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Childhood Atopic Eczema

Childhood Atopic Eczema is a common and miserable condition. General measures such as avoidance of precipitating factors such as use of soaps, wearing wool next to the skin, overheating, house dust and possibly certain foods may be helpful. Secondary infection with staph aureus is a common cause of exacerbation of childhood atopic eczema and this should be treated with a 2 week course of oral Flucloxzcillin or Erythromycin.

Childhood atopic eczema is usually a chronic relapsing condition and management is aimed at providing an acceptable quality of life until remission occurs. Nearly all children will benefit from using an emollient regularly and it is important to choose one that the child will use, and to prescribe adequate quantities. Use of a bath additive and soap substitute such as aqueous cream might also be helpful. Topical corticosteroid preparations should not be withheld if the child is uncomfortable or suffering from sleep loss because of scratching and itching. Generally, topical corticosteroid preparations are given for controlled periods followed by emollient holidays where possible. Mild cases of childhood atopic eczema will usually respond to very mild preparations such as 1% hydrocortisone.

Chronic, dry atopic eczema responds best to ointment preparations, whereas acute weeping lesions require the application of lotions or creams initially. Moderately potent topical corticosteroids may be given for short periods for atopic eczema that is unresponsive to the above measures. Severe atopic eczema exacerbations or very thickened atopic eczema on the limbs may benefit from the addition of bandages at night. Stronger preparations may be needed for discoid patterns of childhood atopic eczema and also for short periods during severe exacerbations unresponsive to simpler measures.

In general, preparations stronger than 1% hydrocortisone should not be used on the face. Quantities of cream/ointment should be recorded at follow-up visits and continuous use of topical corticosteroids should be avoided if possible. Occasionally, coaltar preparations may be helpful in chronic, thickened eczema on the limbs. Short term use of oral sedative antihistamines may be helpful in breaking a cycle of sleep disturbance due to the itch from atopic eczema. The evidence that evening primrose oil is helpful in this condition is not convincing. Occasionally, severe cases of atopic eczema require additional measures such as short courses of oral steroids, oral Cyclosporin A, photochemotherapy and traditional Chinese herbs, but these should be initiated under specialist supervision.

©The Eczema Team 1995