Atopic Eczema in Children

— Common Atopic Eczema in Children

What is atopic eczema?

Atopic eczema is a chronic, itchy skin condition that is very common in children but may occur at any age.
It is also known as eczema and atopic dermatitis. It is the most common form of dermatitis. Atopic eczema usually occurs in people who have an 'atopic tendency'. This means they may develop any or all of three closely linked conditions; atopic eczema, asthma and hay fever (allergic rhinitis). Often these conditions
run within families with a parent, child or sibling also affected.

What does atopic eczema look like?

There is quite a variation in the appearance of atopic eczema between individuals. From time to time, most people have acute flares with inflamed, red, sometimes blistered and weepy patches. In between flares, the skin may appear normal or suffer from chronic eczema with dry, thickened and itchy areas.

Infants

Infants less than one year old often have widely distributed eczema. The skin is often dry, scaly and red
with small scratch marks made by sharp baby nails. The cheeks of infants are often the first place to be affected.

Toddlers and pre-schoolers

As children begin to move around, the eczema becomes more localised and thickened. Toddlers scratch vigorously and the eczema may look very raw and uncomfortable. Eczema in this age group often affects
the outer aspects of joints, particularly the wrists, elbows, ankles and knees. It may also affect the genitals.
As the child becomes older the pattern frequently changes to involve the creases of joints.

School-age children

Older children tend to have eczema affecting the elbow and knee creases. Other susceptible areas include
the eyelids, earlobes, neck and scalp. They can develop recurrent acute itchy blisters on the palms, fingers
and sometimes on the feet. Many children develop a 'nummular' pattern of atopic eczema. This refers to small coin-like areas of eczema scattered over the body. These round patches of eczema are dry, red and itchy
and may be mistaken for ringworm (a fungal infection).

Does atopic eczema persist forever?

Atopic eczema affects 15-20% of children but only 1-2% of adults. It is impossible to predict whether
eczema will improve by itself or not in an individual. It is unusual for an infant to be affected with atopic
eczema before the age of four months. Atopic eczema is often worst between the ages of two and four
but it generally improves after this and may clear altogether by the teens.

Treatment

Treatment of atopic eczema may be required for many months and possibly years.
It nearly always requires:

	Reduction of exposure to trigger factors (where possible)
	Regular emollients (moisturisers)
	Intermittent topical steroids

In some cases, management may also include one of more of the following:

1. Topical calcineurin inhibitors such as pimecrolimus cream or tacrolimus ointment
2. Antibiotics
3. Antihistamines
4. Phototherapy
5. Oral corticosteroids

Longstanding and severe eczema may be treated with an immunosupressive agent.

	Methotrexate
	Ciclosporin
	Azathioprine