Atopic eczema

Atopic eczema is the most commonest form, affecting as many as 15-20% of school age children, with 1-2% of children with the condition being severely affected. It commonly begins in early childhood, when it can be particularly severe.The pathogenesis of atopic eczema is complex and still incompletely understood. It is best considered as an interplay of genetic susceptibility that causes epidermal barrier dysfunction and abnormal immune responses, which are then stimulated by different environmental factors.
Causes for atopic eczema is multifactoral. It might be genetic or caused by various Potential trigger factors, including irritants (eg, soaps and detergents), skin infections, contact allergens, food allergens, and inhalant allergens. Food allergy can be ruled in, if a children with eczema develop immediate symptoms after ingestion of certain food. In infant and young children if moderate or severe uncontrolled eczema persist despite optimum management food allergy can be considered if particularly associated with vomiting,changes in bowel habits or failure to thrive. Children with eczema and suspected cow's milk allergy should not be given diets based on unmodified proteins such as goat or sheep milk or partially hydrolyzed formulas.
Based on severity of the symptoms, management plans is stepped up or down. Mild eczema is managed with emollients and mild-potency topical corticosteroids. Moderate-severity eczema is managed with emollients, moderate-potency topical corticosteroids, topical calcineurin inhibitors, and bandages, in a stepwise approach. For severe eczema, treatment steps, in addition to emollients, may include potent topical corticosteroids, topical calcineurin inhibitors, bandages, phototherapy, and systemic therapy.stepwise management, with regular emollients and intermittent topical corticosteroids forming the basis of treatment and topical calcineurin inhibitors being used as second line treatment under a dermatologist.
Children may be offered a choice of unperfumed emollients for daily moisturizing, washing, and bathing, that suites to their needs and preferences.When emollients and other topical treatments are applied at the same time of day, it is best. whenever feasible, apply these one at a time with several minutes between applications. Management includes control not cure. Even when the eczema is clear, emollients should always be used at least twice a day. In severe eczema, use of greasy emollients are best & in less severe eczema, less greasy preparations are more acceptable.
Parents can be sure of eczema flares, if increased dryness, itching, redness, swelling, and general irritability persist for a longer period. Children have dry skin, itching, so emollients are essential to treat dryness as it acts as a barrier. Children with eczema needs distraction from scratching because as skin is dry and itchy, that becomes a problem.The central heating is very drying so turning down may be helpful.Reducing exposure to house dust mite may also be helpful.
Although infantile eczema is very common, most grow out of it before 13 years of age. Parental support is crucial. Atopic eczema does not last for forever, so there is definitely a ray of hope at the end of the tunnel!