Eczema (atopic dermatitis) is the most common chronic skin condition in children, affecting approximately 1 in 5 children in the UK at some point during childhood. It is characterised by dry, itchy, inflamed skin that can significantly affect quality of life, sleep and wellbeing for both children and their families.

This article explains what causes eczema, what triggers flares, how it is treated, and when allergy testing is appropriate for children with eczema.

What Causes Eczema in Children?

Eczema is caused by a combination of genetic and environmental factors. Children with eczema have a defect in the skin barrier — the protective outer layer of the skin — which allows moisture to escape and irritants and allergens to penetrate. This triggers an inflammatory immune response that causes the characteristic redness, itching and rash.

Eczema runs in families. Children with a parent or sibling with eczema, asthma or hay fever are at higher risk. The condition is part of the "atopic march" — a progression of allergic conditions that often begins with eczema in infancy, followed by food allergy, hay fever and asthma as the child grows.

Common Eczema Triggers

Eczema triggers vary between children. Common triggers include:

  • Dry skin: The most important trigger — inadequate moisturisation allows the skin barrier to break down
  • Irritants: Soaps, bubble baths, detergents, fragranced products, wool clothing
  • Heat and sweating: Overheating, hot baths, exercise
  • Infections: Bacterial (Staphylococcus aureus), viral (herpes simplex), fungal
  • Environmental allergens: House dust mite, pet dander, pollen, mould
  • Food allergens: In some children — particularly young children with severe eczema — food allergy (especially egg and cow's milk) can trigger or worsen eczema
  • Stress and anxiety
  • Hormonal changes

Eczema and Food Allergy

The relationship between eczema and food allergy is complex. Food allergy is more common in children with eczema than in the general population — approximately 30–40% of children with moderate to severe eczema have a food allergy. However, food allergy is not the cause of eczema in most children.

Allergy testing for food is most useful in children with moderate to severe eczema that is not adequately controlled by standard treatment, particularly if there is a clear history of reactions to specific foods. Read more in our article on whether eczema can be caused by food allergy.

Treating Eczema in Children

Emollient Therapy

Emollients (moisturisers) are the cornerstone of eczema management. They should be applied generously and frequently — at least twice daily, and more often during flares. Emollients restore the skin barrier, reduce water loss, and decrease the frequency and severity of flares. They should be applied to the whole body, not just affected areas.

There are many emollient products available. Dr Anandarajan will advise on the most appropriate emollient for your child's skin type and severity of eczema. Emollients should also be used as a soap substitute — avoid soap, bubble bath and shower gel on eczematous skin.

Topical Corticosteroids

Topical corticosteroids (steroid creams and ointments) are the most effective treatment for eczema flares. They reduce inflammation and itching. They are available in different strengths — mild (hydrocortisone 1%), moderate (clobetasone butyrate 0.05%), potent (betamethasone valerate 0.1%) and very potent. The appropriate strength depends on the severity of the eczema and the body area being treated.

Many parents are concerned about steroid side effects. When used correctly — the right strength, for the right duration, on the right body area — topical corticosteroids are safe and effective. Dr Anandarajan will provide clear guidance on how to use them safely.

Topical Calcineurin Inhibitors

Topical calcineurin inhibitors (tacrolimus ointment, pimecrolimus cream) are steroid-free anti-inflammatory treatments for eczema. They are particularly useful for sensitive areas such as the face and eyelids, and for children who need long-term maintenance treatment.

Antihistamines

Sedating antihistamines (such as chlorphenamine) may be used short-term to help with sleep during severe flares. They do not treat the underlying inflammation but can provide temporary relief from itching at night.

Wet Wrapping

Wet wrapping is a technique used for severe eczema flares. It involves applying emollient and topical corticosteroid under wet bandages or wet clothing, which helps the skin absorb the treatment and provides a physical barrier against scratching. Dr Anandarajan can demonstrate wet wrapping technique at the appointment.

When to See a Specialist for Eczema

You should consider seeking specialist assessment at Belfast Children's Allergy Clinic if:

  • Your child's eczema is moderate to severe and not adequately controlled by standard treatment
  • You suspect a food allergy may be triggering or worsening the eczema
  • Your child has recurrent skin infections (infected eczema)
  • You are concerned about the amount of topical steroid being used
  • Your child's eczema is significantly affecting sleep or quality of life
  • You want allergy testing to identify environmental triggers

Read more about eczema and allergy assessment at Belfast Children's Allergy Clinic.

Book an Appointment

Call 028 9066 7878 or book online at kph.fyi/Book-MAnandarajan. No GP referral is required. Same-week appointments are typically available.