Atopic dermatitis or eczema in children

Dr. Anne-Marie Calza

Pediatric dermatologist, Geneva

January 11, 2022

Atopic dermatitis is an inflammatory skin disease that is on the rise, affecting 15% of children. More than 2/3 of patients start their disease in the first year of life. The natural course is often favorable. A minority of them will keep their eczema as an adult or will develop other conditions (allergic rhinitis or conjunctivitis, asthma).

What do the lesions look like?

In eczema there are several types of lesions:

– Redness and oozing
– Dryness
– Blistering, crusting, scratching
– Thickening of the skin.

Does eczema occur in certain areas of the skin?

In the first year of life, eczema likes the chubby areas of the child. Later, the skin disease shifts to the skin folds (hollows, elbows, wrists, knees, ankles). In children, where the eczema is also localized in other places, one must assume contact dermatitis.

How does eczema develop?

Eczema occurs in episodes that can be triggered by various factors:

In children
Infections, habit changes, teething, and in rare cases nutritional.

In older children
Infections, seasonal changes, stress and contact dermatitis.

Why do people get atopic dermatitis?

Several reasons have been identified:

• Family background.
• Dry skin caused by the lack of a protein (Filaggrin), in the epidermis. This skin does not play its role as an impermeable barrier and allows external elements to pass through.
• Malfunction of the skin’s defense system, in which the body’s own army revolts, so to speak, against imaginary enemies and triggers numerous inflammatory reactions. However, this system is capable of learning – this also explains the decline of the disease.
• Superinfections (staphylococcus, herpes, chicken pox, molluscum, warts) are frequent due to the fact that the defense system is occupied by false enemies.
• Certain allergens (dust, animal dander, or pollen), complicate the flare-ups but are rarely solely responsible.

Why is the child treated?

This chronic disease alters the quality of life of those who suffer from This chronic skin disease leads to a deterioration in the quality of life of those affected: The constant itching causes irritability, difficulty sleeping and concentrating, and appearance suffers. Treated children recover more quickly.

Should additional testing be performed?

Systematic testing is not required, but targeted allergy testing (rast or prick test) or epicutaneous testing may be recommended.

What can be done?

Treatable symptoms: Infection inflammation, dry skin, and itching

Infection: Infection is permanent. It can be It can be fought in different ways.

– Treatment of dryness and inflammation
– Regular washing of the skin
– Textiles with a silver ion base or made from certain silks
– Antibiotics (cream, tablets)

Inflammation: two weapons are available.
Corticoids: This large group of active substances consists of molecules classified according to their degree of effectiveness (1-4) and used in cream or ointment form. Their use requires appropriate instructions from parents, and the success of the treatment depends on how long the treatment is carried out. If corticosteroid therapy is used correctly, it can be used for years without growth arrest, immunosuppression, skin bleaching, or atrophy.

Anti-calcineurins (pimecrolimus, tacrolimus). These active ingredients have the advantage that they do not lead to thinning of the skin and are mainly used on the face. However, the following must be observed:

However, specific hazards should be noted:
• Herpesvirus causes more extensive infections and is clinically misleading.
• These are still young molecules and certain experts warn of possible effects on the immune system.

Skin: An important treatment goal between relapses. The skin should be washed with good soap and not too often. After bathing, the child should be generously creamed with a ph-neutral, lipid-replenishing product (urea-, lactic acid- or perfume-free). The best cream is always the one that the child likes best and tolerates best. It is important that the child also has a say when it comes to his or her treatment. Beware of the numerous “organic” oils and preparations! Most of them contain preservatives. In addition, plants are often allergenic.

Itching can be relieved by giving oral antihistamines in the evening. Also, the following additional simple tricks help moist compresses, humidifiers/water vaporizers, cold packs, and cool air.

Symptoms that are more difficult to treat

Environmental factors play an important role, but the child is not served by an overly aseptic environment either. However, all too sudden exposure of the child to animals, dust, mold, or pollen should be avoided. Skin-irritating textiles such as wool or synthetic fabrics should be avoided, and clothing made of undyed cotton should be preferred. Use hypoallergenic detergents, and avoid fabric softeners.
No carpets, wallpaper, or wood paneling in the rooms. Exclusively buy anti-allergy bedding without down and washable stuffed animals.

Cures: This is an opportunity for parents to see the care given to the child up close. These are nice holiday places. Improvements are noted with cures of a minimum duration of 3 weeks.

The effectiveness of homeopathic treatments is very difficult to evaluate. This empirical medicine is currently very popular in Europe, however, its effectiveness has never been objectively proven.

In summary
• Do not exceed the area to be treated prescribed by the doctor.
• Know how much you are using between each appointment.
• Only apply the product prescribed by the child’s doctor.
• Be sure of the diagnosis of eczema.

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