Eczema is an itchy skin condition that affects many children but can affect adults as well. It can occur from as young as a few weeks of age to old age.
Atopic eczema often runs in families where the family members may have asthma, allergic rhinitis or atopic eczema.
The underlying problem is a barrier dysfunction of the skin which makes the skin permeable to infection and allergens. This then leads to immunological changes in the body.
The condition can affect any part of the body but in children it usually occurs on the face, elbow and knee creases. It is extremely itchy and the itch usually aggravates the rash. This can lead to damage to the skin and often results in infection with bacteria, viruses and fungi. The infection can lead to worsening of the eczema.
The diagnosis is made by a thorough history and examination of the skin. The features on the skin are usually typical and the diagnosis is usually very easily made.
There is often a misconception that food allergy causes eczema in patients and children are often tested for food allergy and put onto food exclusion diets. This is not true and can often cause nutritional problems in children. Blood tests and skin biopsy are not necessary in patients with eczema.
Avoid triggers that aggravate eczema. This may vary from patient to patient. The management of eczema consists of:
- Use soaps that do not dry the skin. We recommend Pure soap, Dove soap, Pears soap, Eucerine bath and shower oil or Oilatum soap. Some patients with eczema may have to avoid all soaps.
- Excessive heat or cold may aggravate the eczema. Do not overdress your child. The sweating may aggravate the eczema.
- Wear cotton clothes or cotton underwear and bed linen.
- Chlorine in swimming pools may be an aggravating factor. You can swim in chlorinated pools but shower immediately after swimming and apply copious amounts of moisturiser.
- Lukewarm bath water or showers.
- Cut the fingernails as short as possible to avoid damaging the skin during scratching.
- Avoid all known allergens. These may be dust mites, cat or dog allergens.
- Do not exclude foods from your diet without proper allergy evaluation. Food allergy is not diagnosed purely based on a blood test.
Moisturize the skin. These are the most effective and safe treatments available for the treatment of eczema. They have some effect in restoring the barrier function of the skin which is lost in eczema. Most moisturizers only last on the skin for three hours. Therefore, use moisturizers every three hours if possible. A list of AFFSA approved moisturizers is available from the AFFSA website https://www.allergyfoundation.co.za
You may have to use an emollient that is comfortable to use. Patients respond differently to different emollients.
Aqueous cream is not safe to use in skin with eczema and must be avoided.
- These are highly effective and safe if used properly. There is a lot of unnecessary phobia around the use of steroid creams. Steroids are highly dangerous if used orally and should be avoided if you have eczema since once they wear off, they can cause worsening of your eczema.
- Topical steroids are available in ointments and creams. Your doctor will prescribe the appropriate formulation.
- Steroid creams come in different strengths. Always use the least potent steroid cream to get the maximum control. Your doctor may prescribe a strong steroid initially but once the eczema improves may switch to a milder one.
- They should be used for flaring up of eczema and stopped once the eczema is brought under control. They should preferably not be used on the face. Once the eczema is under control, you can use steroid creams 2-3 times a week to keep the eczema under control or you could switch to a non-steroid formulation like Protopic or Elidel.
- Steroids can be used with “the fingertip method” so that there is no wastage. A fingertip unit is the amount of ointment squeezed from a tube from the last skin-crease to the tip of the index finger of an adult. The number of fingertip units you need on different parts of the body depends on the child’s age.
- There are two types available in South Africa. Protopic (0.03% & 0.1%) which is an ointment that is available in two strengths and Elidel which is a cream.
- These are extremely safe and effective forms of treatment for eczema.
- We prescribe them for the face and to prevent the eczema from flaring on the rest of the body once we have achieved control.
- They work like steroids but do not have any of the side effects of steroids.
- They can be used for long durations without any problems.
- The sedating antihistamines (Allergex) may work for a short while for the itch. They have lots of side effects so best avoided.
- The non-drowsy antihistamines (Deselex, Telfast, Zyrtec, Xyzal & their generics) have no effect on eczema.
- These are used to treat bacterial infection of the skin.
- These are highly effective in controlling eczema and can be used at home. The method is found on the AFFSA website : https://www.allergyfoundation.co.za/patient-information/en/learn-how-to/wet-wraps
Can Eczema be prevented?
- It may be useful to put emollients on the skin of high-risk babies even before any symptoms of eczema occur.
- Parents should not smoke.
- Children should preferably be breast fed until at least 4 months of age.