Atopic eczema – constitutional eczema, neonatal eczema

The condition is “congenital”, which means that the predisposition for eczema is already present at birth. It is a common inflammation of the skin. 

However, the severity with which eczema will occur in a child does not only depend on predisposition. Other factors such as nutrition, house dust and skin care can also play a role in eczema complaints.

The symptoms of an atopic eczema vary according to age.

• In babies, an eczema mainly takes the form of redness and flaking on the cheeks, behind the ears and on the head.
• At a slightly more advanced age, the skin in the hollows of the knee, the elbow folds, the skin at the earlobes and the neck can also be affected. Atopic eczema in very young children is also called neonatal eczema.
• At the pre-toddler age, the eczema occurs predominantly in the hollows of the knee and the elbow folds, while the facial skin and the skin on the head are somewhat less affected.

In addition to itching and redness, other symptoms often occur. Scratching the itchy spots can cause wounds that can become infected with bacteria. This can cause pimples and wet spots where wound fluid comes out. The skin is also particularly sensitive to fungal infections and viral infections. The well-known water warts (mollusca contagiosa), which are caused by a virus, are more common, more extensive and more long-lasting in children with eczema than in other children.

Children with eczema often have dry skin, and wrinkled earlobes. Atopic eczema actually never in the diaper area. Redness and flaking on the buttocks and in the groin (“diaper rash”) is usually caused by irritation of the skin by urine and friction with the diaper and can also occur in children without a predisposition to constitutional eczema.

The exact causes of atopic eczemas are not yet completely clear. It has been established that a variety of factors play a role. A predisposition to eczema is always a main consideration. Eczema occurs much more frequently in the children of parents who are familiar with eczema. Especially if both parents have suffered from atopic eczema, the chance that their children will also develop an eczema is very high, about 40 to 80%. When other “atopic diseases” such as asthma occur in the family, the risk of eczema in the child is also increased.

In addition to hereditary predisposition, other factors that determine the severity of the eczema play a role:

• Decreased resistance: due to illness, fatigue or stress, eczema can worsen.
• Respiratory sensitisers: Much is still unknown about the  role of inhalation allergens ( such as pollen dust mites) and eczema. For example, avoiding these allergens does not really seem to have a beneficial effect on eczema in most children.  Food allergens: Children with eczema are also predisposed to other conditions such as asthma, food allergies, and hay fever. About 30% of children under the age of 1 year with moderate to severe eczema also have a food allergy. This usually manifests itself within 2 hours after eating the food: the development of hives, swollen lips, itching in the nose, vomiting and sometimes even more severe. But it doesn’t cause eczema. Actually, it is very rare for eczema to be caused by food. When should you consider this? In children under 6 months, with very extensive eczema. Often there are other (intestinal-related) complaints.
• Dry skin: Dry skin is much more susceptible to developing eczema. Especially in winter, the skin can become very dry (dry air in the house due to central heating!)

Atopic eczema is a condition caused by hereditary predisposition and therefore cannot be cured by treatment. Fortunately, the eczema disappears in most children over time: the majority of children with eczema symptoms at an early age are free from this skin condition by the time they enter puberty. Although eczema cannot be cured, there are treatments available to reduce skin complaints.

• Ointment for dry skin

Your GP or dermatologist will always start by prescribing an “ointment for dry skin”. This ointment ensures that the dehydrated skin becomes supple again and retains moisture. Keeping your baby’s skin in good condition will make an outbreak of the eczema less likely.

• Corticosteroid

Corticosteroid ointment (“hormone ointment”) has two beneficial effects on eczema. Firstly, the inflammation in the skin is suppressed, so that the redness decreases, and secondly, it also has an itch-relieving effect. Hormone ointments are very effective against eczema, but you should always follow your physician’s instructions in applying them. Apply the ointment, for example, according to a specific schedule (apply it for a few days per week and then you leave it off again for a few days). This can help to avoid side effects. If your baby’s skin condition improves, gradually phase out the treatment.

• Tacrolimus

Tacrolimus (brand name: Protopic) is a substance that affects the immune system. The ointment inhibits the inflammatory response associated with eczema. One of the benefits is the fact that the skin does not become thinner when using the product, unlike corticosteroid ointment where it can happen. A disadvantage is the risk of irritation after applying the ointment. The ointment may be used in eczema patients aged 2 years and older.

New ointments have been introduced in the Netherlands that inhibit the inflammatory response of eczema and do not contain a corticosteroid. These are tacrolimus ointment and pimecrolimus cream:

• Pimecrolimus cream

Pimecrolimus has an effect and application that is broadly similar to tacrolimus ointment. Pimecrolimus cream (brand name: Elidel ®) is available by prescription and can also be used in eczema patients aged 2 years and older. Pimecrolimus cream is intended for the treatment of mild to moderate atopic eczema.

• Tar ointment

Before the discovery of the corticosteroid ointment, tar ointment was one of the few remedies for eczema, and it is still prescribed with some regularity today. The tarointment (mostly liquor carbonis detergens – LCD – 10% ointment) has an anti-inflammatory effect and strengthens the skin barrier at the same time.

• Antibiotics

Skin that has been affected by eczema has a high chance of becoming infected with bacteria. Slightly infected skin can be treated by temporarily applying antibiotic ointment. If the infection is extensive and wet spots are very extensive, a course of antibiotics may be necessary.

• Ointment romper suits

Special eczema dressings have been developed that children can put on at night before going to bed. Their big benefit is that the ointment stays in place and therefore often helps against itching. 

• Anti-itch agents

If your child wakes up a lot at night from the itching despite the measures mentioned, the doctor may also prescribe special itch-relieving medications. These are antihistamines. These can be administered in droplet form or as a tablet before sleeping. These do not affect the eczema its, but can have a mildly sedative effect, so your child may sleep a little better.

• It is important to prevent your child’s skin from drying out too much because dry skin is more sensitive to eczema and also itches. Wash your child as little as possible with soap and occasionally use special bath oil in the bath water. After washing, we recommend that nourish the skin with a neutral, oily “dry skin ointment”. This method is always important, even in periods when your child does not have eczema.
• Make sure that your child does not wear irritating clothing directly on the skin as these may aggravate the itching and thus encourage your child to scratch. Natural silk anti-scratching romper suits and undergarments are available to protect the skin from such irritation.

As mentioned, in most children, the eczema disappears they reach puberty. In 65% of children, the eczema has even disappeared by the age of 12. However, children with eczema have a high chance of developing asthmatic symptoms: about 40% of children with eczema suffer from asthma and 50% from hay fever later in life.

In some children, the eczema persists throughout childhood and does not disappear even when they become young adults. As far as is now known, the type and intensity of the treatment of eczema does not affect the final course and extinguishing of the eczema.

Severe eczema, like any chronic (skin)condition, has a major impact on the life of a child and that of his parents. The regularly occurring lack of sleep of eczema patients can lead to reduced attention and learning performance at school.

In addition, children are often ashamed of the eczema spots and are bullied at school. In classmates and sometimes adults, eczema is often mistakenly thought to be contagious. Hence, it is very important that the school teacher explains the situation, and older children can, for example, give a talk about eczema themselves. The latter is not only useful for the classmates but also gives the child who is giving the talk more insight into their own skin condition.