Eczema occurs in about 3 per cent of children and usually begins between two and 18 months. There is very often a family history of atopic illness such as eczema, asthma, or hay fever.
Eczema can be a very frustrating condition to deal with. The most important first measures in the treatment of eczema are the avoidance of soaps, baby bath products and bubbles, and the use of an emollient in the bath and an emulsifying ointment to hydrate the skin. There are many different products that can be used, but simple preparations such as aqueous cream (which can be used to wash with, and as a moisturiser) or Oilatum are often just as effective as more complex formulations.
Emollients such as aqueous cream can be applied as often as necessary and the better hydrated the skin is, the less likely it is that steroids will be required. Trial and error may be needed to find the right emollient for a particular child. Occasionally, some ingredients can cause sensitivity reactions (lanolin is a frequent culprit) and will need to be avoided.
If these measures are not leading to an improvement, the next step is treatment with a steroid cream or ointment (prescribed by the GP). It is wise to avoid the most powerful steroids. Hydrocortisone one per cent (a mild steroid) is the usual one used. Steroid cream suppresses the inflammation and irritation, and the combination of emollient and steroid cream helps to relieve itching, and therefore scratching, and allow the skin to settle.
Steroid creams used excessively may cause thinning of the skin and changes in pigmentation. However, when steroid creams are required because eczema cannot be controlled by other measures alone, they should be used, and side effects are very unlikely to be a problem. The eczema itself if untreated will lead to skin changes and damage, and any effects from the appropriate use of steroid creams are likely to be tiny in comparison. Research has not revealed any long-term effects relating to the use of steroid cream for childhood eczema and there are no comparable alternatives to steroid cream for this condition.
While in individual cases, factors such as diet, and specific allergies, e.g. to wool, may play a part, in many cases no apparent cause for eczema is found. However, children who have eczema which is difficult to control with all the above measures may require referral to a specialist for further investigation and assessment of their eczema.
On a positive note, of all children suffering with eczema, 50 per cent will have lost it by the age of five years, and a further 30 per cent will have recovered by their early teens.