Atopic eczema in babies and children and treatmentArticle
12. 02. 2021 Dermatovenerology
"Infants often develop eczema during the first year of their life, the first symptoms starting to appear between 2 and 6 months after birth. They often include dry rough skin, redness or highly irritated and itchy rashes in the area of the face, forehead, hair, ears and neck. In the next phase, the elbow and knee pits are typically affected. Eczema can spread to the entire head (scabs appearing in the hair), body and limbs. Insomnia, restlessness and crying are often the presentations of the severe itchiness in infants. The most common causes in infants are food allergens, contact with airborne allergens - often the fur, skin and saliva of pets. A significant negative effect on the development of atopic eczema is the polluted environment by cigarette smoke. Exacerbations of eczema may also be affected by ongoing infections or vaccinations. However, it is necessary to emphasize here that vaccination can worsen eczema and not cause it, as is often mistakenly presented, "describes Dr. Petr Žáček, MBA general practitioner for children and adolescents at Canadian Medical.
The child phase occurs between the ages of 2 to 12 years. Atopic eczema may appear at this age or may progress from the infant stage. Around the 2nd year, the involvement of the elbow and knee holes, as well as the neck, neck, wrists and fingers, predominates. The rash deposits are rough and pinkish red, (compared to the usual pale presentation). Noticeably dry skin with reddish and scaly eyelids is also typical.
Treatment and types of atopic eczema
The main focus of treatment is to reduce the severity of symptoms and prevent further flare ups as well as gaining some control over the progression of the disease and improving the patient’s quality of life. The essence of the treatment lies in optimising the care for the skin and the regenerating the skin barrier by means of emollients (creams). It is also important to adjust the lifestyle (appropriate clothing, detergents and cosmetics), diet, knowledge and reduction of irritant factors causing itching.
Emollients are used to treat milder forms of eczema (dry skin, itching or redness) and it is usually not necessary to give weak effective topical corticosteroids.
Emollients, mild to moderately potent topical corticosteroids and, quite rarely, topical calcineurin inhibitors are suitable for the treatment of moderate forms (dry skin, redness, frequent itching, excoriation).
For the treatment of more severe forms (large areas of dry skin, constant itching, redness, excoriation, weeping/festering wounds, cracking of the skin, changes in pigmentation) emollients, strong topical corticosteroids, topical calcineurin inhibitors, wet compresses, phototherapy, or systemic treatment is commonly used.
The main component of treatment- regenerate and hydrate the skin. Emollients are medical moisturisers and creams that are applied on the entirety of the surface of the skin at least twice a day. Urea is the moisturising component in this treatment form and it also has mild anti-itching properties (e.g. Excipial U Lioplotio). However, products containing urea can be irritating, so they are used in children from 3 years of age.
Topical corticosteroids are used in the acute phase of the disease. They work quickly but can only be used for a short duration to overcome the most serious flare-ups. After the worst phase, they are gradually discontinued and replaced by medication that keep eczema at rest.
They are applied after an evening bath, before treating the skin with emollients. Corticosteroids are prescription drugs.
Calcineurin inhibitors reduce the extent, severity and manifestations of atopic dermatitis and relieve itching and inflammation. They do not have side effects like topical corticosteroids, so they can also be used in areas with thin and sensitive skin (eyelids, face, etc.). They can be used for both acute and chronic presentations, but it is necessary to be informed about how and when to take/not take calcineurin inhibitors.
Ichthammol (Ammonium bituminosulfonate)
Ichthammol-based products (e.g. Ichtoxyl) are used to treat inflammations. Ichtammol promotes keratinocyte regeneration, has anti-inflammatory and anti-itching properties, and its application reduces the risk of flare-ups after discontinuation of other medications.
Sedative antihistamines or soothing anti-allergic drugs are given to relieve itching or hives. They are used in the short term, especially in children (e.g. Fenistil in infants or Aerius in the elderly). Non-sedative antihistamines are used for atopic eczema with severe itching, or if the patient also suffers from respiratory allergies.
Phototherapy, spa treatment and oil baths
Phototherapy is recommended especially in the chronic and subacute stages of eczema. Narrowband UVB radiation is commonly used; UVA1 is preferred for acute manifestations.
As part of the spa treatment, hydrogen sulphide mineral baths are used as they have antiseptic and anti-inflammatory properties. Oil bath additives (e.g. Linola-Fett Ölbad) can also help- they lubricate the skin and form a protective layer that prevents dryness. Baths of 10 to 20 minutes are recommended every other day. After the bath, instead of rubbing your skin dry, it should be lightly tapped using the towel, after which emollients can be applied.
The only solution is getting early treatment
Atopic eczema affects children more often than adults. In about 80% of cases, the disease manifests during the first 5 years of life, sometimes in the first year. In general, the incidence is still rising among the population. Its inflammatory cycling has gradual improvement in adulthood.
The prognosis is more serious if the eczema develops at an early age and with the common occurrence of other comorbidities such as allergic rhinoconjuctivitis and subsequent bronchial asthma. Therefore, do not underestimate this sneaky disease - seek medical attention as soon as possible to start appropriate and effective treatment.