Atopic eczema is thought to be the first allergic manifestation of the allergic ‘march‘ (the progression of allergic symptoms during childhood). ‘Atopic’ means sensitive to allergens. A typical pattern of allergy would be the presentation of eczema followed by a food allergy, rhinitis (affecting the airways), and then asthma later on, although it will vary from child to child.
Atopic eczema often starts between the ages of two and four months and affects around one in five children.
Common symptoms include patches of red, dry, itchy skin on the cheeks, forehead and scalp, behind the ears and in the creases of the neck, knees and elbows. The condition can also ‘flare up’. When this happens, symptoms will worsen and the skin can become infected.
The cause of eczema is unknown, but it tends to be common in families that have a history of eczema, hayfever, and asthma
The cause of eczema is unknown, but it tends to be common in families that have a history of eczema, hayfever, and asthma. It may also be triggered by food allergies, including an allergy to cows’ milk. Flare-ups may be triggered by exposure to allergens such as house dust mites. Environmental factors, irritants such as scratchy woollen clothes, stress, heat and sweat can also worsen symptoms.
A GP will often be able to diagnose atopic eczema by assessing the child’s skin.
There is no cure for atopic eczema, but the condition often improves as children get older. It is, however, important to manage symptoms. An effective skincare routine is a key part of controlling symptoms. Parents are advised to:
This is known as complete emollient therapy. A topical corticosteroid may be prescribed for use during flare-ups, alongside emollients. This will reduce redness and swelling and is safe as long as it is used as directed by a GP.
Research has shown that infants with a family history of allergy who are fed infant formula milk based on intact cows’ milk protein have double the risk of developing atopic eczema compared to those who are breastfed.
Breastfeeding provides the best protection against allergy development, but if exclusive breastfeeding is not possible, an infant formula milk (such as SMA H.A. Infant Milk) that may help reduce the risk of an infant developing atopic eczema could be suitable. For infants with a family history of allergy (and for high risk infants), it can be used from the first formula feed onwards, either in combination with breast milk or on its own.
SMA H.A. Infant Milk should not be used if a baby has already been diagnosed with, or is suspected of having, an allergy to cows’ milk protein.
According to clinical guidelines issued by NICE, an assessment of atopic eczema should consider the impact of the condition on quality of life and wellbeing, as well as the state of the skin, bearing in mind that the two may not be directly related.
Management is stepped:
Potent topical corticosteroids are not usually prescribed for infants under one year of age, and topical calcineurin inhibitors (tacrolimus, pimecrolimus) are not recommended in children under two years of age.
Education is a core element of eczema management, with information provided verbally and in written and practical demonstration forms. Important aspects to cover include how much of each product to use and how often, when and how to step treatment up or down, and how to recognise infected eczema.