Childhood eczema (atopic eczema)

What is atopic eczema?

Atopic eczema (atopic dermatitis) typically causes dry skin, itching and recurring flare-ups of eczema. Symptoms can range from mild dryness to more widespread skin changes that may affect sleep, well-being and daily life.

Atopic eczema is not contagious and is not caused by poor hygiene. The condition is often seen in children with a hereditary tendency towards eczema, asthma or allergies.

At Charlottenlund Private Hospital, we offer assessment and treatment of atopic eczema in infants, children and adolescents.

Symptoms of childhood eczema

The most common symptoms are itching, dry skin, redness, rash, scaling, cracks in the skin and sleep disturbances caused by itching.

Itching is often the most troublesome symptom. It can lead to scratching, which further irritates the skin and may worsen the eczema.

Atopic eczema and the skin barrier



Atopic eczema is a chronic inflammatory skin condition in which the skin’s protective barrier does not function as effectively as normal. In a significant proportion of children with moderate to severe atopic eczema, a mutation can be found in the gene responsible for producing the protein filaggrin — a protein that plays a key role in helping the skin retain moisture and keep irritants out. When the skin barrier is weakened, allergens and microorganisms can penetrate the skin more easily and trigger an inflammatory reaction.

Atopic eczema does not occur in isolation. Many children with atopic eczema also have other atopic conditions such as allergic asthma and hay fever — a connection known as the atopic triad. It is important to emphasise that food allergy is not the cause of atopic eczema, although it can occur as an associated condition.

What does childhood eczema look like?

The appearance of eczema varies depending on the child’s age.

In infants, eczema often appears on the cheeks, forehead, scalp, arms and legs.

In older children, eczema is most commonly found in the bends of the elbows, behind the knees, on the wrists and around the neck.

Eczema can be intermittent, with periods when symptoms improve and periods when they worsen.

Why do children get eczema?

The exact cause is not fully understood, but the condition is believed to result from a combination of genetic and environmental factors.

Children with atopic eczema often have a weakened skin barrier, which makes the skin more sensitive to irritation and dryness.

Factors that can make eczema worse include:

• Dry air
• Cold weather
• Heat and sweating
• Frequent washing
• Irritating skincare products
• Infections
• Stress in older children and adolescents



How is the diagnosis made?



The diagnosis is usually made through a dermatological assessment of the symptoms and skin changes.

There is no single blood test or other test that can diagnose atopic eczema. In some cases, further examinations may be needed if an allergy or another skin condition is suspected.

Treatment

Treatment depends on the severity of the symptoms and the child’s age.

Basic treatment typically includes:

• Moisturiser

Daily use of a moisturiser is an important part of treatment. The aim is to strengthen the skin barrier and reduce dryness and itching.

• Medicated creams

During flare-ups, medicated creams may be needed, including corticosteroid creams or other anti-inflammatory treatments.

• Avoiding triggers

It may be helpful to identify and limit factors that make the eczema worse.

Preventing flare-ups

The aim of treating atopic eczema in children is to keep the condition under control and prevent new flare-ups. There is no curative treatment, but with the right and consistent care, most children can achieve good control of their symptoms.



Regular use of moisturiser is the most important preventive measure. Creams with a high fat content are recommended, preferably fragrance-free, and should be applied at least twice daily — also during periods when the skin is calm and there are no active symptoms. Baths should be short and taken in lukewarm water, as frequent washing and hot water can dry out the skin further and weaken the skin barrier.

Identifying individual triggers is also an important part of treatment. Wool worn directly against the skin, certain cleaning products, furry animals and house dust mites can worsen eczema in some children.

When should you see a doctor?

It may be appropriate to have your child assessed by a dermatologist if:

• The eczema does not improve despite treatment
• Itching affects sleep or well-being
• Flare-ups keep recurring
• There is uncertainty about the diagnosis
• The skin becomes weepy or shows signs of infection



Atopic eczema and sleep



Itching is the symptom that most commonly affects sleep in children with atopic eczema. It often becomes worse in the evening and at night, as skin temperature rises and the skin loses moisture. Sleep disturbances can affect the child’s well-being, concentration and behaviour during the day — and in severe cases, they can also affect the sleep of the rest of the family.

Treatment that reduces itching and brings the eczema under control can help improve sleep quality. The bedroom should be kept cool, and wool clothing directly against the skin should be avoided. During periods of severe itching and sleep disruption, a dermatologist can assess whether additional treatment measures are needed.

Atopic eczema in everyday life



Atopic eczema can affect a child’s daily life at daycare and school. Itching and visible skin changes can sometimes make it difficult to concentrate, and some children may find that others react to the appearance of their eczema.

It is a good idea to inform caregivers and teachers about the child’s condition, especially during periods of active flare-ups. Many children need access to their moisturiser during the day.

Eczema is not contagious, and children can generally take part in normal activities, including swimming, although chlorinated water may irritate the skin in some cases. It is a good idea to apply moisturiser thoroughly after swimming.

Can children grow out of atopic eczema?



Yes. Many children find that their symptoms become less pronounced as they get older. Others may continue to have dry and sensitive skin or experience periods of eczema later in life.

Although the eczema may not disappear completely, most children can achieve good symptom control with the right treatment and skincare.