If you've been catching your child scratching the itchy red rashes on his/her neck, face, front of the elbows and back of the knees, it could possibly be atopic eczema.

What is eczema or dermatitis?

The term "eczema" is used interchangeably with "dermatitis" and means inflammation of the skin.

What is atopic eczema?

Atopic eczema is one of the most common skin problems affecting children in Singapore. It starts as an itchy red rash which causes the child to scratch the area, resulting in broken skin. The red rash may sometimes ooze fluid as well. Common areas affected include the neck, face, front of the elbows and back of the knees. In severe cases, the whole body can be affected.

Why did my child get eczema?

Atopic eczema is not an infection. There are genetic factors involved (although a family history is not always present) and it is often associated with other sensitivity conditions affecting the lungs (asthma) and the nose (allergic rhinitis). Environmental factors can play a role as well, and there are also factors which cause the skin to become very dry, making it less effective as a barrier.

Although certain foods can aggravate eczema, most cases of atopic eczema are not related to diet. You should speak to your dermatologist if you are concerned about this.

Eczema is increasing and about 1 in 20 children in Singapore have atopic eczema. The eczema is more severe if it appears very early in life (2 months of age) and the majority of cases will appear by the time the child is 6 years old.

Eczema runs a chronic course. It can be stabilised with treatment but flares can occur. Many parents who are seeking a total cure may be disappointed when the doctor tells them there isn't one. There is reason to be hopeful, however, because advances in medical research now provide effective treatments which can improve the eczema and keep the child well.

What is the treatment for eczema?

Eczema is specifically treated by steroid creams, which are anti-inflammatory. Besides steroid creams, non-steroid creams are also available; these are called topical calcineurin inhibitor (TCI) creams and are usually used in children above the age of 2. Using mild nourishing soaps, or synthetic soap substitutes can also help to treat eczema.

Moisturizers must be used daily to build good skin barrier and reduce the chance of developing eczema. Moisturisers hydrate the skin and reduce itch. Anti-itch medication in the form of anti-histamines can also be given. Occasionally, a course of antibiotics is required if there is any evidence of skin infection.

What are steroid creams? Are there any side effects?

The doctor will assess your child and prescribe a topical steroid of appropriate strength, depending on the location of the rashes and the child's age. Steroid creams are classified into several grades of potency and generally, the least potent steroid that will reduce the inflammation is chosen. Although there are potential side effects like thinning of the skin, these can be avoided with proper use of the creams under a doctor's instructions.

Many dermatologists use a "step down regime". Initially we might use a stronger cream, and when improvement occurs, the doctor will then reduce the strength of the medication.

The creams are to be used once or twice a day, before using the moisturizer.

Dr Tan Hiok Hee
Dermatologist
Thomson Specialist Skin Centre
Novena Medical Center
10 Sinaran Drive #10-05
Singapore 307506
www.thomsonspecialistskin.com