Why has my 5-year-old been having eczema since she was 3 months old?

Patient's Query

Hello doctor,

My 5 years old girl has been having eczema since she was 3 months old. She was scratchy all the time (at least every 3 to 4 hours). Even though we have applied moisturizers such as Aveeno, it was not helping her. When doctors prescribed topical steroids, we used it and she felt better. But as soon we stopped steroids she got the eczema back. As the doctors told we believed that as age progress eczema will subside. But she has even now and in fact it is little worse than before. We stopped steroids about six months back and trying to manage without it. One thing we noticed recently is that when we did not apply any oil or moisturizer (coconut oil or moisturizer never really helped) she did not scratch in the day time. But in the night between 12 AM and 2 AM she has been scratching all the time without sleep and sleep again. We are really worried if she will carry this lifelong and we are stressed. Also, we do not want to use steroid and would like your opinion on that if there is any complication if we avoid steroid completely and just leave her in this routine in the hope of getting better (we do not want her body to get used to steroid).

After reading the above points please advise on how we should handle her without much medicine, if possible?
Should we avoid moisturizer and oil as she is not scratching in daytime (rough patches still exist though)?
When will she get better or at least have less and manageable eczema? Will it be at least at her teenage?

Answered by Dr. Sunil Kothiwala

Hello,

Welcome to icliniq.com.

You have put your query with nice description but I think you have uploaded wrong images. So, if possible share correct images. From your description, it seems atopic eczema. It is endogenous eczema which may have several aggravating factors. Predisposition may come from the hereditary mechanism. Other first or second degree relatives may have features of some kind of allergy or atopy. Seasonal changes may also affect disease course. Some food like groundnut, cow milk, an egg may cause the problem.

It starts with dry skin. Then some tiny lesions, sometimes oozing, scaling, crusting. They may coalesce to form large plaques. So we have to put first check on dry skin by use of plenty of moisturizers. It is best to use just after taking bath, tap the water with towel softly then apply moisturizer within 3 to 5 minutes of the bath. And have to apply 3 to 4 times a day as per requirement of skin to combat dryness. The dry or cracked skin may produce stinging sensation: burning sensation initially but it will go on its own. Or you can try a different moisturizer, even a good vaseline or coconut is also perfect.

Topical steroids are useful during exacerbation of disease. It comes in different potency, and I hope your doctor had prescribed low-mid potency one. Like Hydrocortisone, Desonide, Flucinolone or Fluticasone. Among these, Desonide is best according to efficacy and safety. There is nothing like being habitual. You can stop anytime. But try to stop in tapering way like initially daily, then alternate day then weekends then stop. Your baby is 5 years old so you have one more option to replace steroids. Topical Tacrolimus 0.03 % ointment. Once lesions are clear by use of steroid then you can shift to Tacrolimus. Or on the face, it is alone sufficient. No need to use steroids on the face. How to manage with minimum medicine:

Moisturiser as much as possible.
Taking care of dry skin, avoid woolen cloths, clean bed mattress, bed sheets. Do not perform dusting or cleaning in front of the child.
Use Syndet in place of soap or use a moisturizing soap.
First, use Tacrolimus 0.03 % ointment if not controlled then topical steroid for few days then again maintain with Tacrolimus.

Can moisturiser be avoided? No. Apply with a soft hand, do not massage vigorously.

When will she get better? Usually, 80 % child become better by age of 12 to 13 years. But it depends on several factors like family history, exposure to aggravating factors, management of exacerbations. You have to pamper skin of your baby, care during cleaning, tapping, applying moisturizer all needed. There are several another way to treat exacerbation so you should not be worried.

For more information consult a dermatologist online --> https://www.icliniq.com/ask-a-doctor-online/dermatologist

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