Understanding eczema

Posted on 24 December 2019

Although there are different types of eczema, atopic eczema (sometimes called infantile or childhood eczema) is the most common form. Although it can affect people of all ages, children are most susceptible.

Atopic eczema is a common itchy rash that can affect up to 20% of children, says Dr Dilshaad Asmal, a dermatologist at Mediclinic Cape Town. “It can occur in combination with asthma and hay fever (allergic rhinitis).”

The good news is that it mostly improves during the school-going years and can disappear altogether by the time your child reaches their teens. However, if your child has severe atopic eczema, they may still experience sensitive skin later in life.

“Atopic dermatitis arises from a combination of genetic (allergies run in the family) and environmental factors,” Dr Asmal explains. “A defect in your child’s skin barrier function makes skin irritations more likely, while the temperature, weather and nonspecific factors can contribute too.”

As Dr Asmal says, in chronic eczema, skin is thickened (lichenification) and dry, itchy patches occur. “In acute eczema, the affected areas can look inflamed, red, blistered and weepy.”

She adds that infants often present with widespread eczema that is dry, scaly and red. Cheeks are commonly affected and scratch marks may be evident. Toddlers and preschool children may have eczema on the joint areas, particularly their wrists, elbows, ankles and knees.

“As a child grows, the pattern can change from the outer aspects to the flexural areas of the joints and may include the face,” Dr Asmal explains.

Spontaneous flare-ups are often the result of triggers, including certain soaps, detergents and fragrances, house dust, pollen, animal dander, certain food and synthetic clothing.

An eczema diagnosis is a clinical assessment made by a dermatologist, paediatrician or GP. “Atopic eczema is definitely not contagious, and it cannot be passed from one person to another through skin contact,” Dr Asmal says.

One of the most commonly prescribed medications for all types of eczema is topical corticosteroids (steroids),  which can ease redness and reduce inflammation and itching so your child’s skin can begin to heal.

“Topical treatments that contain steroids, light treatment, oral treatment and biologics are well-considered treatment options for eczema, together with emollients and antihistamines,” says Dr Asmal. “There are also newer topical therapies that don’t contain steroids which can be used in mild to moderate cases of atopic eczema. Treatment can include a reduction of exposure to trigger factors too.”

To minimise triggers, Dr Asmal suggests keeping your child’s fingernails short and ensuring they moisturise often. Avoid anything fragranced, hot baths, harsh soaps and rough towelling, Dr Asmal adds. “Patting skin dry can help and wearing cotton clothes can also help.”