Eczema or commonly known as atopic dermatitis is a chronic condition that causes your skin to become dry, red, itchy, weepy and bumpy. It’s one of the classic triad of atopy, namely atopic eczema, allergic rhinitis and bronchial asthma. The exact root cause of eczema is unknown as it is often multi-factorial. It’s proven to be due to an overactivity of the immune system that responds aggressively towards any triggers or allergens. The nature of eczema follows the ‘wax and wane’ pattern, whereby patients experience period of remission followed by ‘flare-up’. At the moment, there’s no cure for eczema. Treatments, however, can be very effective in reducing the symptoms of itchy, dry skin. The goal of treatment is to heal the affected skin and prevent flares up.

Eczema can show up anywhere on your skin, but it usually follows a particular pattern. During the infancy, it involves the cheeks and chin The napkin area is typically spared due to the moisture retention of nappies. As kids start to crawl, the extensor aspects of the elbows and wrist, knees and ankles are affected. When they become more older and more active, the eczema may be distributed over the flexural ares such as elbow and knee creases. Besides that, the older children may have thickened, dry and dark skin over their neck, often known as the ‘atopic dirty neck’.

1. Maintain skin moisture
   This is the utmost important part of the treatment. Do shower your kids 5-10min with midl cleanser and lukewarm water to allow their skin to absorb the moisture. Then, gently pat them dry after complete rinsing. It’s good to have some water droplets remained on their body. After that, immediately apply emollients to their skin to maintain moisture. Repeat this process 2-3times a day to ensure adequate moisturization.
2. Putting out the fire
   When a house is on fire, we need to urgently put out the fire. Similarly, when eczema patients have flare-up (On fire), we need to reduce the inflammation by using topical corticosteroids. Many parents are hesitant towards the usage of corticosteroids on their kids in view of the concern on side effects. Rest assure, with proper treatment plan, application techniques and understanding of eczema, the chances of your child getting side effects from corticosteroids are slim.
3. Avoiding triggers
   There are a number of things that may trigger the eczema symptoms. Common triggers include:
   
   1. Irritants - It is recommended to use hypoallergic detergents and gentle cleansers, soups or bath gel. As a rule of thumb, odourless and colorless products are most suitable.
   2. Environmental factors or allergens - Regularly vacuum your house and change the linens. Besides that, avoid setting your air-conditioner temperature too low to avoid over-dryness of the air.
   3. Food allergies - such as allergies to cows' milk, eggs, peanuts, soya or wheat
   4. Clothing material - Pay more attention to the clothing material. 100% cotton is recommended.
   5. Sweat - whenever your child sweats, get them a quick 1-2minutes’ shower to wash away the sweat. Then apply the emollients as mentioned before.
   6. Skin infection
   7. Scratching - Scratching is main culprit for introducing bacterias into the skin. However, it’s also our natural response to ease the itch. The main way to reduce itch is by maintaining good skin moisture although sometimes anti-histamines such as chlorpheniraime, loratadine, cetirizine may be used to suppress the itch.

I strongly believe that by understanding the basic concept of eczema and the principle of treatment, parents would be able to reduce the chances of eczema recurrence, or if not, minimize the severity of flare up.

This article was contributed by Dr Goh Chun Hwee, Consultant Paediatrician at Pantai Hospital Ampang. To know more about where and when to see Dr Goh Chun Hwee at his clinic, click here.