Eczema
What is eczema and what causes it?
Eczema is a common long-term skin condition that causes the skin to be itchy, dry and red. It may start at any age but often in babies and can run in families.
Some children with eczema can also have asthma, hayfever and/or food allergies. The cause of eczema is complex but genes can play a part. A relative may have ‘atopy’ which is a tendency to eczema, asthma or hayfever. Allergy testing would identify food allergies if symptoms suggest this is necessary but would not show a cause for eczema.
How is eczema treated?
A child with eczema has a slightly faulty skin barrier, which lets water out and allows dust, irritants and bacteria in. Moisturiser (emollient) helps repair and protect the skin barrier. Redness caused by inflammation is treated with steroid creams (topical corticosteroids).
When should you worry?
12-18 months
12-18 MONTHS
Contact your health visitor or GP if your baby is 12-18 months and they…
- Have lost skills which they could do before
- Feel very stiff, for example:
- Hold their arms and legs in the same position, such as always pulling their arm to their chest, or always crossing their legs
- Find it difficult to change their position on their own
- You find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
- Feel very floppy when they are awake
- Move their arms or legs in repetitive, jerky, or strange ways
- Use one side of their body more than the other, for example:
- Lean to the side when they sit
- Drag their leg or foot when crawling or walking
- Use one arm to pull to stand more than the other
- Rarely use one of their arms to pick up toys, or eat and drink
- Finds it hard to stand or walk, for example:
- Can’t pull to stand
- Fall over a lot when standing still
- Doesn’t cruise (walk while holding on to furniture)
- Walk on their tiptoes a lot
18-24 months
18-24 MONTHS
Contact your health visitor or GP if your baby is 18-24 months and they…
- Have lost skills which they could do before
- Feel very stiff, for example:
- Hold their arms and legs in the same position, such as always pulling their arm to their chest, or always crossing their legs
- Find it difficult to change their position on their own
- You find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
- Feel very floppy when they are awake
- Move their arms or legs in repetitive, jerky, or strange ways
- Use one side of their body more than the other, for example:
- Lean to the side when they sit
- Drag their leg or foot when crawling or walking
- Use one arm to pull to stand more than the other
- Rarely use one of their arms to pick up toys, or eat and drink
- Find it hard to balance when standing still, or fall over a lot
- Can’t walk by themselves
- Walk on their tiptoes a lot
- Are suddenly unsteady when walking
2 years
2 YEARS
Contact your health visitor or GP if your baby is 2 years and they…
- Have lost skills which they could do before
- Feel very stiff, for example:
- Hold their arms and legs in the same position, such as always pulling their arm to their chest, or always crossing their legs
- Find it difficult to change their position on their own
- You find it difficult to move your child’s arms or legs, making it tricky to change their nappy or clothes
- Feel very floppy when awake
- Move their arms or legs in repetitive, jerky, or strange ways
- Use one side of their body more than the other, for example:
- Lean to the side when they sit
- Drag one leg or foot behind them when crawling or walking
- Rarely use one of their arms to play, eat and drink
- Find it hard to balance when standing still or fall over a lot
- Can’t walk by themselves
- Mostly walk on their tiptoes
- Are suddenly unsteady when walking
- Haven’t started to run
- Move from laying down or sitting to standing by using their hands to push off the ground, and “walk” their hands up their legs until they are standing
3 years
3 YEARS
Contact your health visitor or GP if your baby is 3 years and they…
- Have lost skills which they could do before
- Feel very stiff, for example:
- Hold their arms and legs in the same position, such as always pulling their arm to their chest, or always crossing their legs
- Find it difficult to change their position on their own
- You find it difficult to move your child’s arms or legs, making it tricky to change their clothes
- Feel very floppy when awake
- Move their arms or legs in repetitive, jerky, or strange ways
- Use one side of their body more than the other, for example:
- Lean to the side when they sit
- Drag one leg or foot behind them when walking
- Rarely uses one of their arms to play, eat and drink
- Find it hard to balance when standing still or fall over a lot
- Can’t walk by themselves
- Mostly walk on their tiptoes
- Are suddenly unsteady when walking
- Have not started to jump or run
- Move from laying down or sitting to standing by using their hands to push off the ground, and “walk” their hands up their legs until they are standing
4 years
4 YEARS
Contact your health visitor or GP if your baby is 4 years and they…
- Have lost skills which they could do before
- Feel very stiff, for example:
- Hold their arms and legs in the same position, such as always pulling their arm to their chest, or always crossing their legs
- Find it difficult to change their position on their own
- Find it tricky to change their clothes
- Feel very floppy when awake
- Move their arms or legs in repetitive, jerky, or strange ways
- Use one side of their body more than the other, for example:
- Lean to the side when they sit
- Drag one leg or foot behind them when walking
- Rarely use one of their arms to play, eat and drink
- Find it hard to balance when standing still
- Suddenly become unsteady when walking
- Find it hard going upstairs or uphill
- Trip or fall a lot
- Walk on tiptoes most of the time
- Feel pain in their arms or legs
- Move from laying down or sitting on the floor to standing by using their hands to push off the ground, and “walk” their hands up their legs until they are standing.
5 years
5 YEARS
Contact your health visitor or GP if your baby is 5 years and they…
- Have lost skills which they could do before
- Feel very stiff, for example:
- Hold their arms and legs in the same position, such as always pulling their arm to their chest, or always crossing their legs
- Find it difficult to change their position on their own
- Find it tricky to change their clothes
- Feel very floppy when awake
- Move their arms or legs in repetitive, jerky, or strange ways
- Use one side of their body more than the other, for example:
- Lean to the side when they sit
- Drag one leg or foot behind them when walking
- Rarely uses one of their arms to play, eat and drink
- Find it hard to balance, or trip or fall a lot
- Persistently walk on tiptoes
- Suddenly become unsteady when walking
- Feel pain in their arms or legs
- Move from laying or sitting on the floor to standing by using their hands to push off the ground, and “walk” their hands up their legs until they are standing.
15 months
Your Child By Fifteen Months
Social/Emotional Milestones
- Copies other children while playing, like taking toys out of a container when another child does
- Shows you an object she likes
- Claps when excited
- Hugs stuffed doll or other toy
- Shows you affection (hugs, cuddles, or kisses you)
Language/Communication Milestones
- Tries to say one or two words besides “mama” or “dada,” like “ba” for ball or “da” for dog
- Looks at a familiar object when you name it
- Follows directions given with both a gesture and words. For example, he gives you a toy when you hold out your hand and say, “Give me the toy.”
- Points to ask for something or to get help
Cognitive Milestones (learning, thinking, problem-solving)
- Tries to use things the right way, like a phone, cup, or book
- Stacks at least two small objects, like blocks
Movement/Physical Development Milestones
- Takes a few steps on his own
- Uses fingers to feed herself some food
18 months
Your Child By Eighteen Months
Social/Emotional Milestones
- Moves away from you, but looks to make sure you are close by
- Points to show you something interesting
- Puts hands out for you to wash them
- Looks at a few pages in a book with you
- Helps you dress him by pushing arm through sleeve or lifting up foot
Language/Communication Milestones
- Tries to say three or more words besides “mama” or “dada”
- Follows one-step directions without any gestures, like giving you the toy when you say, “Give it to me.”
Cognitive Milestones (learning, thinking, problem-solving)
- Copies you doing chores, like sweeping with a broom
- Plays with toys in a simple way, like pushing a toy car
Movement/Physical Development Milestones
- Walks without holding on to anyone or anything
- Scribbles
- Drinks from a cup without a lid and may spill sometimes
- Feeds himself with his fingers
- Tries to use a spoon
- Climbs on and off a couch or chair without help
2 years
Your Child By Two Years
Social/Emotional Milestones
- Notices when others are hurt or upset, like pausing or looking sad when someone is crying
- Looks at your face to see how to react in a new situation
Language/Communication Milestones
- Points to things in a book when you ask, like “Where is the bear?”
- Says at least two words together, like “More milk.”
- Points to at least two body parts when you ask him to show you
- Uses more gestures than just waving and pointing, like blowing a kiss or nodding yes
Cognitive Milestones (learning, thinking, problem-solving)
- Holds something in one hand while using the other hand; for example, holding a container and taking the lid off
- Tries to use switches, knobs, or buttons on a toy
- Plays with more than one toy at the same time, like putting toy food on a toy plate
Movement/Physical Development Milestones
- Kicks a ball
- Runs
- Walks (not climbs) up a few stairs with or without help
- Eats with a spoon
2.5 years
Your Child By Thirty Months
Social/Emotional Milestones
- Plays next to other children and sometimes plays with them
- Shows you what she can do by saying, “Look at me!”
- Follows simple routines when told, like helping to pick up toys when you say, “It’s clean-up time.”
Language/Communication Milestones
- Says about 50 words
- Says two or more words together, with one action word, like “Doggie run”
- Names things in a book when you point and ask, “What is this?”
- Says words like “I,” “me,” or “we”
Cognitive Milestones (learning, thinking, problem-solving)
- Uses things to pretend, like feeding a block to a doll as if it were food
- Shows simple problem-solving skills, like standing on a small stool to reach something
- Follows two-step instructions like “Put the toy down and close the door.”
- Shows he knows at least one color, like pointing to a red crayon when you ask, “Which one is red?”
Movement/Physical Development Milestones
- Uses hands to twist things, like turning doorknobs or unscrewing lids
- Takes some clothes off by himself, like loose pants or an open jacket
- Jumps off the ground with both feet
- Turns book pages, one at a time, when you read to her
3 years
Your Child By Three Years
Social/Emotional Milestones
- Calms down within 10 minutes after you leave her, like at a childcare drop off
- Notices other children and joins them to play
Language/Communication Milestones
- Talks with you in conversation using at least two back-and-forth exchanges
- Asks “who,” “what,” “where,” or “why” questions, like “Where is mommy/daddy?”
- Says what action is happening in a picture or book when asked, like “running,” “eating,” or “playing”
- Says first name, when asked
- Talks well enough for others to understand, most of the time
Cognitive Milestones (learning, thinking, problem-solving)
- Draws a circle, when you show him how
- Avoids touching hot objects, like a stove, when you warn her
Movement/Physical Development Milestones
- Strings items together, like large beads or macaroni
- Puts on some clothes by himself, like loose pants or a jacket
- Uses a fork
4 years
Your Child By Four Years
Social/Emotional Milestones
- Pretends to be something else during play (teacher, superhero, dog)
- Asks to go play with children if none are around, like “Can I play with Alex?”
- Comforts others who are hurt or sad, like hugging a crying friend
- Avoids danger, like not jumping from tall heights at the playground
- Likes to be a “helper”
- Changes behavior based on where she is (place of worship, library, playground)
Language/Communication Milestones
- Says sentences with four or more words
- Says some words from a song, story, or nursery rhyme
- Talks about at least one thing that happened during her day, like “I played soccer.”
- Answers simple questions like “What is a coat for?” or “What is a crayon for?”
Cognitive Milestones (learning, thinking, problem-solving)
- Names a few colors of items
- Tells what comes next in a well-known story
- Draws a person with three or more body parts
Movement/Physical Development Milestones
- Catches a large ball most of the time
- Serves herself food or pours water, with adult supervision
- Unbuttons some buttons
- Holds crayon or pencil between fingers and thumb (not a fist)
5 years
Your Child By Five Years
Social/Emotional Milestones
- Follows rules or takes turns when playing games with other children
- Sings, dances, or acts for you
- Does simple chores at home, like matching socks or clearing the table after eating
Language/Communication Milestones
- Tells a story she heard or made up with at least two events. For example, a cat was stuck in a tree and a firefighter saved it
- Answers simple questions about a book or story after you read or tell it to him
- Keeps a conversation going with more than three back-and-forth exchanges
- Uses or recognizes simple rhymes (bat-cat, ball-tall)
Cognitive Milestones (learning, thinking, problem-solving)
- Counts to 10
- Names some numbers between 1 and 5 when you point to them
- Uses words about time, like “yesterday,” “tomorrow,” “morning,” or “night”
- Pays attention for 5 to 10 minutes during activities. For example, during story time or making arts and crafts (screen time does not count)
- Writes some letters in her name
- Names some letters when you point to them
Movement/Physical Development Milestones
- Buttons some buttons
- Hops on one foot
Advice and Guidance
Moisturisers (Emollients)
There are lots of different types of moisturisers;
- Gels – alcoholic or aqueous emulsion which liquefies on skin, often contain fragrances and preservatives.
- Lotions - contain oil and water, light to apply.
- Creams - water based, light, but contain preservatives so can sting especially if the child has very dry skin, also need to be applied frequently.
- Ointments – favoured by dermatology as provide the best skin barrier, preservative free but thick and greasy. Not to be used if there is infection on the skin.
How do emollients work?
Emollients provide a coating on the skin which help the broken skin barrier and improve the level of moisture. A variety of different types can be used at different times of the day depending on the condition of your skin e.g. a cream may be preferred during the day with an ointment at night.
The vast majority of emollients can be used as a soap substitute. Regular soaps can be drying for skin and cause irritation.
How much emollient is enough?
A thin shiny layer to the skin should be sufficient to all the affected areas. If treating the whole body approximately:
- 600g per week for an adult
- 250-500g per week for a child.
Top tips for emollients
- As a moisturiser
Smooth onto clean skin and apply as often as needed to prevent the skin becoming dry. Ideally it should be applied 2-4 times per day.
- As a cleanser
Apply liberally to the skin and wipe off with single layer of paper tissue, taking care not to damage fragile skin.
- As a soap substitute
Mix emollient with water in palm to form lather. Apply to the skin in a downwards direction. Gently rinse lather off skin leaving a thin layer of the ointment on the skin. Pat dry.
- In the bath
Ointments can be dissolved in water. Add a spoon full of ointment to a small amount of hot water in a jug. Then add to the bath water. Take care of the temperature of the water and when getting out of the bath, as it will be slippy.
How should emollients be applied?
Step 1
Always wash your hands for 20 seconds before applying a topical corticosteroid.
Step 2
Do not put your fingers into the tub as this can introduce bacteria and cause infection. Use a clean spoon or a spatula to take your emollient out of the tub.
If your emollient is in a pump this can be done straight on to your clean hands.
Step 3
Apply to the affected area in a downwards motion following the hair growth.
Do not rub in as this can block the follicles and cause infection.
What are topical corticosteroids?
Your doctor or specialist nurse will identify the correct strength of steroid for different parts of the body and discuss how to increase or decrease treatment appropriately using the steroid ladder.
Topical corticosteroids are used on adults, children and young people. More potent steroids are typically in adults used on the affected areas on the body and mild/moderate steroids on the face and skin folds (under arms, breast folds, groin and genitals).
Children and young people will be guided by their doctor or specialist nurse with the use of mild and moderate steroids however when required potent steroids will be used when treating severe skin conditions.
How long should I use topical corticosteroids?
It is important that you follow the treatment plan given by your doctor or specialist nurse in order for your skin to avoid a flare of your skin condition. If used correctly topical corticosteroids should not cause side effects. Thinning of the skin and stretch marks will occur only if a strong steroid is used incorrectly or over a prolonged time.
Step 1
Always wash your hands for 20 seconds before applying a topical corticosteroid.
Step 2
Squeeze the topical steroid in a line from the last finger crease to the fingertip. This is a fingertip unit (FTU).
One FTU would be sufficient to treat an area equivalent to two adult handprints
Step 3
Apply to the affected area in a downwards motion following the hair growth.
Do not rub in as this can block the follicles and cause infection.
How much topical corticosteroid should be applied?
One (FTU) fingertip unit would be sufficient to treat an area equivalent to two adult handprints. In children the fingertip and two handprints are based on that of an adult also. A thin shiny layer should cover the affected area
The tables below show how much is estimated to be used. This is based on the whole area being treated therefore if only a proportion is affected the amount would be reduced.
Children
Adults and young people
Precautions
- Topical corticosteroids and emollients contain paraffin which is flammable. Do not smoke, use naked flames (e.g. candles, BBQs, lighters, cigarettes) whilst these products are in contact with your skin, clothes dressings or bandages.
- If a topical corticosteroid causes irritation, please seek advice from your medical or nursing team.
- An emollient should be applied at least 30 minutes after applying a topical steroid or vice versa.
- If you are having ultraviolet light treatment or radiotherapy, check with your medical and nursing team if there is any specific guidance on your emollient use prior to starting treatment.
- Topical corticosteroids and emollients do not contain SPF and should not be used as sun protection. Sun creams should be used when skin is exposed to direct sunlight with a medium/high UV level.
Wet wraps
Wet wrap bandages consist of two layers of medical grade viscose clothing or bandage. The first layer is applied wet and the second dry. Wet wraps help to moisten the skin and reduce irritation. Wet wraps can help intensify topical corticosteroid treatment. As the garment slowly dries out, the skin feels cooler which can help to reduce the itch sensation. Furthermore, they assist in breaking the itch-scratch cycle with eczema due to the barrier it provides in access to direct skin.
Common brands of garments / tubular bandage include Clinifast®, Comfifast®, Skinnies® and Tubifast®. The garments and tubular bandages come in different sizes to suit different aged children and large and small adults.
Paste bandages
Paste bandages are soaked in zinc oxide or zinc oxide plus ichthammol. These ingredients make the bandage soothing and cooling which helps to relive itching and soreness. Paste bandages have anti-inflammatory and anti-bacterial properties.
How do you apply paste bandages?
There is a special way to apply paste bandages because as they dry they can become tighter. Therefore, extra room is needed to make sure they remain comfortable. This technique should be demonstrated to you by a healthcare professional in the department.
Do not apply around the neck, face or torso to avoid suffocation.
Arm Application (National Eczema Society, 2018)
- Wash your hands.
- Open the pack and remove bandage.
- Start at the hand and work up the arm. Wrap the paste bandage around the wrist, smoothing it into place. After each turn, reverse the direction of the winding to form a pleat.
- Continue up the arm and over the elbow, smoothing the paste bandage into place and reversing the direction of the winding (clockwise/anticlockwise) with each turn to make a pleat.
- Secure the paste bandage in place with a dry bandage, such as CLINI fast Tubular Bandage.
- If the fingers are affected, small strips of paste bandage can be wrapped around individual digits and moulded for comfort.
Patch Application
- Wash your hands.
- Open the pack and remove bandage.
- Cut an appropriate size patch and apply directed to the skin.
- Secure in place with dry bandage, such as CLINI fast Tubular Bandage. Alternatively secure in place with Cotton Garments.
Leg Application (National Eczema Society, 2018)
- Wash your hands.
- Open the pack and remove bandage.
- Start at the base of the toes and wrap paste bandage around the ball of the foot or heel, smoothing it into place. After each turn, reverse the direction of the winding to form a pleat.
- Continue up the lower leg and over the knee to the top of the leg, smoothing the paste bandage into place and reversing the direction of the winding (clockwise/anticlockwise) with each turn to make a pleat.
- Secure the paste bandage in place with a dry bandage, such as CLINI fast Tubular Bandage.
- If the toes are affected, small strips of paste bandage can be wrapped around individual digits and moulded for comfort.
What are the possible side effects of paste bandages?
Commonly paste bandages are used with topical corticosteroids underneath which increases the strength of them. A healthcare professional should always discuss your treatment plan with you before using paste bandages and topical corticosteroids together.
Environmental Triggers
Skin conditions can be triggered by many environmental irritants which include house dust mite, pets, pollen, moulds, central heating, laundry and cleaning products. It is impossible to eliminate all triggers but you can minimise these with some simple measures.
How to reduce house dust mites?
House dust mites are one of the biggest triggers in eczema and other skin conditions. They are tiny insects that feed skin we shed and are found in soft furnishings.
- You can reduce the amount of dust mites in your home by: vacuuming carpets regularly- daily if possible.
- Vacuum mattresses, pillows and covers at least twice a week. Damp dust surfaces and floors on a regular basis.
- Avoid dry dusting, as this can spread dust into the air.
- Wash bed linen weekly on high temperature and wash curtains every 2-3 months.
- Limit soft toys, have one special soft toy in the bed and wash this regularly on a high temperature or put in a plastic bag in the freezer overnight to kill off the dust mites.
How to reduce irritation by pets?
It's not pet fur that causes an allergic reaction but its flakes of their skin, saliva and dried urine. It may not be possible to remove a pet permanently but you could try:
- Keeping pets outside the house as much as possible.
- Not allowing pets into bedrooms.
- Washing pets regularly.
- Opening windows to increase ventilation.
How to reduce the impact of pollen?
Pollen allergy / hay fever is triggered when trees and grasses release pollen into the air. Typically, people are affected during spring (trees) and summer (grasses).
To help keep this under control you could:
- Avoid drying clothes outside when pollen count is high.
- Keep doors and windows shut where possible.
- Shower and change clothes from being outside.
- Avoid grassy areas, such as parks and fields, particularly in the early morning, evening or night, when the pollen count is highest.
How to reduce mould?
Tiny particles released by moulds can also cause an allergic reaction in some people. You can prevent this by:
- Dealing with any damp and condensation in your home.
- Keeping your home dry and well ventilated.
- Not storing clothes in damp cupboards.
- Removing any indoor pot plants from your home.
How to reduce the impact of central heating?
Central heating reduces humidity and dries the skin, making it itchy. You could control this by: Keeping your house at a comfortable 18°c. Hydrate your skin by applying moisturisers or emollient often when in the house
How to reduce the impact of laundry and cleaning products?
People with eczema should take special care with the items that come into direct contact with their skin. For most people fragrances (perfumes) and detergents are what cause skin reactions. Air fresheners, candles, wax melts and diffusers are also irritants and use should be avoided.
To help keep this under control you could: Use non bio washing powder when washing clothes. Use your washing machine’s second or “extra rinse” setting if it has one. Do not use fabric conditioner.
Self care and Prevention
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