Infantile eczema

Reviewed by Dr Stuart Crisp, paediatric specialist registrar and Professor James Ferguson, consultant dermatologist

What is infantile eczema?

Many children in the western world suffer from infantile eczema or atopic dermatitis, a form of eczema (skin inflammation) that won't stop itching. It is characterised by periods without symptoms followed by further outbreaks of differing severity.

Children who suffer from infantile eczema tend to have dry skin. They also have a high sensitivity to itching, together with an increased risk of developing other atopic illnesses - asthma, hay fever and allergy. Most children outgrow their infantile eczema while others continue to suffer from the disease more or less for the rest of their lives.

How does your child get infantile eczema?

Nobody knows what causes the disease, but for three quarters of sufferers infantile eczema, asthma or hay fever run in the family. It is also common for children with the disease to suffer from asthmatic bronchitis, asthma, hay fever or some other kind of allergic illness.

The disease usually becomes apparent before the child reaches the age of five, and most frequently appears when the child is between two- and six-months old.

What are the symptoms of infantile eczema?

Babies with infantile eczema develop an itchy red rash on their cheeks. This spreads over the face, down the neck to the nappy region, and may also appear on the arms and legs. Because of the itching, the child may seem upset or irritable, particularly at night.

The rash is normally dry, but if the skin is infected with bacteria (impetiginized eczema) the eczema will begin to suppurate (produce pus). This is a danger signal, and you should consult your doctor or a dermatologist if this occurs.

When the child is one-and-a-half to two-years old, the disease will follow a more typical pattern, with the rash appearing behind the knees and in the bends of the arms, wrists, ankles and neck.

Among adults, the typical symptoms are a variant of the pattern found in children. The eczema, dry on a base of thickened skin, normally appears on the torso and is often infected with skin bacteria.

A lot of people who suffer from an inherited tendency to develop allergies also show signs of so-called atopic stigmata: darkness around the eyes and a double furrow beneath them, cracks near the ear lobes and itchiness when wearing woollen clothes.

Who is particularly at risk?

Children, either of whose parents or siblings suffer from one of the 'atopic' diseases - hay fever, asthma or infantile eczema.

Good advice

If either or both partners in a relationship is atopic, it is a good idea to talk to your doctor or an allergy specialist before you become parents. They will be able to advise on diet, which may reduce your child's risk of developing an allergy and, to a certain extent, infantile eczema.

Make sure your child wears cotton clothes - not woollen or synthetic items, which will cause sweating and skin irritation.

Wash clothes in perfume-free soap. If your water is hard, add household vinegar when rinsing.

Apply plenty of moisturiser several times a day. In the summer, this should be a relatively thin lotion, whereas in the winter a thick cream should be used. Use non-soap based cleansers when washing the skin, for example aqueous cream.

If the eczema begins to suppurate - ooze pus - or small yellowish blisters appear in the eczema, consult a doctor at once. The eczema is probably infected and will need medication.

If your child has any allergies, make sure you get treatment and try to avoid things or situations you know make the allergy worse. These could include stress.

How does the doctor make the diagnosis?

The diagnosis is usually made on the basis of the visual appearances and the pattern of the disease.

Future prospects

It is important to realise that the disease may not disappear. It needs constant treatment even when there are no symptoms. However, with consistent skincare a number of the more serious complications can be avoided.

If your child suffers from infantile eczema, you should note that the eczema can become infected with micro-organisms. This is especially dangerous if the infection is of the type caused by the herpes simplex virus.

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