Eczema may occur after the third month of life as a weepy rash on the face and outer surfaces of the arms and legs.
In later childhood it becomes a dry, scaly, itchy rash in the inner creases of the elbows and knees. Some children may not outgrow eczema and the condition often continues into adulthood.
Parents should institute general allergy prevention measures in newborns who are at a high risk of allergy. These include avoidance of parental smoking during pregnancy and after birth and breastfeeding until at least six months of age. Common allergy-provoking foods such as milk, eggs, fish, peanuts, wheat and soya should be avoided in the breastfeeding mother's daily diet.
Avoidance of solid foods in babies up to six months of age, followed by the careful introduction of the potential allergy-provoking foods such as cows' milk, wheat and peanut extract at 12 months. Eggs and fish should only be introduced after 18 months.
About 10% of infantile eczema is food-allergy related and food colourants and additives can also aggravate eczema in older children. In addition, adverse reactions to citrus fruit, tomatoes, pineapples and Marmite are common in patients with eczema.
Children should avoid hot, humid and cold, dry weather, excessive sweating, woollen or synthetic clothing close to the skin and perfumed soaps. Cotton underwear, clothing and bed linen are recommended.
Non-biological washing powders such as Sunlight and Skip should be used instead of enzyme-enriched Punch, Biotex, Surf or Omo. Bubble baths, household antiseptics and medicated soaps are best avoided. Swimming pool chlorine may also irritate and dry out the skin. Local household skin irritants include wool, mohair, nylon and feathers. House dust mites as well as dog and cat skin flakes may aggravate eczema.
Bath water should be lukewarm and moisturing emollients applied to the skin within three minutes of patting the skin dry. Never rub the skin dry. If non-perfumed soaps such as Pears, Dove or Neutragena irritate the skin then the use of aqueous cream, Aquabar or Cetaphil lotion are recommended.
As much skin as possible should be covered with non-allergenic lightweight cotton clothing, taking care not to overdress or overheat the child. Cotton night gloves as well as neatly clipped finger nails will reduce scratching. Sometimes elbow splints need to be applied to stop intractable scratching at night.
Routine childhood immunisations should be given. Consult your doctor if you have any concerns about these immunisations.
Young adults should decide on a career that is less likely to expose them to irritant chemicals and should probably avoid nursing, hairdressing, catering, motor mechanics or the building industry. Protective gloves with cotton inner-linings will help prevent irritant contact dermatitis that is so very common in eczema sufferers.
These moisturising creams and ointments, the mainstay of eczema treatment, are completely safe and should be applied liberally at least twice daily to hydrate and protect the skin. Some people may find that certain of these preparations irritate their skin. If this happens, another product should be tried.
Different emollients include emulsifying ointment (HEB), aqueous cream (UEA), Cetomacrogol, Ultrabase and Oilatum cream. Sometimes coal-tar is applied to treat thickend skin.
These produce rapid relief and are used for short periods to settle eczema flare-ups. They may also be used for longer periods when diluted in an emollient, in which case treatment should be tapered off slowly.
However, their long-term use may lead to thinning of the skin, but some of the newer preparations seem to be much safer. Cortisone tablets or injections are very rarely, if ever, used in eczema.
Eczema sufferers are more prone to skin infections (bacterial, fungal and viral, including the common wart). Antibiotic creams and occasionally oral antibiotics are prescribed to treat infected eczema which may present as sudden development of crusting, oozing and redness of the skin.
The older sedating type antihistamine tablets or syrups such as Aterax will reduce itching, especially at night. Antihistamine creams may sensitise the skin and should be avoided.
Evening primrose oil (or gamma linolenic acid) has been tried with some success and extracts of chinese herbal tea are being evaluated. (Health24, updated April 2011)
Kids and allergy
Allergy Society of South Africa (ALLSA)