All over the world, more and more children suffer from atopic eczema, a problem that according to dermatologists is showing a sharp increase. 10 to 30% of children in industrialised countries are affected and the number of cases has tripled in 30 years! The medical name of this particular form of eczema is atopic dermatitis (often abbreviated to AD). Symptoms generally start around 3 months of age, but can appear right at birth, or long after. This very frequent, though noncontagious skin disease can be recognised by the dry red patches on the face and body. Small blisters filled with liquid can appear and may ooze and leave scabs. And itch is intense! Not easy for a little one to deal with, nor their parents…
6 essential points for Atopic eczema
1. Atopic dermatitis is often difficult to diagnose, which means parents can get discouraged.
2. Atopic dermatitis runs in cycles of flare-ups and calm periods, that are more or less spread out over time. Moisturising skin with adapted products is the best way to prevent eczema flare-ups.
3. Atopic eczema is NEVER contagious.
4. It can be hereditary, as part of a family background or genetic predisposition. If you have eczema, your children are more likely to have it as well, especially if the other parent also has atopic skin. But some children can have atopic skin without it previously existing within the family.
5. Atopic eczema’s characteristic sign is skin that is very dry and porous like a sponge and that does not create a barrier to the environment. It reacts to everything – the cold, poorly chosen toiletry products, soap, perspiration, sun, dust, fabric, stress, food…
6. Infant and childhood eczema must ALWAYS be taken care of medically, even if the disease disappears in most cases before puberty.
“Adapted treatment and skincare are essential to dealing with these years of eczema, so that a child doesn’t have to bear the consequences.”
Dr Magali Bourrel-Bouttaz, Dermatologist.
Remember
Don’t wait for eczema to go away all by itself. Be proactive. There are all kinds of solutions to help prevent and treat each flare-up (including topical corticosteroids). There is really no reason for a child to put up with their atopic dermatitis when it’s possible to control flare-ups and make life easier for children – and parents!
Molluscum contagiosum is a skin pathology that is frequent among young children. It heals on its own, but can also periodically aggravate eczema.
“Julia has always had eczema but in the last year, it has become worse. Due to molluscum contagiosum, she has more red patches on her legs than before, as well as a number of small bumps…”
Aude, 5-year-old Julia's Mom
“Very contagious among children, molluscum contagiosum is a virus that produces small bumps that are referred to as warts. When atopic skin is stimulated by an external factor, the only way it knows how to react is with eczema. Molluscum provokes an eczema flare-up around the little spots, that can lead to infection in the area if a child scratches. Children’s warts remain contagious until the molluscum disappears, which it usually does on its own, although their eczema is never contagious. Depending on how severe the molloscum is, your doctor may decide to destroy the warts, for example using curettage or cryotherapy.”
Dr Magali Bourrel-Bouttaz, Dermatologist.
We don’t always realise it, but atopic eczema is a pathology that is visible to others, and this can therefore have a psychological impact that is also visible in children’s behaviour. Being observant and reassuring is most important.
Three effects of eczema on children’s behaviour
Some children have lived their whole life with eczema and have no idea of what it’s like without! Others get to know the itching and unpleasant sensations of those red patches when they get bigger. Whatever their age, the experience usually affects children’s behaviour in some way, depending on how severe the eczema is.
1. Your child often wakes up at night, and gets annoyed easily
This is a classic scenario among babies and children who have atopic eczema. They feel the burning and the itching, which disrupts their sleep at night and during naps. They therefore aren’t getting enough sleep, which is so important when they’re little. Depending on the child, fatigue can accumulate to such a degree that she loses her temper easily during the day, her mood changes suddenly and she can become quite irritable.
"Last week, Julia had a red patch that was bothering her. She didn’t want to go to bed and wanted a topical treatment cream on it. She was afraid she wouldn’t be able to sleep because of her eczema. I put some moisturising cream on it, not the treatment cream because it wasn’t necessary. It worked. Julia calmed down and went to bed without any trouble."
Aude, 5-year-old Julia's Mom
2. Your child can’t hold still
This is also a result of the itching and discomfort that are caused by eczema patches. Babies often appear agitated and very energetic, wiggling and squirming a lot. Bigger children may have trouble staying still for long periods, which can be misunderstood at school. They may find it difficult to concentrate and shift, scratch, often change position and are seen as agitated – whereas they are simply itchy.
3. Your child is not comfortable with himself
If atopic dermatitis is severe and continues for months and years, it may affect a child in how he develops his identity. Dr Bourrel-Bouttaz, dermatologist, analysed self-portraits drawn by children with atopic skin. She detected the feelings and emotions that are typical among these children. They can feel different from others, and may have a painful view of their body that can lead to a deep sadness, which is often well hidden. Parents may worry, and must reassure their child and provide them with the necessary resources and resilience to stand up to this type of unpleasant situation.
"Last year during the lockdown, Julia rarely went to school wearing shorts or a skirt, so with her legs uncovered. This year, I’m going to talk to her since she has eczema patches and molluscum contagiosum spots. She has to learn not to be bothered. Children, even when they’re small, aren’t always nice. And in any case, I will take my usual approach and not make a big deal of it."
Aude, 5-year-old Julia's Mom
Eczema has a real psychological impact
Neither serious nor contagious, atopic eczema can nonetheless shake up family life. With baby eczema, babies have no means other than crying to express their discomfort, during the day and at night. As parents, it’s difficult to stay calm when your child cries every night. Older children can talk about their discomfort but may also be irritated, sad or hyperactive – behaviours which may be misinterpreted. It’s better to understand the psychological impact of atopic dermatitis so that you can handle it in the right way.
“The most important thing to remember is that the better condition skin is in, the better the child feels and is able to grow in a healthy manner.”
Joël Pacoret, Psychologist.
Atopic eczema’s consequences on family life
Obviously, parents are on the front line. Physically, they are often exhausted. Children’s interrupted sleep also creates bad nights for parents. Fatigue builds up, they wonder how long this is going to last, and unknown reserves of patience are called on to not get angry.
Psychologically, parents of children with atopic skin often feel alone and powerless, psychologically. With baby eczema, developing a bond with the baby can sometimes be trying. Diagnosis can take time, since this skin disease is still not well-known. Many parents speak of solitude and confusion. Some may even feel guilt, as if they feel they are responsible for what is happening to their child – even if eczema isn’t a serious disease.
"Seeing her legs with red patches makes me feel so bad. I feel a bit powerless. Cortisone soothes it, but it’s not good to use it all the time. Emollient cream also soothes the itching, but it’s not always easy to put it on everyday, especially when her skin is flaring up. I never really know what to do…"
Aude, 5-year-old Julia’s Mom
“It’s normal that parents worry because their child isn’t well. Atopic skin is not something that parents are responsible for. Atopic eczema is the modern world’s impact on a particular genetic make-up. Fifty years ago, only 3% of children had atopic skin… The environment, and more specifically pollution are at issue. Pollution changes how our genes function.”
Dr Magali Bourrel-Bouttaz, Dermatologist.
“Atopic dermatitis is linked to a genetic predisposition. It’s the result of a biological lottery and there is nothing parents can do to change it. The pathology generates fatigue, of course, and can also create tension and arguments in a couple. Fatigue and stress are normal in all families however, whether children have atopic skin or not! It is therefore essential to separate what is tied to the disease and what isn’t. As a couple, you also need to talk to strengthen your team as parents, and be better able to deal with different stressful situations. As for your family and friends, it is essential to explain to them the problems with eczema and define together a sort of base contract about what needs to be done and what needs to be avoided for the child with eczema (diet, skincare), especially when they are caring for the child in your absence. It may not be as good as at home, but that’s also a learning opportunity – we can’t always be in control of everything.”
Joël Pacoret, Psychologist.
Seven tips to help your child with atopic skin
1. Don’t wait to consult a physician if you have any doubts
Don’t hesitate to see your doctor or a dermatologist as soon as you see a suspicious rash that has all the classic signs of eczema. Also remember that there are specific atopic eczema services at hospital. Diagnosis is not always easy and can take some time. The first thing to do is introduce an eczema treatment for your child so that flare-ups are spaced out as much as possible. Also try to identify any triggering factors: heat, cold, diet, activities, clothing, laundry detergent, toiletry products… All of this information can be useful for your doctor.
Good to know
"Atopic dermatitis is not always recognised as a disease. And if there’s no disease, there’s no treatment! Too often, itchy skin isn’t associated with eczema. With the result that parents apply topical corticosteroids too late and not long enough. They know neither when to start nor when to stop."
Dr Magali Bourrel-Bouttaz, Dermatologist (France)
2. Change your habits
Your daily life will have to adapt!
- First, be sure to check that you are correctly using the toiletry and care products that are adapted to your child’s atopic skin: a gentle shower oil and not soap, for instance. Remember that applying a nourishing cream or emollient balm should be a daily reflex to make sure your child is comfortable. It’s better to teach them good habits for their skin from a young age, so that they can also then become independent and take care of themselves.
"They have lots of flare-ups, but I’ve noticed that if I apply an emollient cream, their skin is better."
Anne-Laure, 10-year-old Maxime and 4-year-old Hadrien’s Mom
Good to know
"A moisturising cream can sometimes sting. That’s normal!"
Dr Magali Bourrel-Bouttaz, Dermatologist (France)
Applying a moisturising cream to skin that is irritated by eczema patches can provoke stinging and burning sensations. This is normal, but treatment shouldn’t be stopped and it’s not a good idea to stop applying it. You should apply a topical corticosteroid as well as the emollient, until skin returns to normal.
“Applying an emollient is like brushing your teeth. For three years, you will explain to your child that she has to brush her teeth. After that, she will obey, but it will take a while before the task becomes automatic. The same is true for understanding the benefits of applying an emollient. However much you are able to do as a child will have a knock-on effect later, especially during adolescence or adulthood, if their atopic skin persists. It’s therefore important to include your child and have her participate as early as 4 or 5 years old, so that it becomes automatic for her, a habit, and so that she also understands that the cream brings greater daily comfort.”
Dr Magali Bourrel-Bouttaz, Dermatologist.
“Applying an emollient can be a special moment that you share with your child. It’s best if you are both calm and also that it doesn’t take too long. Sometimes it isn’t pleasant to apply the emollient when skin is irritated, but that’s not always the case. What is most important is making this a long-term activity and that both child and parents see the benefit: the more we do it, the better it works.”
Joël Pacoret, Psychologist.
Clothing
Choose clothing made out of soft material that doesn’t prickle, squeeze or irritate skin.
Reacting
Always remember that their skin can react to different things in the environment, key to keep in mind for sports, outdoor activities and hobbies.
Discover our article: "Atoderm Intensive baume : the reference in caring for atopic skin"
"We try to make her bath not too hot, and to dry her off without rubbing her skin, but sort of patting it dry. We’re also careful about clothing, choosing soft materials and comfortable styles."
Aude, 5-year-old Julia’s Mom
"The boys don’t always like going to the beach. The salt and sand can make their skin sting."
Anne-Laure, 10-year-old Maxime and 4-year-old Hadrien’s Mom
"That’s part of life – we can’t always control the outside environment. At the same time, if some activities are too painful or embarrassing, it’s always possible to find others that everyone will be happy with."
Joël Pacoret, Psychologist
Finally, eczema can quickly take over a large part of family life, with everyone following the rhythm of flare-ups and calm periods. An affected child’s sisters and brothers may feel like parents are always talking about it, and their sibling has a larger presence in the household than they do.
“Among siblings, conflicts and feelings of jealousy are normal, and part of what children need to learn to prepare themselves for living in a community. It is still necessary, however, to create a balance in your relationships by trying to spend quality time with each, individually. Events and activities that also bring together the whole family are a good way to strengthen ties. If required, this can be done with a professional.”
Joël Pacoret, Psychologist.
3. Talk about it
Atopic eczema is a skin disease that is not generally well-known. Don’t hesitate to explain the situation to your child, to help reassure them. Talk to your child’s friends, too, their teacher, daycamp counsellors, other family members… No, eczema isn’t contagious; yes, itching can be annoying and is nothing to do with a hygiene problem. Itching can also explain why your child may be agitated or change moods, due to a lack of sleep. Dermatological services in hospitals call this therapeutic education. The more your child feels understood, recognised and supported, the more their eczema will be easier to live with. Doctors have good knowledge of this skin problem. Effective treatments exist. Putting into daily practice the different tips and advice they give you will help prevent flare-ups and help you deal with eczema. They are essential for returning to a peaceful lifestyle.
"I told her that eczema is a relatively common skin problem that isn’t serious. I’m always telling her that we need to put cream on everyday. And I don’t make it a big deal so that she doesn’t feel bad all the time."
Aude, 5-year-old Julia’s mom
“It is always possible to help a patient and their family answer questions and comments. At school, discuss the subject with teachers and the other children. Explaining the disease, the symptoms and possible impacts, and showing whether we like to talk about it or not is a sign that we’ve accepted the disease and that we’re open about it.”
Dr Magali Bourrel-Bouttaz, Dermatologist.
“Talking early on to your child’s teachers and school nurse about her disease creates an open relationship. The idea is to explain the symptoms and be sure that they understand the necessity of a specific type of care to give the child, without necessarily making her a special case. There are also forums, online communities, information days organised by associations… All of these make it possible to meet other parents and children who are dealing with the same problems, so that you can discuss and share, as well as see things from a wider perspective and not feel quite so alone.”
Joël Pacoret, Psychologist.
Discover more tips in our article : "Solutions that make living with atopic eczema easier"
4. Managing stress and fatigue
Eczema, stress and fatigue often go together… Try to find a way of organising yourselves so that you don’t become exhausted. Your child needs parents who are in good shape to help him grow and be reassured. If nights are difficult, take turns doing the night shift so that you both get a rest. You can also nap the next day. Keep eczema out of your arguments with each other. If you are a single parent, ask your family to help from time to time if you can, so that you get a chance to rest. And don’t hesitate to tell your child that you need to sleep. Take care of yourself and as much as possible give yourself moments of respite, with activities that you enjoy and that can help, including yoga, meditation, sports… If you think that you or your child need help, there is no shame in consulting a psychologist who can help you manage the situation and provide tips for daily life. As a complement to medical treatment, alternative medicines can also help with lowering stress levels at home, important when stress can also trigger a flare-up.
5. Don’t feel guilty
Don’t blame yourself. It’s not your fault. Bring a sense of proportion to the situation. It’s not always easy, but there are ways to treat atopic dermatitis and improve things. Try contacting associations for parents that can give you all kinds of advice.
"One of my friends made me feel bad when she saw Julia’s legs. “Get her cared for immediately. You can’t leave her like that. She’s going to pass it on to her little brother. Everyone will make fun of her at school.” I defended myself and told her that I follow the doctor’s advice. It wasn’t a very pleasant visit. I reassure myself by saying that Julia’s eczema is made worse by the molluscum contagiosum. It will go away and soon be a bad memory."
Aude, 5-year-old Julia’s mom
“When peers make a hurtful or painful remark, even if it’s not meant on purpose, try to speak to the person who made it, to explain and prevent it from happening again.”
Joël Pacoret, Psychologist.
“Once again, parents are not guilty. Remember that it’s a chronic disease, where care is delegated to parents, and not to a healthcare professional. Parents manage it all. It’s really important to reassure them about how well they are taking care of their children and using the products. There are also gestures that they need to learn, and that can be stressful. Parents need to hear that they’re doing well, too.”
Dr Magali Bourrel-Bouttaz, Dermatologist.
6. Help your child in their development
Your child needs your help to develop a positive self-image from a very young age. Children with atopic skin often feel less good about themselves, or rejected by other children. Bring out their talents and what makes them special, which can help their self-confidence: sports, music, painting, cooking or any other activity they like. This will help them forget the itching while having fun. Spend time with them, touch and hug them, even if there are eczema patches. Maintain a tactile contact with their skin.
"Most important of all is applying cream and not making a big deal about their eczema. Julia needs to be reassured and distracted, even if her eczema is there."
Aude, 5-year-old Julia’s mom
“From the first hours of life, meeting the need for security comes through touch and skin contact. It’s been shown that caressing skin activates a particular part of the brain that develops a child’s lasting feeling of safety.”
Dr Magali Bourrel-Bouttaz, Dermatologist.
“If you notice a lasting change in your child’s behaviour, do try to speak to them. They need help in seeing themselves beyond their eczema: they also have attitudes, skills and other gifts. A child is much more than their atopic skin.”
Joël Pacoret, Psychologist.
7. So many reasons to be optimistic
During times when you or your child feels down, remember what is most important. Atopic eczema is neither serious nor contagious. It’s a disease that when well treated allows a child to live a normal life, just like all their friends. Therapeutic education is there for just that reason: so that parents trust caregivers and have confidence in the treatment and in themselves. Two attitudes help you be effective:
First, respect as closely as possible the dermatological treatment for this disease, based on three key products: a cleanser, an emollient and topical corticosteroids:
- For daily care, a routine using the cleanser and emollient, with specific products that are adapted to your child’s skin
- During a flare-up, continue the cleansing and cream routine and also apply the medical treatment as prescribed by your dermatologist.
Tip : Don’t hesitate to ask about participating in a therapeutic education programme. It will help you understand atopic skin as well as the benefits of treatments and daily care.
Second, help your child in any way you can to get beyond their eczema and continue to develop positively. Going through this kind of difficulty can develop strength of character, resilience and resistance that help enormously when facing with life’s situations. These are all key advantages for their future!
“There is always something positive to take away from a situation. Your child can develop skills and abilities that other children may never have.”
Joël Pacoret, Psychologist.