SingaporeMotherhood | Baby & Toddler

July 2015

The A to Z of Eczema in Children

Eczema is a chronic disorder of the skin that is more common in young children. According to a study done in 2002 (the most recent one here), the prevalence of atopic eczema in Singaporean school children was found to be about 20%, which is keeping with the rates in other parts of the world. But what exactly is this condition and what is the best way to treat it?

“Eczema is a skin condition where there is inflammation of the skin,” explains Dr Tan Kian Teo, Consultant Dermatologist at Skin Physicians. “There are many types of eczema, of which the most common is atopic eczema, which tends to start in early childhood. The severity varies between individuals and it can flare up from time to time.”

The Causes of Eczema

So how exactly does someone get this skin condition?

“The causes of eczema are multifactorial and yet to be completely elucidated,” says Dr Wang Yi Shi, Consultant Dermatologist at W Skin & Laser Clinic. “The current thinking is that eczema sufferers are genetically prone towards development of dry, sensitive skin, and they have a somewhat dysfunctional immune system which ‘overreacts’ to irritants and allergens on the skin.” (e.g.: heat, sweat, dust and chemicals)

“There is a significant hereditary component to the disease, as many eczema sufferers come from families where other members are also afflicted with eczema, asthma or allergic rhinitis. In recent years, genetic mutations of the ‘filaggrin gene’ have been identified to be an important factor in the development of eczema in certain groups of patients.”

“The ‘filaggrin gene’ encodes the production of filaggrin, which can be simply understood as a key constituent in the production of the skin’s own natural moisturising factors. With a dysfunctional filaggrin gene, the skin is unable to produce enough of its own natural moisturising factors. This leads to dry skin which is easily irritated. However, filaggrin mutations are not found in all eczema sufferers and is certainly not the only cause of the disease. There remain other causative factors which are yet to be known.”

Getting A Diagnosis

As you might not be able to tell the difference between a temporary skin infection and eczema, it is advised to see a dermatologist for the most accurate diagnosis for your child. “Eczema is usually diagnosed based on its history, symptoms and signs,” says Dr Tan. “Affected areas of the skin are red, inflamed and scaly. The commonly affected areas are where the skin creases, such as the neck, front of the elbows and behind the knees. The face is frequently affected in babies. However, any area of the skin may be affected. The affected skin is usually itchy. Eczema tends to flare up from time to time. The severity and frequency of these flare-ups vary.”

Once your child is diagnosed with the condition, there are several things you can do to make him feel better. “Patients are generally advised to avoid irritants and triggers,” Dr Tan explains. “A soap-free low pH wash should be used. In patients whose houses contain dust mites, measures such as regular cleaning and vacuuming should be instituted. Patients are advised to avoid scratching the skin as it can worsen the eczema. When necessary, sedating anti-histamines can be given at night as it has been found that some patients frequently scratch while they are sleeping.”

Treatment Options for Eczema

There are also some forms of treatments that are recommended for those suffering from eczema.
“The standard treatment for eczema includes medicated anti-inflammatory creams, which include topical steroids, topical calcineurin inhibitors, as well as moisturisers to hydrate and repair the skin,” says Dr Wang. “Also, the use of a gentle skin cleanser which will not strip away the natural oils and moisture which are beneficial for the skin is recommended. The ingredients in cleansers and moisturisers do matter.”

“For eczema sufferers, I would recommend the use of a body wash and moisturiser which contains filaggrin breakdown products (components of natural moisturising factors) to help restore moisture and rebuild the damaged skin barrier, such as Cetaphil Restoraderm Skin Restoring Moisturiser and Cetaphil Restoraderm Skin Restoring Body Wash. These are also preservative-free, fragrance-free and gentle enough for the entire family.”

“For more severe cases of eczema, other treatments include ultraviolet light therapy and oral medications which suppress the overactive immune system. These treatments are usually administered by a dermatologist and patients need to be closely monitored while on these treatments.” The good news is, eczema can be treated or at least controlled, in most cases.

“Many children do outgrow their eczema,” says Dr Wang. “This is a common observation, especially for children with mild, localised eczema. It tends to become a lot better or goes away completely by the time the child goes to primary school. However, children with very bad eczema have a higher risk of the disease persisting into adulthood.”


A Mother’s Experience with Eczema

Cassandra Ruth, 44, has dealt with her son’s eczema for seven years; Oswald Gerard Emmanuel developed the condition at the age of 14. “Due to sweat, dust and humidity, coin-shaped patches of eczema appear all over his skin, especially at the joints and skin folds, which causes him to scratch. This then leads to wounds and bleeding. Dead skin ends up on the floor and bed sheets are stained with blood. It leaves him very uncomfortable to carry on with the day’s activities, especially any physical activities.”

“When the situation with his skin worsens, so does his attitude towards everything in general,” she explains. “He would rather not go out or meet his friends. He also finds it very difficult to shower because of the open wounds. It causes an emotional turmoil. It affects his school work too as he’s unable to concentrate on his studies or complete his homework to the best of his ability. I usually ask him to take a shower and apply moisturiser as well as any steroid creams, depending on the severity of the situation. To ensure that he doesn’t scratch at night, he takes anti-histamines that allow him to sleep better. Now, he applies creams purchased from his dermatologist.”

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The A to Z of Eczema in Children