MD. M.R.I.P.H.H (UK)
Dermatology Department ,PIMS
Islamabad, Pakistan

Back to Ask the Doc.

The most common dermatological disease in children is ECZEMA ( commonly called ATOPIC DERMATITIS ). It has following further subtypes:

1.Infantile Eczema ( Common in Infants )

2.Childhood Eczema ( Common in children )

3.Adult Eczema (Common in adults )

Our topic here is Childhood Eczema.This is a chronic skin disorder. When it is flaring up - which can be weekly or monthly for some -- it is characterized by red, itchy skin. This condition usually occurs in children with a personal or family history of atopy (allergic asthma, rhinitis, conjunctivitis, or food allergies).

To treat this disease you need to work with your doctor in identifying and reducing those factors in your child's life that exacerbate the disease.

We will discuss this under two headings.

  • The factors which lead to the disease.
  • Its Treatmen.

The factors in your child's life that exacerbate the disease are different for every child, so a single therapy( treatment) is not appropriate for all eczema patients. We encourage you not to self-medicate until you have consulted. In this joint effort, you need to watch for some of the following exacerbating factors:

Possible Exacerbating Factors

1. Irritants

Environmental factors can have a big effect on your eczema. To prevent irritation, you should minimize the use of soaps, solvents, and other drying compounds. If soaps are to be used they should have minimal defatting activity and a neutral pH (examples: Dove, Tone, Alpha Keri, Basis,Lowila, and Neutrogena). Non-soap cleansing agents are also available (examples: Aveeno and Emulave). Since residual laundry detergent in clothes may also be irritating, a second rinse cycle would be beneficial. Changing detergents may also help.

For hand dermatitis--which many eczema patients have--it is especially important to avoid irritant contact with solvents, soaps and detergents. Also avoid jobs and hobbies that require exposure to these irritants, as well as to dust, dirt, and heat. If you wash frequently, it is important to apply emollients after every washing; also trying a non-water cleansing method, such as Cetaphil, may be beneficial. Wearing appropriate gloves when using potential irritants is also important.

If sweating (perspiration)causes itching, modify your activity and surroundings to minimize sweating. Work and sleep in a fairly constant temperature (68-75_F) and humidity (45-55%). Wear open-weave, loose-fitting garments made of cotton blends, rather than wool or stiff fabrics.

2. Allergens

Allergens in the air and in the food are often triggers for a flare-up of this disorder. Your doctor will try to correlate a positive skin. This is helpful in knowing what

allergens to avoid, since you can't--and shouldn't--try to avoid everything that might be considered an allergen without any incriminating evidence. Occasionally, using an electrostatic air purifier can help reduce aeroallergen exposure at home or in the workplace, or in classrooms in the schools.

Dietary management of atopic dermatitis continues to be a controversial subject among doctors. The most common allergens appear to be eggs, cow's milk, soy, wheat, nuts and fish. In children who have had controlled blinded food challenges that result in flaring of dermatitis, it is apparent that avoidance of those foods will be beneficial. Care must be taken to avoid malnutrition when any restrictive diets are used.

3.Feeding in Children :

The role of bottle feeding versus breast feeding of infants in the development of atopic dermatitis continues to be unclear; however, many doctors and mothers believe breast feeding may delay the onset of dermatitis if practiced for at least the first three to six months of life.

5. Infections:

If you get a bacterial, fungal or viral infection, it may cause a flare-up of your eczema. If your eczema is weeping or oozing, if it crusted, or if it has small bumps, your doctor will probably test for the presence of bacterial infection.

Rarely, Herpes simplex ( a very dangerous virus ) may cause extensive local or wide-spread infection, and is usually treated with topical or systemic acyclovir.

"Athletes foot" (tineas pedis) can occur in older children (usually over age 12) in addition to foot dermatitis. Therefore, when standard topical therapy for foot dermatitis fails, your doctor may test for this fungus and, if present, treat accordingly. 

5. Emotional Stresses

Anger, frustration, and anxiety are commonly experienced by patients with atopic dermatitis and often complicate the problem. If there is added family hostility, rejection, and guilt, the family structure may be damaged. So it is very important that you and your family understand that such feelings are common and understandable in chronic disease, and try to move beyond them. Do not use this frustration to press for a quick "cure" to your eczema, since it is not possible. Instead, have your doctor discuss with you about the nature of chronic disease, exacerbating factors, and management measures (as generally outlined in this literature). Seek out positive strategies for coping with the disease that include learning more about the disease and how it is treated. Be reassured that the disease can be controlled, and that the majority of patients improve with age. Recent research is suggesting a variety of new, promising therapeutic approaches.