What is eczema?

There are different types of eczema, but atopic eczema is most common. Sometimes it’s referred to as atopic dermatitis.

Atopic eczema is more common in children than adults; it makes the skin very sore and itchy, and it will look dry, scaly and cracked. Eczema can appear anywhere on the body, but it’s often found on the backs of knees, insides of elbows, hands and scalp.

Skin colour affects the appearance of eczema – the NHS explains that it can be more difficult to see on darker skin where patches of eczema and inflammation look darker brown, purple or grey. Lighter skin can become red.

Pictures courtesy of DermNet

Sometimes symptoms are mild, but they can be very uncomfortable which might disrupt a child’s sleep and can lead to recurrent infections in scratched, broken skin.

What causes eczema?

Doctors aren’t 100% sure.

Sometimes it runs in families, and it Is common in people who have asthma and hay fever. People with these conditions are known as “atopic” (sensitive to allergens).

Professor Adam Fox, one of the UK’s leading paediatric allergists, told The Allergy Team that a child who has two parents with atopic tendencies has about an 80% risk of being atopic as well.

What’s the link between eczema and food allergies?

Being atopic and having atopic eczema means you are more at risk of having food allergies.

Dr Neeta Patel is a consultant paediatrician and allergy lead at a major London hospital, she says it’s really important that parents and carers are vigilant if a baby has eczema, particularly if it is severe and it appears when they’re very young – she explains “they’re the ones who are most likely to get food allergies and I think educating yourself if you’re in that situation and getting reliable advice about early introduction of allergenic foods, alongside doing the best to be able to breastfeed, are the best things you can do.”

Eczema is both a sign that your child might be predisposed to allergies and doctors think it can cause allergies too. That’s because eczema disturbs the skin’s protective barrier. This barrier is meant to keep things like bacteria, viruses and allergens out of the body but when it is disrupted it allows allergens to enter and sensitise the body. [1]

Weaning an atopic baby

Your doctor may advise you to wean your baby early onto potential allergens, especially egg and peanut. This is because allergists think it’s better for the immune system to come across allergens for the first time in the gut rather than through the skin. This way the immune system is more likely to build a tolerance than see the food as something harmful and create an allergic reaction.

However, if you have to wait a very long time for an allergy appointment, it can be worth pressing on with weaning and introducing allergens – there is a balance to be struck here because the risk of becoming allergic increases if you delay for too long.

You can read more about Weaning and food allergies in our factsheet.

Treating atopic eczema

Doctors say it’s really important to treat your child’s eczema – it can be very painful and difficult to live with, both mentally and physically.

It’s important to try and stop babies and children scratching their eczema although this can be very hard! Putting mittens on your baby, making sure their nails are short and dressing them in light clothing can help.

Your doctor may suggest or prescribe creams to moisturise and treat your child’s eczema; emollients are moisturising and can be used daily, topical corticosteroids can reduce swelling, redness and itching. [2]

Dr Neeta Patel told The Allergy Team it’s important that parents and carers follow the instructions for treating their child’s eczema even if the regime feels gruelling. “It can be quite heavy, we would ask you to put creams on quite a lot of times a day, often we’d ask you to put steroid creams on – I know there’s a lot of anxiety about steroid creams but actually it is much better to treat with steroids than to not and to have that ongoing eczema for a long time.”

Watch Clinical Nurse Specialist (Allergy and Asthma) Deirdre Brown explain the basics of eczema treatment:

Video transcript

So, there’s different schools of thought about which cream should be applied first, but I think the most important message is to have a gap between applying topical steroids and moisturizers otherwise emollients, so leave about 20 or 30 minutes between application.

Generally, after you bathe your child, it’s a really good idea to get the emollient on first because the skin is going to be more susceptible to absorbing that really well when it’s damp.

And at other times you may want to apply this steroid first using validated measuring such as the fingertip measuring units.)

SOURCES:

NHS: https://www.nhs.uk/conditions/atopic-eczema/#:~:text=Atopic%20eczema%20often%20occurs%20in,detergents%2C%20stress%20and%20the%20weather.

US Department of Health and Human Services

UK National Eczema Society website: https://eczema.org/

https://www.annabelkarmel.com/advice/weaning-baby-allergies/

 

Reviewed by Dr Deb Marriage, June 2023