What is eczema?

The last 40 years has seen dramatic rise in allergic diseases, particularly in the Western world. As well as huge increases in the amount of childhood asthma and hayfever, it is now estimated that ‘atopic’ or ‘allergic’ eczema effects almost 20% of children. Atopic eczema (also known as atopic dermatitis) is a chronic itchy skin condition that most commonly develops in early childhood. Eczema tends to be a variable disease with children suffering from dry skin, which flares up with sore patches from time to time, often for no apparent reason. Fortunately, for most children eczema is relatively mild, albeit still irritating. However, for a smaller proportion of children, eczema can be more severe and continuous, having a significant impact on a child’s quality of life as well as that of their parents. In a recent survey of parents of children with eczema by the National Eczema Society, one in six mums said they would consider having no more children if they too would suffer from eczema.

In infancy, eczema tends to affect the face and outside surfaces of the limbs.

In toddlers and older children, eczema most commonly effects the creases of arms and legs.

Conventional medical treatment of eczema revolves around two principles. Emollients (moisturisers) are used regularly on areas of dry skin, together with bath oils, to improve the hydration of the skin. These do not prevent the sore, inflamed areas from developing, nor do they help calm them down. For these sore or ‘active’ areas of eczema, anti-inflammatories such as steroid creams are needed. If a bacterial infection has caused the flare up of eczema, antibiotics will also be used. Parents are often very nervous about using steroid skin creams, because of the possible side effect. Long term use of steroids can thin the skin, which is a particular issue in areas where the skin is already thin such as on the face.  However, when used carefully, under the direction of a doctor, steroid skin creams are both effective and very safe. Despite this, parental concern about steroids often results in eczema being undertreated, which can also lead to skin damage.

Eczema may flare up for a variety of reasons such as skin infections, irritants (such as abrasive clothing or sweating), viral infections as well as numerous other factors. Many parents also worry that their child’s diet may be one of the causes of their child’s eczema. In fact, studies have shown that 75% of mothers have made changes to their child’s diet in order to try and improve their eczema. Many doctors are sceptical that there is any value in such dietary manipulation, which may place the child at risk of missing out on essential nutrients as well as resulting in the considerable hardship that careful avoidance of any specific food will lead too. However, our understanding of the possible role of food allergy in eczema has improved considerably and it is becoming increasingly clear that in some children, identifying and excluding problem foods can have a significant impact on eczema. Identifying the correct foods in the correct children still requires considerable expertise and parents should be encouraged to raise their concerns with their family doctor or paediatrician rather than experimenting themselves.