Eczema (Child)

​What is Atopic Dermatitis / Atopic Eczema?

Atopic dermatitis (AD) or atopic eczema is a very common recurrent, itchy skin condition in children.

Many patients have a personal or family history of other atopic conditions (eg. asthma, allergic rhinitis or allergic conjunctivitis). Many genes involved in the formation of the skin barrier and the skin's immune system play a role in the development of AD. Many patients with AD have dry skin which is easily irritated.

Most children with AD improve as they get older. However, the condition can recur even after an inactive period.

​What triggers or worsens Atopic Dermatitis / Atopic Eczema?

• Environmental
  • Changes in climate
  • House dust mites / dusty environments
  • Heat, sweating
  • Strong soaps, detergents, bubble baths
  • Pets, carpets, stuff toys
• Infections
  • Flu, upper respiratory tract infections
  • Skin infections (eg. Staphyloccoccus aureus, herpes simplex virus
• Insect/mosquito bites
• Vaccinations
  (However, we do not advise avoiding your child's vaccinations.)
• Stress
• Scratching (itch-scratch cycle)
• The role of food allergy in triggering AD is controversioal.
  If there is suspicion of a food allergy worsening your chid's AD, discuss this with your doctor, who will determine if further testing or referral to a paediatric allergist is warranted.

General advice:

• Reduce the level of house dust mites. Avoid stuffed toys, pets and carpets in the home. Family members should avoid smoking.
• Avoid strong soaps, chemicals and bubble baths.
• Take a short (10 min) bath or shower daily with tepid or slightly warm water. Avoid hot showers or baths.
• A soap substitute is recommended for patients with AD. Sometimes, an antiseptic wash may be prescribed for patients with repeated skin infections.
• Avoid extreme temperatures. Avoid excessive sweating if possible. Consider stopping physical exercise when there are severe flares.
• Minimise scratching. Cut and file fingernails regularly.
• Moisturise two to three times daily with a fragrance-free moisturiser. Apply the moisturiser liberally over all skin surfaces, even on normal-looking skin. Your doctor will be able to recommened which moisturiser is suitable for your child.

Specific Treatments

Topical steroids:

• Topical steroids are used as the main treatment of AD.
• The strength of the steroids will depend on the age of your child, as well as the location and severity of the eczema.
• They should be applied two to three times daily depending on the instruction of your child's doctor.
• Topical steroids* are to be applied on the red, itchy and bumpy areas. Once the rash improves, decrease the frequency of application. Stop application once redness and itchiness resolves and skin is flat.
• Your child's doctor may provide you with an "Action Plan". Remember to follow the instructions on your "Action Plan".
• Prolonged use of potenet or super potent topical steroids can lead to sidfe effects like skin thinning, easy bruising, stretch marks (striae) and increased hai growth

Topical calcineruin, inhibitors:

• These are non-steroidal creams used to treat AD, with a better side effect profile compared to topical steroids. Examples include: Elidel cream and Protopic ointment.
• They are applied in a similar way to topical steroids (see *).
• Some patients may experience some burning or stinging sensation after continued applications. Do inform your child's doctor if these symptoms occur.

Oral anti-histamines:

• These may be prescribed by your child's doctor to relieve itch and help your child sleep better at night.
• Different anti-histamines may be prescribed for day and night.
• These should be given as long as your child is having itch from his/her eczema.

Oral antibiotics:

• These may be prescribed if there are any signs of skin infection worsening the AD in your child.
• Your child should complete the course of antibiotics that is prescribed.