Paediatric Eczema: An Itchy Problem
Published on the 17 September 2015
Published on the 17 September 2015
Eczema is a chronic inflammatory skin condition that usually develops in early childhood. It is typified by dry itchy skin and is episodic in nature, except in very severe cases. Most children with eczema will experience flares, sometimes as often as three or four times per month.
There is little understanding why children get eczema. A filigrin deficiency is thought to be one of the main causes of eczema, which leads to ‘leaky skin’. A break in the filigrin barrier means moisture can leave the skin and irritants can penetrate.
We also know that genetics play a huge part. According to Arnaldo Cantani, a child with two parents who have experienced eczema has a 50-70% likelihood of developing the condition. With only one parent, the chance decreases to around 35%. If neither parent has eczema, the chance of spontaneous development is around 5-10%.
Food and inhalant allergies can exacerbate eczema in children. Eggs, cow’s milk and peanuts have also been shown to have a direct link to eczema exacerbations in infants. Although most children will grow out of eczema, 30% will go on to have some form of eczema as an adult.
Eczema in children can look different as the child ages. In infants, it often begins on the cheeks and can become widely distributed. It’s typically dry and scaly with erythematous patches.
Toddlers often scratch vigorously. They are more mobile and their eczematous patches can become dry and thickened (lichinified) from scratching. The abdomen, face and flexures are the most affected and as the child becomes older, their eczema tends to develop a flexural pattern. [Tweet “Eczema in children can look different as the child ages.”]
Babies and young children may also develop peri-oral eczema associated with drooling, often caused from teething or self-feeding. Peri-orbital eczema can also be an issue, and is associated with sore, itchy eyes. Children tend to rub their eyes, exacerbating the issue.
Kids with eczema scratch. They have disturbed sleep (and so does everyone else). School work may suffer. They report feeling self-conscious about their appearance and being restricted in what they can wear. They may suffer bullying at school and have difficulty forming relationships. School camps and trips away can cause anxiety for both the children and their carers.
Parents and caregivers report worrying about their children’s future and how they’ll manage once they are living alone. There is concern over treatment and many people are worried about using steroid treatments.
Skin barrier maintenance is vital. A good emollient can be used twice a day, even in the absence of a current flare. As a general rule, creams should have a low pH and should contain no added plant or food substances in order to avoid further reactions.
Steroid creams have excellent safety data and can be a very effective treatment of eczema. Cortisteriod creams can help treat exacerbations, hydrocortisone on the face and on mild exacerbations is helpful. A stronger steroid from the neck down can be advised–this should be applied sparingly and under medical supervision. A non-steroidal inhibitor of inflammatory cytokines may also be safely used around the peri-oral and peri-orbital regions and has good long-term safety data in children.
Wet wrapping can be effective. Commercial products or simple crepe bandages soaked in lukewarm water with emollients can be applied to dry exacerbated areas and removed once dry. Applying these after steroids and emollients is the most effective strategy. Cool compresses can be applied to the face and other areas that are not easily wrapped.
Eczema can lead to infections and treating these is vital. Oral antibiotics and topical antibiotics may be needed in an active infection. Twice weekly bleach bathing can help to reduce the staph load and eradication therapy for the whole family may be useful.
Eczema has no cure. It can be a lifelong disease that causes great distress for children and their families. Treatments can be time-consuming and constant. But with good support and consistent treatment, the patient can be successfully supported through flares and gain an improved quality of life.
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Abbie is a Nurse Practitioner currently working in a Specialist Allergy Clinic in Brisbane. She has been a paediatric nurse for over 20 years originally working in the UK before moving to Australia with her young family 8 years ago. Abbie has a diverse career working with some of the most vulnerable patients. She has worked in paediatric oncology , emergency and general paediatrics. She has worked for NGO's in the fields of child protection and parental support as well as currently working with re- settled refugees. Abbie is a passionate nursing advocate and has just started the new challenge of blogging.