Around one in five children suffer from eczema, also known as atopic eczema or atopic dermatitis, causing inflamed, dry, and itchy skin. During flare-ups, the skin becomes vulnerable to cracks, bleeding, and infection, leading to discomfort and distress. The impact of eczema on children is far-reaching, affecting sleep, concentration at school, mood, and self-confidence.
Eczema, though chronic, can improve or even clear as children age, but it remains one of the most common reasons for children to seek medical care. Treatments can alleviate symptoms, including soothing sore skin, reducing itching, improving skin appearance, and preventing infections. This article explores common treatments, emerging research, and the support systems that families need for effective eczema management.
Prevention and Treatment
Common interventions to prevent or treat eczema in children often fail to provide significant relief. Research has shown that certain widely used treatments, such as bath emollients, silk clothing, and water softeners, do not reduce eczema severity. These findings help guide families and health professionals in choosing the most effective treatments while reducing unnecessary healthcare costs.
Daily Emollients from Birth Do Not Prevent Eczema
Eczema tends to run in families, prompting the idea that daily use of emollients from birth could help prevent the onset of the condition. However, studies like the Barrier Enhancement for Eczema Prevention (BEEP) trial involving 1,394 newborns found no evidence that daily emollient application reduced eczema risk or severity by age two. This result was consistent in a five-year follow-up, which confirmed that daily emollient use did not prevent eczema or lessen its severity.
A 2022 Cochrane review also supported these findings, concluding that interventions such as emollients are probably ineffective in preventing eczema and may even increase the risk of skin infections in infants.
Emollients for Treating Established Eczema
Although emollients may not prevent eczema, they are a critical part of managing established eczema by maintaining skin moisture. The National Institute for Health and Care Excellence (NICE) recommends daily moisturisation as part of eczema treatment, even during periods of remission. In 2019, the NHS spent over £95 million on emollients, underscoring their widespread use.
The 2023 Best Emollient for Eczema trial tested four types of emollients – lotion, cream, gel, and ointment – to determine which was most effective and acceptable. The trial showed that all types were equally effective at improving skin condition, but skin reactions were common. Parents and children reported that thinner emollients like lotions and gels were preferred for their quicker absorption, though some found these less effective for lasting protection.
Bath Emollients Are Not Beneficial
Despite being widely used, bath emollients, which are poured into the water, have shown no clinical benefit in treating eczema. The Bath Additives for the Treatment of Eczema in Children (BATHE) trial, involving 482 children, concluded that bath emollients did not improve eczema severity or provide additional benefits over standard care, leading to updated guidance advising against their use.
Silk Clothing Does Not Help Eczema
The 2017 CLOTHES trial examined whether specialist silk clothing could relieve eczema symptoms. The study found no significant improvement in eczema severity or medication use among children wearing silk clothing, prompting the discontinuation of its routine prescription in favor of more effective treatments.
Water Softeners Offer No Additional Benefit
The Softened Water Eczema Trial (SWET) tested whether home water softeners could improve eczema symptoms in areas with hard water. Despite some improvement in eczema severity for all participants, there was no added benefit from using water softeners over standard care.
Steroid Creams for Eczema Flare-Ups
During flare-ups, strong steroid creams are often used in combination with emollients. Recent reviews suggest that a once-daily application of strong steroid creams is as effective as twice-daily use and can be safely used for long-term management. The reviews also confirmed that stronger steroids are more effective than weaker ones. Despite concerns about side effects like skin thinning, recent research has found that the long-term use of steroids does not pose significant safety risks.
Oral Methotrexate and Ciclosporin for Severe Eczema
For severe eczema, systemic treatments like oral methotrexate and ciclosporin can be considered when topical treatments fail. The 2023 TREAT trial found that both drugs are effective, with ciclosporin working faster but methotrexate providing longer-lasting relief. Methotrexate may also offer a more cost-effective treatment option for the NHS.
Antibiotics for Infected Eczema
Eczema flare-ups often lead to skin infections, but recent research suggests that antibiotics should not be routinely prescribed for mild infections in children with eczema. The 2016 CREAM trial found that antibiotics did not offer additional benefits compared to standard treatments like emollients and steroid creams, even for children with suspected mild infections.
Conclusion
While eczema treatments like emollients, steroid creams, and systemic medications can effectively manage symptoms, some common interventions like bath emollients, silk clothing, and water softeners provide no substantial benefit. Families and healthcare providers need clear guidance to focus on proven treatments that work, ensuring children with eczema receive the most effective care.
The support that children and their families need to understand and self-manage eczema is just as important as the treatments themselves. By providing better information about treatment options and ensuring that families know how to use them effectively, healthcare professionals can help children manage their eczema and improve their quality of life.
Note: This article summarizes recent studies from the National Institute for Health and Care Research (NIHR) and NICE guidelines.
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