Atopic dermatitis in children: causes, symptoms, diagnosis, treatment of childhood eczema

By Cristiano Antonino On May 24, 2023

Atopic dermatitis of children (or infantile eczema) is a benign disease; it is neither infectious nor contagious. The main symptom is itching: it is present at all ages and can be intense and almost constant

Atopic dermatitis is a chronic skin disease, neither infectious nor contagious, usually occurring in the first months of life

The main symptom is intense and constant itching
It can be caused by various factors such as a family predisposition, dry and itchy skin and environmental factors such as pollution
The areas of skin affected by atopic dermatitis may appear moist, reddened or dry
Cleansers and emollient creams are very helpful in treating atopic dermatitis. In some cases, creams with cortisone can be used under medical supervision.
Bathing will bring relief to the baby and eliminate itching. Dry him by patting the skin and then gently massaging on the prescribed cream
Constant care accelerates healing and reduces the intensity and frequency of relapses. Spontaneous healing usually occurs at around 3-4 years of age.

Atopic dermatitis is a chronic benign disease that usually occurs in the first few months of life, in about 20-30% of children.

It occurs most frequently in children with a family history of allergic diseases such as asthma, eczema or allergic rhinoconjunctivitis.

Atopic dermatitis is a multifactorial disease

Known causes are:

A genetic predisposition: children almost always have a family member with asthma, rhinoconjunctivitis or atopic dermatitis;
Alteration of the skin barrier: dryness, water loss, increased susceptibility to itching;
Environmental factors: in industrialised countries, atopic dermatitis is more frequent;
Food allergens: atopic dermatitis is rarely associated with food allergy-intolerance.

Symptoms are variable and change with age

Skin lesions may be exudating (moist), erythematous (red) or xerotic (dry).

Usually, these manifestations may occur simultaneously in the same patient and on the same day.

The localisation varies according to age and may be limited to certain areas (folds of the neck, elbows, knees) or extend to the whole skin.

The main symptom of atopic dermatitis is itching: it is present in all ages, can be intense and almost constant, sometimes even in the absence of lesions.

Itching may lead to a worsening of the skin manifestations with related complications, the most frequent of which is bacterial infection.

The itching can sometimes be so severe that it prevents the child and his or her family from sleeping at night.

The lack of sleep, of course, affects the child’s school performance and the parents’ work.

Itching, therefore, makes the family situation much worse.

Atopic dermatitis is not a psychosomatic disease

However, itching worsens and is experienced exaggeratedly when the dermatitis is not dealt with calmly by the family.

Moreover, children usually have certain character traits: intelligent, emotional, sensitive, with a very strong attachment to their mother, they require a lot of dialogue, attention and dedication.

These characteristics, obviously positive in themselves, constitute aggravating factors.

In fact, the child, at any age, often perceives that he can exploit his parents’ anxiety and apprehension about his dermatitis to remain constantly, but incorrectly and exaggeratedly, in the centre of attention.

In addition, the intense and frequent itching and the cosmetic repercussions lead to a vicious circle further affecting the emotional state of the little patient and his family.

It is by no means serious. It is chronic, not infectious or contagious, and regresses without leaving scars.

However, due to its complications, proper management is essential.

The diagnosis of atopic dermatitis is usually clinical and very simple

Biopsy (the microscopic study of a diseased skin fragment) or laboratory tests can sometimes only help to rule out other apparently similar diseases.

In selected cases, such as severe and treatment-resistant forms, or in cases where there are telltale symptoms of food allergies (e.g. diarrhoea, vomiting, constipation, poor growth, or the presence of a proven cause-and-effect relationship), more specific tests may prove useful.

It is more correct to speak of management than of cure.

The management of atopic dermatitis always involves appropriate dermatological therapy and the removal of the underlying causes, if present.

Therapy does not solve the problem at its root, but alleviates symptoms and prevents complications.

Atopic dermatitis is a skin disease, so its treatment relies mainly on topical (for local use, on the skin), pharmacological and cosmetic (cleansers, emollient creams) products.

Topical corticosteroids and/or immunomodulators must always be used appropriately, under the supervision of the prescribing specialist (paediatrician, dermatologist or allergist).

The choice of product to be used is complicated for a parent as it varies according to the type of lesions: the child may present simultaneously with erythematous (red), exudating (moist) or dry lesions and the parent must therefore know which product to apply to each of these.

Only the correct use of therapy can accelerate healing, reduce the intensity and frequency of relapses and prevent side effects.

Therefore, therapeutic education must be an integral part of the treatment of atopic dermatitis to ensure the success of the treatment and to encourage adherence to the treatment.

In the case of moderate-severe severity or if the location of the dermatitis negatively impacts on the quality of the child’s vision, therapy with more complex drugs (corticosteroids, immunosuppressants and/or biologics) may be considered.

Bathing has negative effects on childhood eczema

Absolutely false.

In reality, bathing:

Brings relief and eliminates many causes of irritation;
It should preferably be done in the evening with lukewarm water (35-36°C), with a mild detergent and should last about five minutes.

In addition, it should be:

Dry by gently patting the skin dry;
Apply the prescribed treatment with a gentle massage starting from the feet up to the face: this is an excellent opportunity for relaxation and interaction between parent and child.
Wound dressing and moisturising should be carried out according to the doctor’s instructions and very consistently.
It is necessary to follow the therapy prescribed by the specialist and to follow the teaching of the professionals during therapeutic education to become autonomous in the management of dermatitis at home.

In this way, the number of specialist visits is reduced and dressing time is transformed into a pleasant opportunity for parent/child contact.

Generally, the sun has a positive effect, with due caution, depending on the age of the child

Sun protection must be applied and sun exposure times adapted to the child’s age and skin colour must be respected.

In addition, special care should be taken for children with acute dermatitis and irritants such as sweat and sand.
Atopic dermatitis should not prevent the child from leading a normal social life and should not limit his or her play activities;
Particular care must be taken during pollination periods, but without prohibiting the child from playing in the open air;
The child can safely go to the swimming pool, even though the chlorine may irritate the skin, just shower immediately afterwards and apply the prescribed creams (medication or moisturiser);
Insect repellents should usually be avoided or at most only applied to clothing;
Shower after sporting activity and wash your hands thoroughly after handling irritants.

The development is chronic, lasting several months or years, but it usually tends to heal spontaneously and regresses around the age of 3-4 years.

In some cases it persists beyond that.

It rarely persists after puberty.

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