By Dr. Teo Wan Lin, Consultant Dermatologist at TWL Specialist Skin & Laser Centre
1. What causes eczema in children?
Eczema in children and in general is primarily due to a defect in the skin barrier, which is genetically determined. It can be made worse by skin irritants, allergies, environment and stress.
2. Is eczema hereditary?
Definitely. If one or more parents suffer from eczema, the child is also more likely to develop the condition.
3. What should parents look for when trying to detect the onset of eczema in children?
Eczema typically starts as an itchy, dry skin condition in the first year of life or later. Parents may notice red, scaly patches occurring on areas such as scalp, face, chin, body, arms, legs or knees. Children may rub themselves against bedding to relieve themselves of the itch. This could be severe because it will interrupt children’s sleep at night.
4. Are food and allergies always linked for eczema in children?
Food does not cause eczema. However, some studies show that children below the age of 4 may find that certain foods worsen the condition of eczema. It is important to consult with your child’s dermatologist before excluding food from your child’s diet as children need a balanced diet . Only children with established food allergies will find that certain food can aggravate their eczema condition.
5. What should children with eczema refrain from doing?
Eczema in children can be especially hard to manage if good habits are not inculcated early on. Instead of scratching, children should be taught to pat their skin. At the same time, they should also keep the skin properly moisturised, keep their fingernails clipped and wear cotton gloves to bed. They should also wear clothing of light, breathable material such as cotton to sleep.
6. How should parents shower their child with eczema?
It’s best to use soap-free cleansers or bath oils. Try to avoid soaps containing sodium laureth sulphate as it contains a lathering agent that can irritate and dry the skin even more. Parents should also avoid abrasive materials such as loofahs or wash clothes.
The shower is preferably kept short, using lukewarm rather than hot water. After the shower, pat the skin dry with a towel and use moisturiser liberally when the skin is slightly damp.
After showering, diligent moisturising with a ceramide-based moisturiser such as the Multi-CERAM is also an important part of eczema management. The skin barrier may be thought of as a brick wall and ceramide, the cement that is sealing in between the bricks that confers a strong barrier function to the wall to prevent water penetration. Diseased eczema skin is often deficient in ceramides, resulting in poor skin barrier function and allowing rapid trans epidermal water loss. Hence, one may see the appearance of dry scaly patches around the diseased areas.
Diligent moisturising with a ceramide moisuriser – i.e. using a thick visible white layer on affected areas several times a day initially, is imperative in any eczema treatment. This is in order to replenish ceramides naturally found in the skin and support restoration of healthy skin barrier function. Healthy skin will in turn kickstart its own production of ceramide which will help to sustain the benefits of intensive ceramide moisturisation initially.
7. When do parents need to bring their child to a dermatologist?
Eczema in children and at any age needs to be treated, ideally by a dermatologist. In the situation when eczema gets out of control, such as when the itch significantly affects the child’s daily activities. If the skin is infected — red with pus oozing out or if the child is unwell — then it will be necessary to seek medical attention.
8. I heard eczema cannot be cured, is that true?
The root cause of eczema in children or adults is in the genetics, which cannot be changed. With better understanding of eczema these days, it can be fully treated and controlled by a dermatologist. Topical steroids are of paramount importance when reducing inflammation caused by eczema.
9. Are there any side effects of steroid treatments?
If steroids they are used inappropriately, they can cause skin thinning, which is cosmetically disfiguring. There is also a phenomenon called tachyphylaxis, which is when normal steroids lose their effects, and stronger steroids are required instead.
However, if you are getting your eczema treated by a qualified medical professional, the correct dose, potency, duration and class of steroid will be given — appropriate to your child’s eczema depending on the location, age group and severity of eczema.
© 2017 Dr Teo Wan Lin. All rights reserved.
Dr. Teo is an accredited dermatologist at TWL Specialist Skin & Laser Centre who is well-versed with childhood eczema. She has been interviewed on the topic by Singapore magazine, Motherhood, and Singapore news channel, Channel NewsAsia.