Eczema is a common condition that causes the skin to become dry, itchy, and red. Symptoms can vary from a mild rash that disappears quite quickly to a more severe condition that is present for a long time.
The main goal of treatment is to eliminate itching which, in left untreated, can cause the condition to get worse.
Eczema (atopic dermatitis) affects one in three New Zealanders. It is particularly common among young New Zealanders, occurring in 15% of children and 9% of adolescents. There are also ethnic differences, with eczema more common among young Maori and Pacific New Zealanders.
Although eczema can occur at any time of life, it usually develops in a child’s first year. Most children have a substantial improvement in their eczema by their mid-teens but, in some, severe eczema persists into adulthood.
Eczema is not contagious - you cannot get eczema from, or give it to, another person. However, skin affected by eczema may be more vulnerable to infections such as warts, cold sores, and athlete's foot.
Potential causes of eczema are:
- Factors that cause the skin to become dry, and more vulnerable to irritants or infection
- Genetic factors – eczema runs in families
- Immune system dysfunction causing an unwanted inflammatory response in the skin.
Certain substances or conditions called trigger factors can cause eczema to flare-up:
- Irritants such as soaps and detergents, wool, skin infections, dry skin, low humidity, heat, sweating or emotional stress.
- Allergens such as dust mites, pollen, moulds, or foods.
Consultation with your doctor may be helpful in identifying the triggers.
Signs and symptoms
Eczema usually starts on the face followed by the hands and feet. Older children tend to be affected in the elbow and knee creases, neck, wrists, ankles, and feet. The hands and feet tend to be the most commonly affected areas in adults.
The classic symptoms of eczema are:
- Itching. This is the worst aspect because it can be upsetting for a young child with eczema. It also makes the child scratch causing further rawness of the skin and possible infections to develop.
- Redness caused by extra blood flowing through the blood vessels in the skin in the affected area.
- A grainy appearance to the skin, caused by tiny fluid-filled blisters just under the skin called “vesicles.”
- Weeping when the blisters burst, either by themselves or because of scratching, and the fluid oozes on to the surface of the skin.
- Crusts or scabs that form when the fluid dries.
- Children with eczema often have dry, scaly skin. This may be the result of the eczema or it may also be the natural skin type of the family. Dry skin can be a predisposing factor to developing eczema.
- Pale patches of skin may appear because eczema can disturb the production of pigment, which controls skin colour. The effect does fade and disappear.
- Areas of rough, leathery, thicker skin as a result of scratching.
The main goal of treatment is to eliminate itching, which is uncomfortable and causes or worsens the other symptoms. In some very mild cases eczema can be managed by:
- Avoiding likely sources of irritation (triggers)
- Using emollients such as special bath oils and moisturisers.
Additional treatment options may be needed if the condition worsens. In some cases, a GP will refer the child to a skin specialist (dermatologist).
There are different strengths of corticosteroid creams and ointments available on prescription. that can reduce itchiness and redness. Care needs to be taken, especially if applying a strong corticosteroid as it can cause the skin to become thin. Only thin smears should be applied to the rash. The best time to do this is after a bath, as the skin is more absorbent.
It is not advisable to use a corticosteroid on the face unless prescribed by a doctor. Occasionally, corticosteroid medication may need to be given orally.
Pimecrolimus cream (Elidel) is a steroid-free medication used to treat eczema, and other inflammatory skin conditions. It is available on prescription and can be applied to affected skin on the face, head, and around the eyes where corticosteroid creams are not recommended.
Antihistamines may help the itching. The drowsiness they cause can also be useful at night to conquer sleeplessness caused by the irritation.
In severe cases of eczema, medications to suppress the immune system may be needed to treat the condition.
Skin that is broken and damaged is more likely to be infected by bacteria or fungi (yeasts). One common type of bacterium (Staphylococcus aureus) produces yellow crusts or pus-filled spots. Should bacterial infection occur, this can be treated with a course of antibiotics.
Antibiotics can be applied to the skin as a cream or taken orally in the form of syrup, capsules, or tablets. Fungal infections can be treated with antifungal medication in the form of creams or tablets.
Phototherapy, or ultraviolet (UV) light treatment, may be suggested for severe eczema. Phototherapy involves controlled exposure to UVA and/or UVB rays for a few minutes, two to three times each week. A course of treatment may continue for several months.
Special diets that exclude certain foods (elimination diets) have been effective in treating eczema in some children. However, not all children respond to diet therapy.
The following may help alleviate the symptoms and prevent future bouts (‘flares’) of eczema:
- Use moisturiser often (at least twice a day) even when there are no symptoms. Applying moisturiser while the skin is still moist after a bath or shower to help ‘lock in’ the moisture. Adding oil to bathwater will also help to moisturise dry, eczema-prone skin. Discuss with a doctor or pharmacist the different types of moisturiser available. It may take some time and experimentation to find the best product for your child
- Wear pure cotton or cotton-mixture clothes instead of wool or synthetics
- Do not use soap, especially deodorant or anti-bacterial soaps. Instead use a mild, non-fragranced liquid cleanser, emulsifying ointment, or water-dispersible cream
- Take shorter showers or baths and use warm instead of hot water
- After bathing, gently pat rather than rub your skin dry using a soft towel.
- Avoid enzyme detergents and fabric softeners when washing clothes as these can irritate the skin
- Avoid foods that are known to provoke allergic reactions such as peanuts, eggs, seafood, milk, soy and chocolate
- Direct use of antiseptics and solvents should be avoided
- Environmental factors, such as heat, sunlight, and cold can irritate the condition. If this is the case, avoid them as much as possible
- Use a humidifier in winter and summer
- Bandages can be used to stop scratching at night. Cotton mittens can also be helpful
- Fingernails should be kept short to decrease the damage caused by scratching.
Further information and support
Allergy New Zealand and the Eczema Association of New Zealand can assist with further information, support, and resources. Their contact details are:
Allergy New Zealand
Eczema Association of New Zealand (EANZ)
Allergy New Zealand (2010). Eczema (Web Page). Auckland: Allergy New Zealand. http://www.allergy.org.nz/A-Z+Allergies/Eczema.html [Accessed: 20/05/20]
Clayton, T., et al. Time trends, ethnicity, and risk factors for eczema in New Zealand children: ISAAC Phase Three. Asia Pac Allergy. 2013 Jul;3(3):161-78.
EANZ (Date not stated). Facts about eczema (Web Page). Eczema Association of New Zealand (EANZ). http://www.eczema.org.nz/eczema-facts/ [Accessed: 20/05/20]
NHS Choices (2019). Atopic eczema (Web Page). Redditch: National Health Service (NHS) England. http://www.nhs.uk/Conditions/Eczema-(atopic)/Pages/Introduction.aspx [Accessed: 20/05/20]
Kim, B.S. (2020). Atopic dermatitis (Web page). Medscape Drugs and Diseases. New York, NY: WebMD LLC. http://emedicine.medscape.com/article/1049085-overview [Accessed: 20/05/20]
Schwartz, R.A. (2020). Pediatric atopic dermatitis (Web page). Medscape Drugs and Diseases. New York, NY: WebMD LLC. http://emedicine.medscape.com/article/911574-overview#a4 [Accessed: 20/05/20]
Last reviewed – June 2020
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