childhood eczema

[Amakonchi]

There's probably something in the waters but why is there an increase in eczema in children in UK? The weather, the food or probably the water. My son is really having a hard time with this and only a particular steroid cream appears to have helped. I am really reluctant in continuing him on it as I'm not aware of its long term reparcussions. We try to manage it during the day by moisturising with Cetrabene but not sure if thats doing any good. How exactly does it work? Do GPs and Specialist just recommend the latest cream - Oilatuml/ Deprabase etc? or is there some actual backing that it works?

[Dr Anton Alexandroff]

Hello,

thank you for your question. I am very sorry to hear about your son.
I am afraid eczema (dermatitis) is very common in developed countries and up to one in three children may suffer from dermatitis in the UK. We are not sure why this happens but it has been suggested that it might be because our environment is too clean. There are a number of studies are going on to address how eczema can be helped or prevented (see my twitter for details).

Moisturisers (emollients) are the most important part of the treatment. The greaser emollients the more effective they are, therefore ointments are more effective than creams and lotions. My favourite is emulsifying ointment but Cetraben ointment, Hydromol ointment, Epaderm ointment are equally good. Cetraben ointment has advantage because it is soft and is easier to apply to the skin at room temperature. Thus if you use creams rather than ointments you need to use them more often. Other than that it depends on what moisturisers your child prefers. However, try not to use aqueous cream because in some patients it can make eczema worse.

Please avoid washing with soaps. Instead wash with emollient soap substitutes e.g. E45 wash or Oilatum wash. I would recommend to take a small amount of emulsifying ointment and lather it under water - it becomes an excellent soap substitute! If you run a bath remember to add bath oil. If eczema is infected you can consider to wash with Ezcmol cream (for up to 2 weeks at the time).

Topical corticosteroids of an appropriate strength used as directed for an appropriate duration under a medical supervision are the second line treatment. They are used for more severe dermatitis if emollients alone are not sufficient. Emollients still should be used in parallel but not at the same time as topical corticosteroids (space them out by at least 30-60 minutes).

If topical steroids are not sufficient newer non steroidal creams and ointments can be used (e.g. Protopic, Elidel). If it is not sufficient special therapeutic UVB phototherapy can be administered in hospitals (under medical supervision). Rarely potent systemic medicines may be required.

New promising non steroidal topical treatments are being currently developed (see my twitter for updates).

It is always a good idea to consult your family doctor but if it is not sufficient consider to be referred to a Dermatologist on NHS or see a Dermatologist privately.

if you would like to read more about dermatitis and available treatments you can go to my website
www.alexandroff.org.uk

I hope this might be of help.

with very best wishes,

Dr Anton Alexandroff CCT(Dermatol) FRCP(UK) FAAD FRSM
Consultant Dermatologist and Senior Lecturer
Member of British Association of Dermatologists
De Montfort University, Leicester Spire Hospital, Leicester Nuffield Health Hospital, Bedford BMI Manor Hospital
www.alexandroff.org.uk