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The main symptom is
itchiness. Scratching in response to an itch may cause many of the changes seen
on the skin. The itch can be severe enough to interfere with sleep, causing tiredness
and irritability. Typically, atopic eczema goes through phases of being severe,
less severe, and then gets worse again. Sometimes a flare-up can be due to the
reasons outlined below, but often no cause can be identified.
Atopic eczema can affect any part of the skin, including the face, but the areas that are most commonly affected are the creases of the joints at the elbows and knees, as well as the wrists and neck. The affected skin is usually red and dry, and scratch marks (sometimes accompanied by bleeding) are common. When atopic eczema is very active, it may become moist and weep during a flare-up and small water blisters may develop, especially on the hands and feet. In areas that are repeatedly scratched, the skin may thicken (a process known as lichenification) and this may cause the skin to itch more. Sometimes affected areas of the skin may become darker or lighter in colour compared to the surrounding, unaffected skin.
Picture credit: Skin Deep is a project developed by two groups in the UK who aim to produce resources that educate professionals and the public about skin presentations in children with different skin colours.
The features of atopic eczema are usually easily recognized by health visitors, practice nurses and doctors, when they assess the skin. Blood tests and skin tests are usually not necessary.
Your healthcare professional should:
1. Recognize that your child has eczema or an eczema flare 2. Find out whether anything seems to make the eczema worse or better? You may be asked about irritants (e.g. washing products, toiletries, bathing) and triggers (e.g. foods, toiletries, pets, heat and cold) and what creams or lotions you are using 3. Help you to manage symptoms by providing a management plan or refer you to someone who can provide you with a management plan 4. If your child has severe eczema or is not improving despite treatment, your GP surgery may refer your child to a specialist clinic e.g. dermatologist (skin doctor), allergy specialist or pediatrician (children's doctor).
The most commonly used treatments are moisturisers and steroid creams.
Flare treatment should be started as soon as symptoms appear, and carried on for at least 48 hours after the flare has stopped.
Many things, called 'trigger factors', can make atopic eczema worse. These include soaps or bubble baths, allergens (for example, pollen, pet fur and house dust mites) and certain foods. Being unwell, for example having a common cold can cause a flare-up as can infections with bacteria or viruses; bacterial infection (usually with a type of bacteria called Staphylococcus) makes the affected skin yellow, crusty and inflamed, and may need specific treatment whilst an infection with the cold sore virus (herpes simplex) in skin affected by eczema can cause a sudden painful widespread (and occasionally dangerous) flare-up of atopic eczema, with weeping small sores.
Wash your child with a moisturiser instead of soap (known as a soap substitute), and avoid soap, bubble baths, shower gels and detergents.
Click below to hear a consultant dermatologist talking about managing eczema in children:
or contact the National Eczema Society
London, N19 5NA
Tel: 0800 089 1122
Email: [email protected]
or click here for a Parent information leaflet produced by the British Association of Dermatologists.