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ALL ABOUT SKIN

Atopic dermatitis

What is atopic dermatitis?

Atopic dermatitis is common among children and inflammation of the skin causes a dry and itchy rash. It usually starts in infancy and childhood. In infants, the face and outer side of the limbs are affected but during childhood, it usually affects the neck and skin folds. Heat and perspiration aggravate the rash. In mild eczema, the rash is red, dry and itchy. If the condition worsens, there may be oozing, crusting and bleeding. The itch can be severe enough to interrupt the child’s sleep.

Why does my child have eczema?

Genes play an important role as atopic eczema often runs in families. It is usually inherited from parents, often the mother, though the father can be affected. About 1 out of 20 people in Singapore have sensitive skin. Eczema is more severe if it appears early (2 months of age). The child may also have a tendency to develop other hypersensitivity disorders such as asthma, allergic rhinitis or hay fever.

In atopic eczema, the immune system is altered and overreacts to things such as irritants (eg soaps, fragrances, detergent), and allergens (eg house dust mites, animal dander). In addition, an impaired skin barrier also contributes to dryness and increased penetration of allergens and bacteria/viruses.

Is eczema contagious?

No, it is not infectious and you cannot spread it to other people.

Will my child grow out of eczema?

In general, atopic eczema tends to improve as the child gets older and 50-75% may clear in the teens. However, eczema may still occur on and off at times, even in adulthood. Good skin care and use of appropriate medications is important to minimise these occurrences.

How can I care for my child’s skin?

  1. Use mild nourishing soaps, or cleansers such as bath oils. For infected skin, antiseptic cleansers with antiseptic may be needed.
  2. Moisturise your child’s skin frequently to build a healthy skin barrier and reduce the risk of developing eczema, especially during travel to cold and dry climates, or after swimming. When a moistened dressing like Tubifast dressing is used over the moisturiser, it enhances the effect. Moisturisers do not cause thinning of the skin.
  3. Certain clothing material like cotton are more comfortable for atopic skin and can absorb perspiration well.
  4. Try your best to help your child avoid scratching, rubbing and picking the skin. This makes eczema worse and leads to unsightly pigmentation, broken skin and scars. Let us help you with techniques to minimise scratching!

Why does my child have an eczema flare?

  1. Environmental factors, such as heat, dust, pets and irritants (eg harsh soap)
  2. Dry skin
  3. Being unwell (eg having a cold or flu)
  4. Teething in babies
  5. Skin infections with bacteria or viruses, which may be due to excessive scratching
  6. Food allergens (rare)
  7. Stress

Is it true that certain types of food worsen atopic eczema?

The prevalence of food allergies is highest in young children less than 3 years old with severe eczema. It may be suspected if eczema is difficult to control or rashes appear after eating a specific food. Common food allergens in children include cow’s milk, hen’s egg, peanut, tree nuts, shellfish, wheat and soy. Tests for food allergies are available, speak to your dermatologist regarding these tests.

I need help to manage my child’s eczema!

Let us work hand in hand with you to improve your child’s skin condition as we recognise that eczema may affect your child in many ways. Poor sleep can result from constant itch and scratching, leading to reduced concentration in the day. Severely affected children may refuse to socialise and play as school mates may call them names or think they have “dirty skin”. Thus, it is important to treat eczema and maintain good skin health.

Most people are familiar with the use of topical steroids to reduce skin inflammation, but there are many misconceptions present. Your dermatologist will share how to use topical steroids safely and effectively, together with moisturisers, for maximum benefit.

Steroid-free topical medications are available and effective for children, and the doctor will advise you accordingly.

In cases of severe recalcitrant eczema, oral medications may be needed.

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