By Dr Neil Persadsingh,


Many children suffer from eczema. This is probably the commonest skin disease seen in childhood.

The exact cause of this disease is unknown at the present time. But something seems to be wrong with the skin of these children, their skin becomes unstable and they suffer from outbreaks of eczema. The skin of these children is very dry and dry skin itches, and then a rash develops. The fundamental defect, however, is the dryness of the skin.

The incidence of eczema seems to be increasing. This is a world-wide trend and dermatologists everywhere are becoming very worried about this, because not only is the incidence of eczema increasing, but the proportion of children who are going on to develop adult eczema, is also increasing. Some studies are showing that eczema may well become the most common skin disease of adults in the 21st century.

Backs of knees

Caribbean nationals in the UK. My colleague, Dr Carol Burrel Morris, is at present doing a study in Jamaica with the University of London examining the prevalence of eczema here as compared with the prevalence in the London area.

Eczema tends to be recurrent, that is, the child will have repeated attacks. This is not the fault of the child nor of its parents, nor of the doctors. Instead, this is the nature of the disease. Many parents get very frustrated when they are told that the child may have attacks of eczema again and again, but this is just the nature of the disease. The infant with eczema usually has a rash which develops on her cheeks. Later the rash develops around the mouth. Later still, as the child begins to crawl, the rash becomes localised to the back of the wrist and the front of the ankles.

Then as the child continues to grow, the rash comes in the front of the elbows and the back of the knees.

On the cheeks 

In Jamaica we see a lot of children with eczema on the body and on the face. Therefore although we divide the eczema into these patterns, we must understand that this disease may not always conform to this pattern.

It is important that we understand that these are all manifestations of the same disease.

The rash of eczema itches. When we look at this rash it is scaly and the skin is usually inflamed. We may also see marks where the child has been itching. Sometimes the child may be perfectly at ease with his eczema, at other times he may be miserable and crying.

Usually the doctor can put the child on medication and the rash will settle. Eczema is, in many cases really a nuisance and both the child and the parent will have to learn to live with this disease. It is important that the doctor takes the time to talk with the parents because there are many simple things which the parent can do to help the child.

For example, heavy clothes should not be worn, as this causes the skin to become hot, and leads to even greater dryness of the skin. This makes the eczema worse.

The disease can be brought under control, and everything seems fine, but the patient will need to use a moisturising cream, such as glycerine in aqueous cream all the time, as this hydrates (that is, gives the skin the extra moisture it needs) and helps prevent the eczema from breaking out. At the first sign of the eczema recurring, the patient must start using the medicines and try and see the doctor. The patient should not wait until the disease has broken out badly, but instead try and see the doctor right away.

Eczema has been called an atopic disease. What we have noticed is that the children with eczema will have relatives, maybe the mother or father, brothers or sisters, aunts or uncles, cousins, and so on, who have suffered from asthma, hay fever, migraine headaches or from eczema. These four diseases are called the atopic disorders.

We do not believe that diet plays any part in this disease, but some parents will claim that milk makes the eczema break out. In these cases we will ask that the child be put on soya milk, that is, pro-sobee.

The treatment of this disease is based on steroid creams. Usually we will use one per cent hydro-cortisone cream as the mainstay of our treatment. Sometimes we may use emulate cream. We try and manage all our eczema patients on these two medicines. There are a few patients who will need a stronger steroid cream, but in children I rarely use anything besides one per cent hydro-cortisone or emulate cream. Many doctors use more potent steroids like lotrisone or elocon on these children. These should be avoided as we are seeing a lot of children who develop stretch marks and white spots on their skin from the use of these potent medications. If these strong medicines are used on the skin of children they must be used with care and the doctor must see the child within a week of starting to use them.

It is important that the parent understand that the child must discontinue the use of the creams slowly.

We always start with hydro-cortisone cream and we may have to use it in combination with anti-biotics if the eczema has become secondarily infected. We always ask that the parent apply a cream like glycerine in aqueous cream -- that is, oil of chantel -- or of zinc in castor oil cream over the hydro-cortisone cream.

It is very important that when the eczema settles that the child continues to use the oil of chantel on the skin even though there is no evidence of eczema at this stage.

We may take the child off the usual soaps at this stage. Instead, a soap substitute may be used, such as emusol or ungemulsificans. This is the soap substitute that the child will have to bathe with. The correct way to use this soap substitute is to obtain an empty coffee bottle. Into this bottle a tablespoon of the emusol is placed and boiling water is poured over it. The bottle is then shaken and the contents are then diluted with normal tap water.

This solution is used to bathe the baby with and although it may not make as much suds as soap, you must not be worried as it will cleanse the skin just as well as soap.

The child will need anti-histamines to cut down on the itching. Usually we prescribe clarathine syrup or oral DPH or puritan. These two medicines, although they are cheap, are very useful at bedtime, and they will help the child to get a comfortable night's sleep.

The alternative medicines have been tried with some success and many failures.

Oil of primrose was hailed as a breakthrough. Many patients have tried it. It has helped some children, while others have found it useless.

Chinese herbal medicines have also been tried. These seem to work, but only for a time. I know that most patients in Jamaica will try these medicines and then they usually come right back to the dermatologist. An analysis of these medicines found that they contained steroids in high concentrations.

There are also many other ingredients in these herbal medicines. Some of the effects of these medicines on the body we do not know. But we believe that they act synergistically, that is, they act together to get the patient well. These medicines are usually obtained as a mixture of twigs and leaves from which a tea is brewed. The concoction smells vile and its taste is horrible. Some patients may persist with it but most after their first taste flatly refuse to take any more, and go back to the conventional medicines.

Meditation has been tried for this disease. Perhaps if you are really good you can try to get a group of children to sit still and meditate for their eczema. In Jamaica this would seem to be a waste of time.

Massage, too, has been used as a form of treatment in the UK. The parents were taught to give the child a massage by a masseur. The parents would then give the child a massage at bedtime. The results have been encouraging and this is a useful addition to our treatments for this disease.

The majority of children with eczema will clear up as they get older and only a minority will go on to develop eczema as an adult.

If your child has eczema, do not despair, as the doctors in Jamaica are very good at treating this disease and your dermatologist will be able to help you to understand what is going on with your child's skin. Please see your dermatologist at the first sign of an outbreak of eczema. You will make everyone's life much easier, and really help your child.