Atopic Eczema in Childhood

1) How common is atopic eczema in childhood, and is there a typical age of onset?

Atopic eczema is a chronic relapsing skin condition, which is characterized by recurrent bouts of itchy red rashes on the body. 

Atopic eczema is more common in children, affecting 25% of school-going kids in Singapore. At the clinic, atopic eczema accounts for more than 75% of the children who come to seek treatment for various skin complaints. 

The prevalence of atopic eczema has increased over the years. Genetic, environmental allergens and dietary factors have been blamed for this trend. 

In the majority of patients, eczema develops before the age of 4 years.

2) What are the main symptoms and signs, and what is the long-term prognosis?

The most common symptoms are itchy and red rashes, which tend to occur at typical locations:
- In infants, the rashes are usually found on the cheeks and scalp.
- In children, the rashes are usually found in the folds of the neck, elbows, wrists and knees.

Commonly associated with eczema in children is the appearance of white patches on the face (which is often mistaken for a fungal infection). The affected parts of the skin may gradually thicken and darken over time. Most children with eczema will have dry skin.

The rashes may appear as red bumps or rough patches. Occasionally, broken skin and oozing from the skin may be seen. The itch is very intense, and the child can be scratching throughout the night as a result of the itch.

One-fifth of children will recover by 12 years of age. The remainder will experience fluctuating disease into their teenage years. Of the latter group, about two-thirds will eventually grow out of their disease. If the eczema is more severe and not adequately controlled in childhood, it is more likely to persist in adulthood.

3) Are topical corticosteroids the mainstay of therapy? If so, which ones are the most appropriate to use?

Topical corticosteroids are effective in reducing itch, redness and thickness of the skin affected by eczema. They are usually prescribed during treatment. However, the use is not without risks, and therefore should only be used under doctor’s instructions. Topical corticosteroids are available in various strengths (potency) and your doctor will be able to advise on the appropriate strength for use.

Prolonged use of high-potency creams will result in increased dryness of the skin, sensitivity and worse, thinning of the skin.

4) What can be done to prevent atopic eczema in childhood?

The development of atopic eczema in an individual is determined by the interaction of the child’s genes and his environment. More than half of children with eczema have a close family member with the same condition.

The genes involved in the development of eczema control the immune system and the structural defence of the skin. An abnormality in any of these genes will make the child more prone to developing eczema later on in life.

Factors that are known to trigger eczema include harsh soaps and detergents, house dust mites, woolly clothing, and emotional stress. Occasionally, eating certain foods may aggravate the eczema.

Children with atopic eczema also suffer from dry skin. Dry skin is a weak barrier against environmental insults. Therefore, it is important to moisturize the skin frequently so as to maintain a healthy skin barrier. One should also use very gentle soaps, which will not dry out the skin even more.

If there is a family history of eczema, total breastfeeding for the first 3 months of life has a protective effect on the subsequent development of eczema in the infant.