INFANTILE ECZEMA

In infants atopic eczema is often papular and tends to occur on the face
and the neck, the trunk, the hands and feet, which may be scratched open
causing bacterial superinfection. The major complaint these infants have
is itch. Often young infants also have seborrhoic eczema especially on
the scalp, in the nappy area and body folds. Attempts to differentiate
between the two become difficult. For practical purposes the term
infantile eczema is therefore used. In the majority of cases the course is
chronic recurrent up to age 2 to 3 years, after which the eczema disappears.
In a minority it progresses to childhood or adult atopic eczema.
Management of infantile eczema
- Explain to the parents the recurrent nature of the disease! Also reassure them
that the eczema will most likely clear completely after some months to years.
Explain how to take care of the skin and how to use topical medication.
- Stop the use of irritants such as vaseline and excessive use of soap, contact with
wool, excessive sweating and temperature extremes. Bathe the baby using
aqueous cream or emulsifying ointment as a soap. Apply moisturiser (aqueous
cream, emulsifying ointment or coconut oil) while child is still wet.
- Keep fingernails short, cover itchy lesions with loose, airy clothing.
- Lesions: - A mild topical steroid such as hydrocortisone 1% once to twice daily
until lesions clear, usually 1 or 2 weeks. Continue aqueous cream etc. and
re-apply steroid only when lesions recur.
- Always use topical steroids intermittently when they are used over
longer periods of time.
- In chronic cases with lichenification: coal tar 2-10% paste or ointment
Apply this nightly because of its photosensitising potential.
- Eczema in the nappy area, armpits and on the scalp is usually
seborrhoic in origin: use an imidazole or sulphur 3-5% cream twice daily.
In the nappy area cover with a thick layer of zinc oxide paste.
- Itchiness: only in severe cases use a sedating antihistamine like promethazine.
Take care not to overdose in infants!!
- For superinfection use betadine shampoo or bathe in potassium permanganate
1:4000 solution (this is pink, not purple, a purple solution is too strong, it will stain
the skin and cause irritation), and if necessary antibiotics (cloxacillin, erythromycin).