Lifestyle Choices

Atopic eczema

Onset and inheritance

This type of eczema often starts in the first year of life, though rarely before three months, but may begin at any age. It affects at least one baby in 50 and is usually mild.

Fortunately it clears up in most children by the age of four or five but it may linger on after the age of ten or rarely into adult life. There may be a long gap when it seems to have settled only to reappear. Doctors are very wary about predicting what will happen: for example, in the case of a baby with atopic eczema, there may be an eighty per cent chance of it clearing by the age of five. But that means one in five will not clear and the parents of that one will naturally be disappointed and lose faith in their practitioner. It is best to show a cautious optimism stressing the fact that a great deal can be done to improve eczema.

Atopic eczema often occurs in people with asthma and hay fever, or in their relatives. Not all family members will necessarily have the same problem. A parent may have hay fever only and each child may have eczema or asthma. The inheritance of these so-called atopic diseases is not simple. If one parent is affected there is a fifty per cent chance of each child developing an allergic disease. If both parents are affected the risk may be seventy-five per cent. It is remarkable, however, that sometimes only one member of a pair of identical twins may be allergic. This strongly suggests that in addition to inheritance, some other factor in the environment acts as a trigger.

What it looks and feels like

In a young baby the first sign may be an unhappy, restless child who rubs the face on the pillow but as soon as he or she can control the fingers, they are used for scratching. Red, scaly areas appear on the cheeks and behind the ears. Slightly older children often have crusted red areas on their ankles and wrists and by the age of three or four years, the folds of the elbows and skin behind the knees are usually involved. This latter pattern may persist into adult life. It is important to remember that most children are only mildly affected and may not be troubled by the slight dryness of their skin. The longer it goes on, the more likely it is that chronic changes will appear. The thickening and dryness start in the areas mentioned but can eventually spread more widely. Acute and chronic changes may exist together. All eczema sufferers go through good and bad stages and the reasons are not always obvious.

Itching is often severe and makes children very unhappy. The intense scratching and digging quickly leads to the appearance of raw scratch marks and bleeding areas. All this interferes with sleep and leads to chronic overtiredness and often failure to concentrate at school or work. Parents also get tired because they have to deal with an itchy, miserable and demanding child by day and a fretful, wakeful child at night.

Infection

The dry skin often has minute cracks through which bacteria can pass. Scratching makes this dry skin much worse. The usual bacterium causing trouble is Staphylococcus aureus and it may lead to yellow crusting areas or worse, to fever and pain.

Herpes is the virus that causes cold sores. Eczema sufferers often get more severe infection that spreads across the damaged skin and occasionally admission to hospital may be necessary. Two other viruses are those that cause warts and molluscum. They too may become more widespread in atopic individuals.

Living with atopic eczema

Affected people have to learn to live with their problem. It may be difficult to adjust but it makes life easier if you do. Teachers should be told of the problem, and so should other children’s parents so that they can stop any teasing and help your child while he or she is away from home. Forming relationships may be awkward if your eczema is bad. It may be possible to hide badly affected areas by wearing suitable clothing.

Type of work is very important because some jobs can make eczema worse - e.g. hot, dry conditions - and it is important that the boss knows so that he or she can II^-) and fit you in to a more suitable job. People often assume that the chlorine in swimming baths will aggravate eczema but in fact so long as you take a shower afterwards it should not be a problem. It may be a much greater problem later in life not to be able to swim.

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