What Is Eczema?
Eczema is a chronic, inflammatory condition of the skin that causes redness, dryness, scaling, and itching. The exact cause of eczema is unknown, although it tends to run in families with a history of allergic conditions such as hay fever and asthma. (Around half of all children with eczema will develop asthma or hay fever during childhood.) A number of factors, such as weather, food, or environmental allergies, can affect eczema and cause the rash to worsen, but eczema cannot be passed from one person to another.
Eczema is commonly seen in young children, affecting approximately 15 percent of infants. It can appear throughout childhood but usually starts during the first year, often before the age of 5. Eczema is a long-term, or chronic, condition, but in most cases it disappears before adulthood. It can be mild or severe and symptoms may come and go.
There are three common types of eczema:
- Atopic dermatitis is chronic skin rash that affects children in families with a history of allergies. The rash is usually dry and itchy; the skin becomes red, irritated, and scaly. Scratching may lead to breaks in the skin, with resultant secondary infection and scarring.
- Seborrhea is also known as seborrheic dermatitis; it affects children under age 2 but usually infants up to 3 months. The cause is unknown, but it is thought to be a disturbance in the skin's production of sebaceous matter and sweat. Unlike atopic eczema, the rash is not particularly itchy and is dry, red, and slightly flaky. Seborrhea is usually localized to the face, neck, chest, folds of skin, and the diaper area. Infants may develop yellowish scabs on the scalp, called cradle cap. This rash generally disappears after a few months.
- Contact dermatitis occurs when certain substances, such as nickel, cosmetics, creams, and detergents, irritate the skin and cause a hypersensitivity reaction. The skin becomes red and angry-looking, occasionally giving rise to raised papules or vesicles in the affected areas of skin. The rash is often itchy but may also be moist, with blisters. Poison ivy is an example of a contact dermatitis.
Symptoms and Signs of Eczema
Children with eczema usually have a dry, red skin rash with crusted patches susceptible to infection. If the skin becomes infected, the rash may look redder and fluid may ooze from the area. The rash is also particularly sensitive and easily irritated by various detergents, soaps, and perfumes. Scratching the itch will only make it worse, easily developing into a cycle: rash, itching, scratching, and more rashes.
In infants, the eczema rash usually begins on the face, forehead, or scalp, and it can spread toward the hands and feet before possibly spreading over the body. The diaper area usually is spared because this area is always protected and often moist. In older children, the usual location of eczema is the back of the knees and the inside of the elbows, as well as around the wrists and ankles. Those who have eczema for a long period of time will have thicker, dryer, and browner skin from scratches and previous sores.
How to Prevent Eczema
Many cases of eczema are hereditary and cannot be prevented, but exclusive breastfeeding of a baby without introducing other foods for the first six months may prevent some cases of eczema.
Limit the flare-ups of eczema by keeping the child away from dust, pollen, pet dander, and certain foods. Avoid using strong soaps, detergents, or anything that can irritate the skin. Make sure your child does not shower or bathe too often because that can dry out the skin; scrubbing or rough drying after a bath can irritate the skin and cause the eczema to worsen.
Apply moisturizing cream two to three times a day, especially after bathing, even when your child does not have an eczema flare. Your child should wear loose, soft cotton clothing, which is the most gentle for skin affected by eczema. Encourage your child to drink plenty of fluids to retain moisture, and keep your child's fingernails short so they do not tear the skin when he scratches. Your child's doctor may also recommend an oral antihistamine to reduce the itching.
Treatment for Eczema
The basic treatment for eczema consists of avoiding things that irritate the skin, moisturizing frequently to lessen the dryness, and using medications to calm any inflammation when necessary. During good periods, moisturizing cream or ointment should be applied every day and the use of bath oil can keep the skin soft enough to prevent the eczema from flaring up.
In more severe phases of eczema, it will be necessary to use a topical steroid ointment or cream for a short period. When eczema does not improve with these therapies, other medications, such as antihistamines or oral steroids, may be recommended. If the eczema has become infected, your doctor may prescribe oral or topical antibiotics. In some cases, it may be appropriate to have the child tested for allergies that could be triggering the eczema rash. It's important to have a written treatment plan for your child, because the treatment will change depending on the severity of the eczema.
When the skin is torn from eczema being scratched, the sores can become infected. These infections most commonly result from staphylococcus bacteria, which often cause a discharge of pus. The skin becomes redder than usual, warmer, and tender to the touch. Children may also have a fever. If a child with eczema also gets chicken pox or a herpes virus skin infection, the rashes usually become more severe and the child's overall condition will be worse. Contact the doctor immediately if this happens.
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