All About Childhood Eczema

This post was written by WhiteCoat Partner Paediatrician, Dr LIM Yang Chern. You can find out more about WhiteCoat’s General Paediatrics service here

What is childhood eczema?

Childhood eczema, also known as “atopic dermatitis”, is an inflammatory condition of the skin that affects around one-third of children. The incidence is often higher in developed countries such as Singapore. The signs of eczema in infants and children include dry, red, and itchy skin.

It is part of an overall condition called atopy, which refers to the genetic tendency to develop allergic diseases, such as allergic rhinitis (a condition that is commonly mislabelled as “sinus” problems in our local context). Other allergic diseases also include eczema, allergic conjunctivitis, and asthma.

Eczema very commonly starts in infancy, before the age of one. About 10-15% of children develop lifelong eczema. It is believed that the earlier the eczema is managed and treated in childhood, the better the chances of a child outgrowing their eczema. Hence, it is important to recognize the condition early and begin treatment!

What are the common causes of eczema?

The causes of eczema are multi-factorial and not completely understood yet. There is, however, a genetic component to it, with a child being more likely to develop eczema if one of their parents has had it.

Infrequently, children can have food triggers that cause eczema flares. It is important to note that the food is not a cause of eczema but a trigger. In such cases, you can suspect a certain food to be a potential trigger when there is a clear temporal cause and effect relationship. Confirmation of this trigger can be obtained via skin testing.

Children with eczema also tend to have a stronger reaction to mosquito and insect bites, and might experience large local swellings.

Is there a difference between eczema and an allergy / viral-related rash? How do I tell the difference?

Allergies can trigger eczema. For example, a common local topical trigger is house dust mite allergy.

A viral-related rash (for example: chickenpox and HFMD) often has a different appearance from eczema. Eczema rashes are often dry and scaly, with some possible swelling. Viral-related rashes, on the other hand, can vary greatly in terms of appearance. Most of the time, they resemble splotchy red spots.

In terms of timing, viral rashes tend to be acute, and can go away quickly with the right treatment. Eczema, however, tends to be more long-standing. As both conditions may exhibit overlapping symptoms, it may be hard to tell distinguish between the two on your own. Speak to a Paediatrician who can help make that assessment for you.

How can I treat my child’s eczema?

As genetic contribution plays a large role in the formation of eczema, there is no established cure for the condition currently. However, there is good news — there are means to control eczema!

For eczema to be well-controlled, it takes discipline on the part of both the parents and the child. This includes early intervention, persevering with consistent adherence to a treatment plan, and avoidance of known triggers.

Since eczema is an inflammatory condition, it will require anti-inflammatory medication to control it. This will take the form of a steroid-containing cream or other novel non-steroidal anti-inflammatory creams. Typically, you will not be receive oral steroid prescriptions for eczema. However, in certain cases, your doctor may prescribe oral steroids for your child.

Is it really safe for my child to use steroids?

Personally, I have encountered much steroid phobia in my professional practice thus far. It is important to make a distinction between topical and oral steroids. Steroidal toxicity occurs when oral steroids are taken for a prolonged period of more than two weeks.

Topical steroids, on the other hand, are mostly absorbed into the skin. In this case, only a small fraction enters the body. It is very rare to encounter steroid toxicity in distant organs from using topical steroids. This tiny risk of steroid toxicity from topical steroids pales in comparison to the risk of complications due to untreated or poorly controlled eczema. I have seen too many bad skin infections resulting from undue steroid avoidance in children with severe childhood eczema.

How can I help my child avoid eczema flares? 

The mainstay of maintaining remission of eczema is good daily skincare with proper cleansers and moisturisers. Additionally, it is important to choose clothes made of non-synthetic materials for daily wear.

Examples of eczema treatment modalities include topical creams, eczema baths, wet dressings or compresses, and sometimes even oral antibiotics.

As eczema is a skin condition, treatment is targeted at ALL the skin. It is important to apply moisturiser from top-to-toe! Spot treatment is insufficient, as eczema can flare at any part of the body that is covered by skin. Moisturise your child twice a day, and apply more moisturiser when the skin feels dry or rough.

Most importantly, it is important to understand that there is no one-size-fits-all treatment plan for eczema. Doctors often need to try a variety of creams to find the best one for your child, so please be patient while your doctor titrates the treatment plan in partnership with you. It is recommended that parents avoid doctor hopping during this period of treatment titration.

When should you teleconsult a Paediatrician?

First, you’ll have to ask yourself these questions. Is the rash blistering and forming little bubbles? Or, does the ranch not blanch (when performing the glass cup test*)? If the answer is yes to any of these questions, you should seek early medical consultation.

Furthermore, most viral rashes disappear within a week. If you are observe that your child’s rashes are not healing, you should also seek medical attention.

If your child has already been diagnosed with childhood eczema, further follow-ups and tweaking of treatment can often be done via teleconsultation.

Should you observe persistent or even worsening symptoms, teleconsult a Paediatrician on the WhiteCoat app with your child for eczema / rashes. Experience the convenience of remote care for your child, and receive the required care and medication from the comfort of your own home. Click here to find out more about our Paediatrics service, or click here to go back to the blog.

*Here’s what you need to do when performing the glass cup test . First, press a transparent material (e.g. glass cup) against the rash. If the red coloration fades and then returns when you release pressure, that rash is blanching. If there is no blanching, the rash is potentially dangerous. You should ensure that the patient receives medical attention as soon as possible.