Eczema in children

Child eczema or atopic dermatitis (AD) is a chronic, recurrent, inflammatory skin diseases that happens to 10 – 20% of the general population. The basic symptoms are dry skin, an itching sensation, redness and peeling and then thickening of certain skin regions. Periods of disease worsening and improvement alternately change. Often some of the family members of the diseased child has a bronchial asthma, allergic rhinitis or/and AD.

When does the disease usually occur?

The disease usually occurs in the period from the 2nd to the 12th month of life and in most cases retreats around the age of 5. It very rarely develops in adulthood.

What are the causes of the eczema appearance?

The cause of AD isn’t completely explained, it is considered that the disease is a consequence of interplay between genetic, immune and various factors from the surroundings. Numerous studies have shown that children with AD have a heightened risk for the occurrence of allergic rhinitis and bronchial asthma. The most significant provoking factors that can influence the development and worsening of the disease are: moist and cold climate, infections, emotional stress (vaccination, teeth growth, going to school, change of residence), exposing the skin to detergents, soaps, wool and synthetic materials, exposure to aeroallergens such as pollen, mites from house dust, animal hair, and in childhood food allergens (egg white, milk, soy, peanuts, almond, wheat flour, fish and crabs).

Clinical picture of eczema

The basic characteristics of AD are dry skin and a sense of itching while other manifestations of the disease vary in appearance and localization depending on the age of the patient. Up to the age of two the disease is denoted as child eczema. Changes in the form of redness, peeling, bubbles, moistening and scabs can be seen on the cheeks, chin and forehead, rarely on the scalp, creases and around the ankles. Changes usually withdraw spontaneously after the age of two.

After the age of two the disease is localized in the area of elbow and knee pits, area of the joints and rarely in other regions in the form of limited surfaces (plaques) with thickened skin with emphasized skin drawings and peeling, occasionally with acute outbursts of eczema. In a few people AD stays after the age of 30 and takes a chronic and recurrent form with the appearance of thickened plaques in the creases or on the entire surface of the skin. It often manifests in the form of chronic eczema of the hands and/or feet and inflammatory changes around the eyes. An intense itch is characteristic for all forms of the disease. Complications arise due to bacterial (Staphylococcus aureus or Streptococcus pyogenes) and viral infections which are helped by the skin damages due to intense itch and scratching. An infection with a Herpes simplex virus is usually generalized, with a difficult general state and it demands clinical treatment.

The diagnosis of atopic dermatitis is made based on the clinical picture and anamnestic data considering certain criteria. In diagnostics, laboratory analyses are applied to prove the total number of IgE antibodies which are usually increased in these patients, then intradermal prick tests to prove the presence of allergies on nutritive and inhalation allergens (substances from food and air that cause an allergy). Skin tests are done in a way that introduces the allergens into the skin in a certain way and if the patient is allergic to a certain substance the skin reacts with the appearance of redness and swelling on the place of application of a certain allergen.

Prevention and treatment of eczemas

It is very important that the patient abides every day, for several years, to the general measures for skin care and avoids provoking factors to prevent worsening of the disease. It is advised to bathe without a soap, in special oily baths; avoid exposure to house dust, feathers, animal hair and excessive heat that increases sweating and itching. In rare cases it is necessary to have a diet free of eggs, milk, peanuts, soy, nuts, fish and clams. Holidays on the sea usually have a positive effect on the course of the illness, noting that it is necessary to avoid direct Sun exposure in periods when the radiation is at its strongest and that it is necessary to protect by applying anisole creams with a protection factor over 30.

Also, it is advised to regularly oil the skin with neutral emollient creams (Emollients ungv. Atopic cream, Lipikar Bacum up cream), preferably after swimming and several times a day. Emollient substances significantly reduce itching and the need to scratch, and so they are significant in prevention of the illness reactivation, and sometimes enough for complete therapy effect.

Local corticosteroid mixtures in the form of oils, creams or lotions are still the foundation of the AD therapy and are given in phases of illness worsening. The strength and type of corticosteroid mixtures as the duration of treatment are determined by the severity of the clinical picture. Calcineurin inhibitors – Tacrolimus (Protopic cream) and Pimecrolimus (Elidel cream) are the latest substances used to treat AD. They are used in therapy for resistant forms of diseases that don’t react to a standard corticosteroid therapy and when it is necessary to decrease the use of corticosteroid mixtures due to the length of the treatment. Antibiotics given in the form of general therapy or locally are often used in AD therapy because staphylococcal and streptococcal skin infections are common. In general therapy, antihistamines (Aerius, Pressing, Xyzal) are used, and corticosteroids Cyclosporine A, Azathioprine and Interferon gamma only in severe, generalized forms of disease. PUVA therapy is applied with success but only after puberty.

We can conclude that there is no unique and certain method of treatment which could in every moment control symptoms of the disease. A proper skin hygiene and skin care is of utmost importance, with regular use of emollient substances and adequate clothes, and with avoiding the provoking factors. A lucky circumstance is that in most cases the healing comes spontaneously, with the age of five.

MA.Sci.Med.Dr. Danica Milobratovic, dermatologist
Dermatological clinic DERMATIM, Belgrade, Serbia