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What is Eczema in Children?

Main points summarized

• Eczema (atopic dermatitis) is a common, non-contagious skin condition in children that causes dry, itchy, sensitive, and inflamed skin due to a weakened skin barrier.

• It often begins in infancy or early childhood, affecting around 10–20% of children worldwide and over 20% in some Malaysian reports.

• Common symptoms include dryness, itching, redness, inflammation, scaling, cracking, and rashes. The affected areas can vary with age.

• Management focuses on moisturising regularly, using gentle fragrance-free products, avoiding triggers such as heat, sweat, harsh soaps, and irritating fabrics, and following medical treatment when needed.

• Parents should seek medical advice if eczema is severe, persistent, worsening, affecting daily life or sleep, or showing signs of infection. With proper care, many children improve as they grow older.

Eczema, also known as atopic dermatitis, is a skin condition that causes the skin to become dry, itchy, and sensitive. It often appears as red, rough, or inflamed patches that can make children feel uncomfortable and restless, especially when the itching becomes intense (1).
Eczema is not contagious and cannot be passed from one child to another. Children with eczema have a skin barrier that does not function as effectively as it should, causing the skin to lose moisture more easily and become more sensitive to triggers such as heat, sweat, dust, certain fabrics, and environmental allergens (2).
The appearance of eczema may vary with age. In toddlers, it commonly affects the cheeks, forehead, scalp, and outer parts of the arms and legs, while in toddlers and older children it is more often found in skin folds such as the elbows, knees, wrists, and ankles.

How common is Eczema in Children?

Eczema is one of the most common skin conditions affecting children and typically begins during infancy or early childhood.

Globally, eczema affects approximately 10% to 20% of children and 2% to 10% of adults (3). In Malaysia, the condition is particularly common among children, with the Dermatological Society of Malaysia reporting that more than 20% of Malaysian children are affected by atopic dermatitis (4). This highlights the significant impact eczema has on children and families both locally and worldwide.

The severity and pattern of symptoms can differ from one child to another. Some children may experience only occasional mild patches of dry skin, while others have recurring episodes of redness, irritation, and itching. Symptoms often fluctuate over time, with periods of improvement followed by flare-ups.

Although eczema is considered a long-term condition, many children experience significant improvement as they grow older, and some may eventually outgrow their symptoms altogether.

What Are the Symptoms of Eczema in Children?

The symptoms of eczema can vary between children, ranging from mild dryness to more severe itching and inflammation. Recognising the common signs of eczema can help parents identify the condition early and take appropriate steps to support their child's skin health.

1. Dry and Sensitive Skin
Children with eczema often have dry, rough, and sensitive skin due to a weakened skin barrier that loses moisture more easily.

2. Itching
Itching is one of the most common and distressing symptoms of eczema. Scratching can further damage the skin and worsen irritation.

3. Redness and Inflammation
Areas of the skin to become red, irritated, swollen, and inflamed during flare-ups.

4. Rough, Scaly, or Cracked Skin
Affected areas may become rough, flaky, thickened, or cracked

5. Skin Rashes
Eczema rashes appear in different areas depending on a child's age. In toddler, it commonly affects the cheeks, forehead, scalp, and outer arms and legs. In older children, it is often found in skin folds such as the elbows and knees.

6. Oozing or Crusting Skin
During more severe flare-ups, the skin may develop small blisters, leak fluid, or form crusts.

Evidence-Based Ways to Relieve Eczema

Although eczema (atopic dermatitis) cannot be cured completely, it can be effectively managed with the right approach. Management aims to reduce flare-ups, relieve symptoms such as itching and discomfort, strengthen the skin barrier, prevent infections, and improve a child's overall quality of life (9).

1. Maintain a Consistent Skincare Routine
A good skincare routine is the foundation of eczema management. Regular bathing with gentle, fragrance-free cleansers and applying moisturisers regularly can help restore moisture, strengthen the skin barrier, and reduce dryness. Moisturisers are especially important after bathing to help lock in hydration and prevent the skin from becoming irritated.

2. Avoid Known Triggers
Identifying and avoiding triggers can help reduce the frequency and severity of eczema flare-ups. Common triggers include harsh soaps and detergents, fragrances, certain fabrics such as wool, heat, sweating, extreme temperatures, dust, and environmental allergens. Since triggers differ between children, parents can observe patterns to identify factors that may worsen their child's symptoms.

3. Use Wet Wrap Therapy When Recommended
For children with more severe dryness or flare-ups, dermatologists may recommend wet wrap therapy. This involves applying moisturiser or prescribed medication to affected areas, followed by damp and dry layers of clothing or bandages. Wet wraps help increase skin hydration and may improve the effectiveness of topical treatments (10).

4. Support Overall Skin and Immune Health
Maintaining healthy lifestyle habits may support eczema management. A balanced diet rich in fruits, vegetables, whole grains, fibre, and healthy fats can support overall health and help maintain a balanced inflammatory response. While diet alone cannot treat eczema, good nutrition may complement other treatment approaches.

When Should Parents Seek Medical Advice?

While many children with eczema can manage their symptoms with regular skincare and trigger avoidance, medical advice may be needed when symptoms become difficult to control or significantly affect a child's daily life. Parents should consult a doctor or paediatrician if:

Eczema symptoms are frequent, severe, or continue to worsen despite proper skincare.

Itching affects the child's sleep, concentration, or daily activities.

The skin becomes painful, swollen, warm, or increasingly red, which may indicate an infection.

There is oozing, crusting, pus, or signs of skin infection.

Eczema appears to be spreading or new areas of the body become affected.

The child experiences significant discomfort or emotional distress due to their skin condition.

Parents are unsure about which skincare products or treatments are suitable for their child.

Early medical advice can help children receive appropriate treatment, prevent complications, and improve their overall comfort and quality of life.

Conclusion

Eczema is a common skin condition that affects many children, causing dryness, itching, and skin irritation. While it can be uncomfortable, understanding the condition can help parents provide better support and care.

Managing eczema involves more than treating flare-ups. Consistent skincare, avoiding triggers, and following appropriate treatment plans can help protect the skin barrier and reduce symptoms.

Every child experiences eczema differently, and finding the right approach may take time. With proper care and support from healthcare professionals, most children with eczema can achieve better skin comfort and improved quality of life.

Frequently asked questions on eczema in children

What causes eczema in children?

Eczema is a multifactorial condition, meaning it develops from a combination of genetic and environmental factors.

Children with a family history of eczema, allergies, asthma, or hay fever may be more likely to develop eczema. Their skin barrier may not work as effectively, causing the skin to lose moisture more easily and become more sensitive to irritants and allergens.

Environmental factors can also trigger or worsen eczema flare-ups. Common triggers include heat and sweating, dry weather, dust, environmental allergens, harsh soaps or detergents, fragrances, and irritating fabrics such as wool.

Every child is different, and not all children will react to the same triggers. Identifying and avoiding the factors that worsen your child's eczema can help reduce flare-ups and keep their skin more comfortable.

Do children outgrow eczema?

Yes, many children experience significant improvement in their eczema as they grow older, and some may eventually outgrow it. Eczema often starts during infancy or early childhood, and symptoms may become less frequent or less severe with age.

However, not every child will completely outgrow eczema. Some children may continue to experience occasional flare-ups into adolescence or adulthood. The pattern and severity can also change over time.

With consistent skincare, avoiding known triggers, and appropriate treatment when needed, eczema can usually be well managed, helping children stay comfortable and maintain a good quality of life.

How to treat children’s eczema?

Eczema can usually be managed with a combination of good skincare, trigger avoidance, healthy nutrition, and appropriate medical treatment. The main goal is to keep the skin moisturised, reduce flare-ups, and relieve itching.

·        Moisturise regularly: Use a gentle, fragrance-free moisturiser to keep the skin hydrated and protect the skin barrier.
·        Avoid triggers: Reduce exposure to heat, sweating, harsh soaps, fragrances, dust, and fabrics that irritate your child's skin.
·        Maintain a balanced diet: Provide a varied, nutritious diet with fruits, vegetables, whole grains, protein, and healthy fats. Avoid removing foods unnecessarily unless advised by a doctor or dietitian.
·        Seek medical advice when needed: Consult a doctor if eczema is severe, persistent, affects sleep, or does not improve with regular skincare. Pain, swelling, increasing redness, pus, oozing, or crusting may indicate an infection and require medical attention. Doctors may recommend topical treatments or other medications depending on the severity of the eczema

Can children get eczema on their hands?

Yes. Children can develop eczema on their hands. It can be triggered or worsened by frequent handwashing, strong soaps and sanitizers, detergents, sweating, prolonged cold or dry surroundings, and contact with irritating substances.

Keeping the hands moisturised with a gentle, non-triggering lotion and avoiding known irritants in soaps can help.