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Understanding Childhood Eczema

Children who have eczema

The term “eczema” is used interchangeably with “dermatitis” and means inflammation of the skin. Atopic eczema is one of the most common skin problems affecting children in Singapore.  It starts as an itchy red rash and upon scratching will result in broken skin. The rash may sometimes ooze fluid as well. Common areas affected include the neck, face, front of the elbows and back of the knees. In severe cases, the whole body can be affected.

How did my child get eczema?

Atopic eczema is not an infection. There are genetic factors involved (although a family history is not always present), and it is often associated with other sensitivity conditions affecting the lungs (asthma) and the nose (“hay fever”). Environmental factors can play a role as well, causing the skin to become very dry and making it less effective as a barrier to bacteria.

Certain foods can aggravate atopic eczema, but most cases are not related to diet. You should speak to your child’s doctor if you are concerned about this.

Eczema runs a chronic course. It can be stabilised with treatment but flare-ups can occur. Parents who are seeking a total cure may be disappointed when the dermatologist tells them there is no cure for eczema. There is reason to be hopeful because advances in medical research now provide effective treatments that can improve the condition and keep the child well.

What are the treatment options?

Eczema is specifically treated by anti-inflammatory steroid creams, which are applied once or twice a day before the application of moisturiser. Non-steroid creams are also available; these are called topical calcineurin inhibitor (TCI) creams and are usually used in children above the age of 2.

Use mild nourishing soaps or synthetic soap substitutes. Moisturisers must be used daily to build good skin barrier and reduce the chance of developing eczema or flare-ups. Moisturisers also hydrate the skin and reduce itchiness. Anti-itch medication in the form of antihistamines may also be given. Occasionally, a course of antibiotics is required if there is any skin infection.

What are steroid creams, and are there any side effects?

A topical steroid of appropriate strength is prescribed depending on the location of the rashes and the child’s age. Steroid creams are classified into several grades of potency, and generally the least potent steroid will be selected to reduce the inflammation. Although there are potential side effects like thinning of the skin, these can be avoided with proper use of the creams under a doctor’s instructions.

Many dermatologists use a “step down regime”. Initially, a stronger cream may be prescribed and when improvement occurs, the doctor will then reduce the strength of the medication.