How is Eczema diagnosed in Children?
The following are pointers to Eczema – the child need not have all of these features except for itching:
- The rash is almost always itchy.
- Over 18 months of age the rash usually affects the front of the elbows or backs of the knees, back of the neck and other “flexural” areas – but not always
- Generally Dry Skin
- A child over 4 years has a history of Hayfever or Asthma
- A child under 4 years of age: There is a significant family history of Hayfever, Asthma, or Eczema
- The younger the age of onset, the more likely it is Eczema
Your GP will be able to make a diagnosis of Eczema in the majority of cases.
What Causes Eczema?
Eczema that starts in childhood is usually caused by a genetic susceptibility to environmental allergens – in otherwords, atopic dermatitis / Eczema. Other atopic conditions are asthma & hayfever.
A genetic defect in One of several genes that code for the Protein Filaggrin
Abnormal structure and function of the upper layer of skin (Epidermis)
Defective Skin Barrier Function
Skin becomes sensitised by allergens & inflamed in response to irritants, bacteria, dehydration etc
|Medium Moisturiser (eg. out and about)||QV Cream||Cetaphil Moisturising Cream|
|Heavy Moisturiser (eg. overnight or flare ups)||QV Flare Up Cream||Cetaphil Intensive Moisturising Cream|
|Light Moisturiser (Lotion)||QV Skin Lotion||Cetaphil Moisturising Lotion|
|Soap Substitute – For Bathing||QV Gentle Wash (Intensive wash has more moisturiser)||Cetaphil Gentle Skin Cleanser|
|Antibacterial Bathing Products||QV Flare Up Bath Oil||Cetaphil Gentle Cleansing Antibacterial Bar|
Dr Richard Beatty has no affiliation with any of the emollient cream retailers or manufacturers (or any other products) & gives no particular judgment or recommendation about these products.
In 2015, A consensus statement about the safety of steroid creams in kids was put out by 20 Australian Paediatric Dermatologists. They are worth listening to – I’ve heard a Paediatric Dermatologist say that around half of their workload is Paediatric Eczema, and they see lots of very severe cases including those admitted to hospital.
The statement goes along these lines “The advice given by dermatologists to parents of children with Eczema regarding the use of topical steroids is unfortunately frequently undermined by other health care professionals … Recommendation to ‘use sparingly’ is nonsensical and has no value”
The problem is that fears over the side effects of topical steroids are based on evidence from the 1960s and there’s a lot of data to support their safety when used according to guidelines. Indeed, the risk of not using it appropriately is really what has prompted this statement.
The statement indicates that the following side effects do not occur when the treatment is prescribed in accordance to guidelines: Thinning of the skin, loss of pigment, excessive hair, bruising, prominent blood vessels, stretch marks.
The experts above are really saying this: Look at the risks poorly controlled Eczema (they see a lot of that) and put the the much over-done risks of topical steroid treatment into perspective. We’re really all on the same page: The objective is well controlled Eczema with minimal side effects.
We all think of Eczema as being an allergic condition. In truth, only a small proportion of eczema is ‘explained’ by allergy to anything external.
There are three main types of allergies in Eczema. Contact allergic dermatitis is more common on adults and is confirmed with Patch testing. This test is usually performed in a dermatology or allergy clinic.
Airborn Allergy can contribute to eczema. Think of animal dander, grasses and house dust mite. The eyelids are normally involved.
Food allergy can also trigger eczema. This type of allergy starts in early childhood, most commonly after ingestion of eggs, wheat, cow’s milk, soy or peanuts. Look for an immediate flare of eczema after starting the new food. Food Allergy Testing with skin or blood testing is most useful in kids with moderate to severe eczema who do not improve on standard treatment. However, it is important to understand that the test may or may not help improve control of eczema. Around 1 in 5 infants with eczema have a trigger with some type of food.
Food intolerance is is rather different than food allergy because there is no known mechanism for the food to trigger an eczema flare up. In more practical terms, food intolerance can be suspected in kids with dermatitis around the mouth, even if food is eaten without contact on the skin. Foods that are implicated include strawberries, tomatoes, citrus, and artificial sweeteners.
Baby wipes are increasingly recognised as a cause of contact allergic dermatitis. Look for the ingredient Methylisothiazolinone which is found in a wide variety of products – not just baby wipes.