Dr. João Tavares

Paediatrician

Atopic eczema
A multifactorial disease

HPA Magazine 16

Atopic eczema (or atopic dermatitis) is a multifactorial disease, which is not completely understood.
Parental history of allergies (especially maternal) is one of the most important risk factors. Approximately one third of children will later end up suffering from allergic asthma and/or rhinitis. This phenomenon is called “atopic march”.

Its incidence has been increasing over the last few years, estimated to affect between 10-20% of the paediatric population being more frequent in urban areas.
Its symptoms are itching, red and scaly skin, sometimes with cracks and oozing.
The first symptoms usually appear in the first five years of life. In younger babies, it usually involves the face and limbs. In children, from 2-3 years of age, the involvement is more frequent on the bends of elbows and knees and in the most persistent cases, with dry and thickened skin.
In Portugal, it is estimated that around 10% of children are affected by the disease. In most situations, this pathology tends to improve a lot and even disappear with age, although it can remain for life. Persistence is more frequent in cases where onset is late.
Atopic eczema is treatable. Depending on the clinical situation, the attending physician will recommend the most suitable treatment. In 60% to 80% of cases atopic eczema improves during adolescence.

GENERAL RECOMMENDATIONS FOR CHILDREN SUFFERING FROM ATOPIC ECZEMA:
• Regular hydration (1-2x a day) and always after a shower (the emollient can cause burning if applied to an inflamed and untreated area);
• Emollient and hygiene products should be specific for atopic skin – follow the recommendation of the treating physician;
• Bathing should be quick (< 10 minutes) preferably a shower with lukewarm water;  
• Comfortable clothing should be worn, preferably cotton and light-coloured when in direct contact with the skin;
• Keeping nails short can help reduce the damage caused by itching and decrease the chance of infection;
• Excessive heat and sudden changes in temperature can be aggravating factors. Rooms should therefore be well ventilated and heaters avoided. Excessive use of blankets in bed should be limited to prevent sweating;
• Avoid scratching; antipruritic drugs or lotions may be used;
• Avoid overheating - heat and perspiration can cause exacerbation of the legions;
• Regulated sun exposure can help improve symptoms;
• Careful application of steroids, avoid applying indiscriminately, but do not promote corticophobia. The risks and benefits will be weighed in each case by your treating physician;
• Depending on the severity level, both systemic and topical treatment may be necessary;
• Strictly comply with the treatment prescribed by your treating physician.