Eczema

Eczema is a very common skin condition affecting at least one in every five children. Eczema makes the skin very itchy, red, dry and cracked. This page from Great Ormond Street Hospital (GOSH) explains the causes, symptoms and treatment of eczema and indicates where to get help.

Genetic factors are important, particularly those that lead to poor skin barrier function. Eczema can be triggered or worsened by factors that cause increased dryness of the skin, including soaps and shampoos, hard water and central heating.

Eczema can affect any area of the skin.

The severity of symptoms and areas affected can vary.

Itching is the most significant symptom of eczema, and scratching makes it worse. The itching is often bad enough to disturb sleep. Sometimes the scratching can be so severe that areas of skin start to bleed. They may also become infected so that the skin oozes and crusts. If inadequately treated patches of eczema may become thickened and discoloured.

As eczema is such a common condition, it can almost always be diagnosed by your family doctor (GP) or health visitor. They may ask about when the symptoms appeared, how long they have been present and how they are affecting the child’s everyday life. They will also look at the child’s skin to ‘map’ which areas are affected. If any patches seem to be infected, they may take a skin swab to send to the laboratory for testing. This is needed to identify the bug causing the infection.

There is no cure for eczema but the symptoms can be managed well if appropriate treatment is used, and aggravating factors avoided. Emollients are needed to soften and moisturise the skin and steroid creams to reduce inflammation. There are also special bath creams which add moisture to the skin which should be used instead of bubble bath or soap. Antihistamines are not useful for treating eczema.

More intensive treatment is sometimes needed in more severe cases. This can include ‘wet wraps’, which involve application of emollient and steroid cream covered with layers of wet wrap clothing. The aim of wet wraps is to increase the moisture in the skin and calm down the inflammation. Stronger medicines are also available – most commonly medicines to damp down the immune system. These will only be prescribed by specialist doctors.

Removal of food groups from the diet does not cure eczema. Some children with eczema may have food allergies, which will require specific management but this will not remove the need for treatment of eczema..

Scented products should be avoided as far as possible. Cotton clothing should be worn next to the skin day and night, and affected children should be kept cool.

If properly managed in early childhood, eczema can be cleared or well controlled, with minimal need for ongoing treatment. It is advisable to continue to consider the skin as delicate and avoid perfumed body sprays, deodorants, soaps, face wipes and body washes. In terms of employment, there should be few jobs that are unsuitable though hand eczema can be provoked by hairdressing, food preparation or the frequent hand washing required in healthcare professions.

Watch our video series on eczema and how to treat it on the GOSH Health Information YouTube channel.