It’s never too late to treat atopic eczema in babies and children

In many new-born babies, eczema can show up as red patches that may be itchy and irritating. Atopic eczema (AE) is a chronic and relapsing skin disease characterised by itchy dry skin. It is common in childhood and estimates show that up to 20 per cent of children may be affected at some stage. It can have a significant detrimental effect on the quality of life in affected children and their families. Most children will be affected before school age and although AE generally improves with age, the condition may persist into adulthood in 30 per cent of patients.

AE is associated with other atopic conditions such as asthma and allergic rhinitis, which often develop at a later age. The causes of this condition are complex, and involve genetic factors, exposure to environmental agents and altered regulation of skin’s immune system.

Genetic defects in susceptible children lead to an impaired skin barrier that allows water loss. The entry of environmental triggers results in skin inflammation and allergic sensitisation.

So, what is childhood AE? The main symptom of dry red skin is itchiness, which at times may be unbearable, causing a child to want to scratch constantly. As it becomes more severe, the skin can crack and bleed. In young infants, the main areas affected are the face and scalp progressing to the neck, and creases in arms and legs. If left untreated, it could lead to the skin becoming discoloured and thick.

Diagnosis can be established after analysing history and a thorough examination. The treatment should be tailored to the severity of the AE. A few important factors to address here are the education of the child and parents/care givers, the restoration of skin barrier, reduction of skin inflammation, elimination of avoidable triggers and treat complications. The time spent in explaining the condition and how to apply treatment in a safe manner can aid in relief. Moisturisers can help reduce water loss and restore the barrier function of the skin.

The mainstay of reducing inflammation is the use of steroid ointments with guidance for the parents on how much and how often to use. In very young children and with more severity, looking for common food allergens such as milk, eggs, dairy products and wheat may be important in conjunction with a paediatric allergist. Older children may develop contact allergy, which is investigated by patch testing. Infections are the most common complication of AE and can be managed by antibiotic creams and syrups. A few children may need powerful systemic medication under the supervision of a dermatologist.

The future is very exciting for new therapies and the UAE now has the licence to treat those aged between 12 and 18 years for moderate to severe AE with Dupilumab. If you have a child with AE, do not be afraid to ask your doctor or other healthcare workers about your concerns.

Diagnosis can be established after analysing history and a thorough examination. The treatment should be tailored to AE’s severity.” Dr Hossain Shahidullah consultant paediatric dermatologist