What is Eczema?
Eczema is a dry itchy skin condition. Boys and girls are equally affected and the condition often runs in families. The condition typically starts in the first few months of life and usually before the age of 3. The skin becomes dry and flaky and is likely to be itchy. The skin barrier does not function normally and this makes the skin susceptible to otherwise harmless trigger factors, including irritants and allergens which make the eczema worse. Eczema is a relapsing and remitting condition through early childhood. Most children grow out of it. Typical features of eczema include -:
- Red skin
- Dry skin
- Itchy skin
- Small watery blisters on the skin – these can weep, particularly when on the hands and feet
- Scaly thickened patches of skin, especially areas of the skin which are scratched regularly – this may be termed ‘lichenification’ in the medical evidence
Scratching skin that is itchy leads to abrasion of the skin, abraded areas feel itchier as they heal – this is the itch scratch cycle. Children with itchy skin may not sleep or feed well. Areas of flaky, dry or weeping skin may become infected with bacterial organisms or blistered when involved in herpes virus infection – both of these are acute complications of eczema and require urgent medical treatment.
Children in the toddler age group are most likely to have eczema. The areas of skin most commonly affected include -:
- Backs of knees
- Front of elbows
- Chest
- Face
- Neck
The majority of cases will be mild and children will grow out of their condition around the time they begin primary school.
Eczema is a chronic condition that can be controlled with treatment. For the majority of children eczema is well controlled with treatment, with occasional flare ups. Treatment needs to be stepped up during flare ups and stepped down when the skin is under control. This applies to any severity of eczema; baseline treatment is used when skin is good and step up treatment used when eczema flares up. Treatment is likely to be more time consuming in a severe case than a mild case. A small number of children will have moderate or severe eczema. They are less likely to grow out of their eczema completely but it is likely to improve over the years. Small numbers of children will have eczema that persists into adulthood. The majority of children with eczema lead normal healthy lives, controlling their eczema with effective medication. The time taken by parents and carers to provide care to control the skin condition is the basis of care needs in this condition.
Incidence/Prevalence
1 in 5 children under 3 in the UK have symptoms of eczema. The majority of children (over 80%) have mild eczema. 15% of children with eczema will have moderate eczema and 5% of the children with eczema will have severe eczema.
Eczema follows a typical pattern in most children. The vast majority of children with eczema will develop the condition under the age of 3 years. It is most likely to be severe in this age group. Children will then grow out of their eczema, with the mildest cases resolving earliest. 50% of cases will have resolved by age 5. Children with moderate to severe eczema are likely to take longer to grow out of their eczema completely, however the eczema often improves over the years; a child with severe eczema at age 3 may have moved into the moderate category by age 6. Children with the most severe eczema are likely to continue to have eczema to some degree. Eczema often improves substantially at puberty.
