Eczema in children: an expert’s guide

Written by: Professor Adam Fox
Published: | Updated: 17/01/2019
Edited by: Cal Murphy

There has been a dramatic rise in allergic diseases in the Western world over the last 40 years, and almost 20% of children today are thought to have either allergic or atopic eczema. So, what is eczema, what can trigger flare-ups and how can we treat it? Dr Adam Fox, a leading paediatric allergist explains.

What is eczema?

Atopic eczema (a.k.a. atopic dermatitis) is a chronic skin condition characterised by patches of dry, itchy skin, which periodically flares up with no apparent cause. It usually starts in early childhood and fortunately, it is usually mild, albeit irritating. However, for some children, it can be more severe, with soreness, peeling skin, and rash-like symptoms, and it can be continuous, severely impacting the child’s life, as well as the lives of their parents or caregivers.


What is the best way to treat eczema?

Emollients (moisturisers) and bath oils are often used regularly on babies and children with eczema to keep the skin hydrated; however, these measures do little to calm down sore, enflamed patches and are no guarantee of preventing them either. These active areas of eczema are most effectively countered with anti-inflammatory measures, such as steroid creams.

The idea of using steroid creams on children can make some parents nervous due to the possibility of side-effects. This leads to many cases where eczema is under-treated and the child suffers skin damage as a result. The fact is, with the direction of a doctor, steroid creams are largely safe and usually very effective at treating eczema.

If a bacterial infection has caused the flare-up, antibiotics may also be required.


Why does eczema flare up?

Eczema may flare up due to:

  • Skin infections
  • Contact with irritants
  • Abrasive clothing
  • Sweating
  • Viruses

One possible but controversial factor could be that of diet. Some parents try to change their child’s diet to improve their eczema, but many doctors remain sceptical of the value of this, not least because it could mean that the child is missing out on important nutrients, which could affect their health in other ways.

However, as our understanding of food allergies improves, it is becoming clear that at least in a small proportion of children, excluding certain foods does indeed seem to have an impact on the child’s eczema. Establishing if food is a factor with the particular child and identifying the problem foods is not easy – if you think you have spotted a connection, take your child to see their family doctor or a specialist allergist rather than experimenting yourself.

By Professor Adam Fox
Paediatric allergy & immunology

Professor Adam Fox is an expert consultant paediatric allergist and one of the founding consultants of the children's allergy service at the world-renowned Guy's and St Thomas' Hospitals, home to the UK's largest paediatric allergy centre. Professor Fox is one of only a handful of UK doctors with recognised higher specialist training in paediatric allergy. His specialist interests include the management of food allergies, eczema, asthma, rhinitis (including hayfever), conjunctivitis, and drug and insect sting allergy. He is also the current president of the British Society for Allergy and Clinical Immunology, having become the first paediatrician to be elected into this role, in 2017.

As a result of his extensive experience and expert care, Dr Fox was included in The Times' Magazine ‘Britain's 100 Best Children's Doctors’, with the Tatler 2013 Guide listing him as one of the UK's top 250 specialists. In 2007, he was recognised as 'Paediatric Allergist of the Year' by Allergy UK. He also received the Raymond Horton-Smith award from Cambridge University for his research and a national Clinical Excellence Award from the Department of Health in 2016. In 2016 he was awarded the William Frankland Award from the British Society for Allergy & Clinical Immunology for his contribution to the speciality and in 2017 elected as the first paediatrician to be President (from October 2018).

Professor Fox completed his clinical training at University College London, having read Medicine and Neuroscience at Cambridge University. He went on to complete specialist training in paediatric allergy in 2006, before spending nine years as clinical lead of allergy at Guy's and St Thomas' Hospitals, London - one of Europe's largest specialist allergy services, recognised as a Centre of Excellence by both the World Allergy Organisation and GALEN (European Asthma and Allergy Network). Following three years as clinical director for specialist ambulatory medicine, he began as commercial medical director for Guy's and St Thomas' Hospitals NHS Foundation Trust. 

Professor Fox has conducted extensive research and is actively involved in cutting edge research in allergy desensitisation, asthma prevention, and food allergy, in setting up the largest allergen desensitisation programme in the UK. He has also published extensively, and is the senior author of the Milk Allergy in Primary Care guideline, which has been adopted around the world and received the Allergy UK Innovation Award in 2018. Professor Fox is an advisor to National Institute of Healthcare and Clinical Excellence (NICE) and chaired a clinical guideline development group for food allergy in children. 

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