Barts and The London Children's Hospital | For patients, families and carers | Health tips | Health tips - eczema
Health tips - eczema
Questions
Q. My 10-year-old has eczema. Will it ever go away?
Answered by Jean Robinson, Clinical Nurse Specialist for Children's Dermatology.
If used correctly, the topical steroids prescribed by your doctor will be very helpful in treating your daughter’s eczema and controlling her symptoms.
Unfortunately, many parents worry about side effects and either under-use or fail to use steroids. This means their children’s eczema is not properly controlled.
The most common side effect is skin thinning when the skin gets papery and wrinkly, but this is very rare and should not happen if steroids are used properly.
Topical steroids (also known as corticosteroids) have been the main treatment for eczema for 50 years. They help to reduce skin inflammation by damping down the abnormal reactions which happen in the skin with eczema.
They come in four strengths in the UK:
- Mild (weak)
- Moderately potent (moderately strong)
- Potent (strong)
- Very potent (very strong)
Most steroids come in cream and ointment formulations. Ointments are generally better as they are greasier and contain fewer preservatives than creams. Many children are prescribed two different strengths of topical steroid: a weaker one for face and neck eczema and a stronger one for body eczema.
You usually apply steroids once or twice daily and only to active eczema (reddened, thickened and open areas but not to cuts or grazes). After applying steroids, try to leave a 20-30 minute gap before applying moisturiser as applying it at the same time dilutes or weakens the effect of the steroid.
Some dermatologists may suggest you use the ‘fingertip’ method to apply steroids. One fingertip unit is about 0.5g – about the amount you can get on an adult fingertip. But it is probably easier if you simply apply a thin layer of steroid (just enough to make the skin shiny) to areas of active eczema. If there is eczema, it should be treated but you probably won’t need to use the steroid every day unless there is active eczema.
Answered by Jean Robinson, Clinical Nurse Specialist for Children's Dermatology.
Your son’s dry skin is part of his eczema. Healthy skin cells contain lots of water but children with eczema have skin which makes fewer fats and oils that act as a cement between cells. This means the skin cells dry out and shrink, and more water can be lost through the gaps in the skin barrier.
The pigment or colour changes in your son’s skin are a result of the inflammatory process which happens in eczema. Pigment changes are more marked in children with pigmented skin. It is also possible to have paler areas after periods of inflammation. If the eczema is controlled and kept that way, the colour of your son’s skin will go back to normal although it may take some months. The colour change will not be permanent.
Moisturisers (also called emollients) hydrate and soften the skin. They provide a protective film over the skin to keep moisture in and harmful things out. They come in different formulations and each child needs the one that best suits their skin.
Lotions are light. They are often good for hairy areas like the scalp. Creams are light and good for less dry skin. Gels are often good for use on the face or scalp. If the skin is dry, then ointments which are greasier are usually best. If your son’s skin is very dry he would probably benefit from an ointment-based moisturiser.
You should apply them 3-4 times during the day and at night if your son is awake and itching. Always apply them in the direction of hair growth so you don’t irritate any hair follicles or places where hair leaves the skin. You should always use the moisturiser even when your son’s eczema is clear. Your son probably needs to use about 250g each week (most pots contain 500g).
My 10-year-old has eczema. Will it ever go away?
Answered by Jean Robinson, Clinical Nurse Specialist for Children's Dermatology.
It is impossible to say on an individual basis if your son will grow out of his eczema but up to 90 per cent of children do so by the time they are adults. Your son is a little less likely to grow out of his eczema if it has been very bad and widespread and there is a strong family history of the condition. However, with treatment it is possible to control most children’s eczema.
Answered by Jean Robinson, Clinical Nurse Specialist for Children's Dermatology.
If your baby has eczema, bathing is an important part of the skin care she needs and there is no evidence that bathing her every day will lead to her catching colds. Make sure you have everything ready before you start and bath your baby in a warm room.
Babies and children with eczema should be bathed once a day. It may help to do this in the evening before she goes to bed as bathing is often soothing and will help the child settle better to sleep. It is important to make sure that washing and bathing are part of the eczema daily routine and that it is enjoyable for you and your daughter.
Washing and bathing removes previous treatments and cleans off any loose scales and crusts so that further treatments can sink into the skin effectively. We believe that bathing is preferable to showering because it allows the baby or child to soak in the water. We recommend adding prescribed bath oil to the water which will leave a film on the skin after your child has finished bathing. The water should be warm as hot water generally irritates the skin more and can lead to more itching.
We recommend that you don’t use soap to wash your baby but use a soap substitute such as Aqueous cream. Your baby should stay in the bath for about 15-20 minutes. The oil will make your baby and bath more slippery so consider using a non-slip bath mat and try to bath her when you can have help from another adult.
Bathing should be enjoyable for your baby so you could find some bath toys for her to play with in the bath. In some cultures, children are rinsed with fresh water after bathing but as this would rinse away the film of oil, we recommend that if you do rinse you do it with water which has some of the bath oil added. Remember to pat your baby dry rather than rubbing because this irritates the skin.
