at least twice a day and should be used even when your child's eczema appears clear. What about other treatments?The mainstay of treatments for atopic eczema are topical corticosteroid creams. These are very effective and are quite safe if used properly. Occasionally, tar preparations may be used, but some children find them irritating and rather messy. Short courses of anti-histamines one hour before bedtime are occasionally helpful in breaking patterns of sleep disturbance due to eczema. Soothing cotton or paste bandages can also be very helpful for your child. Occasionally, other medicines, such as Cyclosporin A, ultraviolet light treatment and Chinese medicinal herbs are used to treat eczema but these are not without their side effects and are only used in extreme circumstances. But aren't steroids bad for you?You should not confuse taking steroid tablets with topical corticosteroid creams and ointments applied to the skin. Whilst it is true that some of these creams were abused in the 1970's by prescribing strong preparations for delicate sites such as the face, we have yet to see a child who has developed any side effects from topical corticosteroid creams used properly in our clinic. Thinning of the skin can be a problem if the cream is applied continuously for a very long period but we normally recommend that these creams are used for bursts of several days and then followed by emollients only. Untreated eczema gives rise to far more side effects on the skin than does the sensible use of short term topical corticosteroid creams. Occasionally we use these creams in conjunction with bandages to the limbs in order to give your child's skin a holiday from scratching. What about infections of the skin in eczema?Secondary infection by an organism called Staph aureus is one of the commonest reasons for childhood eczema to deteriorate from time to time. This can be recognised as the skin becomes very red and oozy. Occasionally, yellow pus spots may appear. If the infection is very extensive, then it is important for you to get antibiotics (Flucloxacillin if your child is not allergic to penicillin) from your own doctor for 2 weeks to bring this infection under control. Where can I get further information?
© The eczema team, Queen's Medical Centre, Nottingham March 2002
|
