Childhood Eczema: What Parents Need to Know About Managing the Itch

Eczema is a common skin problem that can start in infancy, and while some individuals are able to handle the condition with minimal impacts on everyday life, others will find that it becomes a lifelong condition to manage. This is especially concerning for parents, as according to the Dermatological Society of Malaysia, over 20% of Malaysian children are affected by eczema, also known as atopic dermatitis.

While eczema is not always an allergic disease, allergens can play a role in exacerbating the condition such as dust mites and pet dander – leading children to develop allergies to food, pets, dust mites or even pollen.

Dr Melanie Majaham, Consultant Paediatrician from Sunway Medical Centre Velocity (SMCV) shares that “Eczema usually happens in a child who already has a tendency for dry skin. When exposed to triggers such as chemicals, sweat and heat, the skin becomes inflamed and very itchy. This results in the child constantly scratching which further damages the skin. Damaged skin is very prone to bacterial, viral and fungal infection. The child may be in pain, constant discomfort and even have fever and may even require hospital admission to get IV antibiotics and antiviral drugs”.

Treatment of eczema and allergy in children
Children that suffer from eczema can develop red, dry, itchy patches on the skin that result from inflammation. Frequent scratching can cause blisters, oozing, crusting or sores from infection. Dr Melanie advises that treatment options depend on which phase the eczema is in.

“In active flare-ups, the child may need steroid-based creams which are important to reduce the inflammation and break the “itch-cycle”. In situations where the skin is infected, antibiotics and antiviral medications may be needed. Parents should be reassured that steroid creams prescribed correctly and in short duration will not lead to long term complications.

“During the subacute/chronic phase whereby the skin is merely dry, but not actively inflamed, maintenance therapy is important to prevent flare-ups. This includes intensive moisturizer creams that are free from fragrance and certain chemicals. The child will also need to bathe with soap free solutions to prevent excessive drying of the skin. Wet skin should be pat dried, gently with a towel. Water that is too warm tends to worsen the eczema,” Dr Melanie notes.

Dr Juani Hayyan Abdul Karaf, Consultant Ear, Nose, Throat (ENT) and Head and Neck Surgeon from Sunway Medical Centre Velocity (SMCV) adds that treatment options for allergy also varies and depends on the site of the manifestation for symptomatic treatment. “There is immunotherapy in the form of shots that is available to treat allergies, but this is for specific allergens such as house dust mites. Allergic reactions have their triggers, so parents should observe the recurrence of their children being exposed to certain food or environment such as dusty, cold, hot environments or animal dander.”

In the case of newborns, Dr Juani shares that parents should look out for signs of intolerance such as diarrhoea, vomiting or skin rashes, and should change to dairy-free milk instead.

Can children continue to have eczema in adulthood?
Although it is not a rare occurrence, not many are aware that children with eczema can develop food allergy, allergic rhinitis and asthma which is also known as the atopic march – a natural progression of allergic diseases from infancy into adulthood. More than 50% of children with eczema develop asthma later in life, with a further 33% developing food allergies – with an increased risk of developing allergic rhinitis.

Dr Juani shares that the atopic march happens when children continue to develop inter-related allergies into childhood that can begin with eczema.

“Atopy is known to be an excessive immune body response, and generally can cause a whole body reaction. Atopic March starts with a skin condition as it’s the first body barrier that can be breached. The body’s response can continue and manifest later as food allergies, allergic rhinitis and asthma,” she shares.

Is eczema or the atopic march hereditary?
Many studies have shown that genetics play an important role in the development of atopic conditions. Eczema is caused by a combination of environmental and genetic triggers. They tend to be more common if there is a family history of eczema or other form of allergic manifestation like asthma or allergic rhinitis. Environment triggers can be of certain factors such as foods, soaps, creams or chemicals. However, for most patient with eczema, there is no identifiable source.

When it comes to pregnancy, studies have shown that women who eat more poultry while pregnant may increase the risk of eczema in infants. Studies have also shown that pregnant women who consume more dairy, eggs and a plant-based diet may play a role in protecting their child from eczema.

Dos and Don’ts
As there is currently no cure for the skin condition or other allergies, Dr Melanie has one word for parents who are managing eczema in their children or babies: moisturise!

“Parents should ensure the child is kept cool as heat can aggravate eczema. Constant round-the-clock moisturising also does wonders in keeping the child comfortable. Refrain from using anti-septic soaps which are harsher and can worsen eczema. Some parents think eczema is caused by poor hygiene and tend to use antiseptic soaps. However, the more appropriate bathing solution would be something soap-free and fragrance-free and rich in emollients. “Organic” soap is not always the answer as it may not be moisturising enough.”

There are also a variety of steps that patients can carry out, with the support of their parents or caretakers such as eating healthy and staying active. “Exercise regularly, spend time outdoors and soak up Vitamin D which is beneficial for the child’s overall wellbeing. Maintaining a healthy weight and getting plenty of sleep will help in building up a stronger immune system,” Dr Juani notes.