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Five ways to help care for your child’s atopic eczema

Eczema is a common condition that has a big impact on the lives of children and their families. It can cause soreness, itching and disturbed sleep. Keeping eczema under control takes a lot of effort.

Some parents find it difficult to know how best to look after their child’s skin. They sometimes find seeing their GP unhelpful. Some parents are overwhelmed by the amount of information available and that they don’t know who or what to trust.

In this study a group of parents of children with eczema, and health professionals – nurses, doctors and  community pharmacists – have worked together to offer 5 key messages to improve eczema care. Using this knowledge will help. 

1) Eczema is more than just dry skin Image for Eczema Mindlines research project  

  • Children with eczema will  always have dry skin
  • Dry skin is usually caused by skin inflammation, which makes the skin feel itchy
  • Itchy skin leads to scratching, which causes skin damage and then more itching
  • Correct eczema treatment can help prevent itching and skin damage
  • Moisturisers (emollients) should be used every day, even when the skin is clear
  • There is no one cause of eczema (apart from a variety of genes), but lots of individual triggers (such as being tired, teething, cold weather) working together
More helpful tips
  • People with eczema are at increased risk of asthma, hay fever and food allergy 
  • Soap, bubble bath detergent and being too hot will irritate the skin and flare every child’s eczema
  • Some children find their eczema is made worse by pollen, grass, pets and sometimes food, these are individual triggers, which are allergies
  • It is impossible to find just one factor that causes eczema, triggers are almost always multiple and sometimes difficult to avoid like house dust mites
  • Try to find out  your child’s individual triggers and avoid these triggers
  • Some children may ‘grow out of’ eczema but eczema can also be a lifelong  condition, there is no easy way of telling which child will have eczema for life 

2) Eczema doesn’t just go away eczema 2  

  • Children with eczema will  always have dry skin
  • Dry skin is usually caused by skin inflammation, which makes the skin feel itchy
  • Itchy skin leads to scratching, which causes skin damage and then more itching
  • Correct eczema treatment can help prevent itching and skin damage
  • Moisturisers (emollients) should be used every day, even when the skin is clear
  • There is no one cause of eczema (apart from a variety of genes), but lots of individual triggers (such as being tired, teething, cold weather)  working together
More helpful tips
  • People with eczema are at increased risk of asthma, hay fever and food allergy 
  • Soap, bubble bath detergent and being too hot will irritate the skin and flare every child’s eczema
  • Some children find their eczema is made worse by pollen, grass, pets and sometimes food, these are individual triggers, which are allergies
  • It is impossible to find just one factor that causes eczema, triggers are almost always multiple and sometimes difficult to avoid like house dust mites
  • Try to find out  your child’s individual triggers and avoid these triggers
  • Some children may ‘grow out of’ eczema but eczema can also be a lifelong  condition, there is no easy way of telling which child will have eczema for life

3) Moisturisers are for everyday eczema 3  

  • Moisturisers (emollients) are important for treating and protecting dry skin
  • Emollients should be used every day, even when skin is clear to prevent flares
  • The best emollient is the one that suits your child and works
  • You may need more than one emollient, depending on the dryness of your child's skin, the part of the body affected or time of the year
  • Medical moisturisers contain no perfume or detergent 
More helpful tips
  • Don’t use soap or bubble baths. Nearly all emollients can be used  instead of soap by putting on before getting in the bath or shower, washing by rinsing off
  • Put on emollients after patting skin dry with a soft towel. Apply in smooth downwards strokes and do not rub in
  • Emollients come in different forms, lotions, creams, gels and ointments
  • Lotions are lighter but do not moisturise as well, creams are better for daytime use or for places like the face, ointments are very greasy so for very dry skin or night-time use
  • There should be a gap (around 20 minutes if possible) between applying emollient and other eczema treatment creams

4) Steroid creams are okay when you need them eczema 4  

  • Steroids creams and ointments (topical steroids) are advised by the NHS as first-line treatments for eczema flares. They are very safe when used as directed
  • When using steroid creams, it is important to get control of the eczema. First with a short treatment burst, usually up to two weeks, so that the eczema ‘under the skin’ is treated. Some people with frequent flares find that using topical steroids for two days every weekend on their eczema ‘hot spots’ helps them to then keep control. Talk to your healthcare professional about this
  • Steroid creams should be used for short treatment bursts, usually up to two weeks, or as advised by your healthcare professional
  • To treat eczema flares effectively, it is common to be prescribed a stronger steroid for 5-7 days  and then reduce the strength
  • It is important to use enough topical steroid. The finger-tip unit shows the correct amount needed, which is explained in the leaflet in the steroid pack
More helpful tips
  • You usually need to apply steroid cream only once a day 
  • Topical steroids  come in four strengths , mild, moderate, potent and very potent
  • Different strengths of topical steroids will be prescribed for different areas of the body, mild for the face and moderate or potent for the body
  • Different strengths of topical steroid will be prescribed depending on the age of your child and on how bad their eczema is
  • Topical steroids only need to be applied once a day. Around 30 minutes before bedtime is a good time to allow the medicine to take effect.  
  • Topical steroids can have side effects such as skin thinning and spots but only if used for too long (constantly for months) and in the wrong places like on the face. Undertreated eczema is much more likely to damage your child’s skin and lead to a miserable quality of life

5) You know your child’s eczema best eczema 5  

  • Your primary healthcare professional, a GP, nurse practitioner or practice nurse can help you to manage your child’s eczema
  • Book an appointment just to discuss your child’s eczema, don’t add it on to when you are seeing your health care professional for something else
  • Write down how you currently manage your child’s eczema on a daily basis, use this to discuss how treatment can be improved
  • Try to keep a diary how your child’s eczema is. Note if their skin is dry or rough skin, itchy, flaking, red, weeping or oozing, bleeding or disturbing their sleep. There is an app to help you do this, https://www.nottingham.ac.uk/research/groups/cebd/resources/poem.aspx 
  • You can also take pictures of when your child’s eczema is bad, to help your health care professional. It is frustrating when the eczema is better on an appointment day.
  • Tell your health care professional how eczema affects your child and your family. You could complete this questionnaire with your child to discuss at the  appointment.
More helpful tips
  • If your child is prescribed topical steroid cream, ask how much, how often, how to apply and when to stop. Book a review appointment for 2 weeks
  • Does your child’s emollient suit them? Does it reduce dry skin? If not ask for another emollient to be prescribed
  • If your child is prescribed topical steroids, ask how much to use, how often, how to apply and when to stop. Book a review appointment for two weeks’ time.
  • Ask your healthcare professional if a referral to a dermatologist (consultant doctor who specialises in treating skin conditions) is required, particularly if topical treatment is not effective or you are not coping
  • You need to see a healthcare professional if:
  1. Your child’s eczema becomes infected, look out for signs  of redness and irritated skin which is weepy with yellow crusts or pus spots. If you spot these signs take your child to the health centre
  2. Your child’s skin becomes sore with painful tiny blisters. There is a rare, but serious infection called eczema herpeticum, this has the same virus as the cold sore and can cause an eczema flare .Eczema herpeticum is a medical emergency and your child will need urgent medical care in hospital