Eczema is a common, non-contagious chronic skin condition that mostly recurs. During seasonal changes, particularly at the onset of spring and autumn, changes in temperature or humidity can cause children who already have dry, itchy skin or existing eczema to relapse or worsen. Although eczema cannot be cured, it is a manageable condition if medical advice is sought early and the allergens are addressed. However, many parents still worry that using steroids to treat eczema will affect their children's growth. Are steroids really that frightening?
This time, we've invitedPaediatric Specialist Dr Chan Yick-ChunTo debunk myths for everyone, he will also introduce two new methods for treating eczema: "desensitisation therapy" and the non-steroidal anti-inflammatory ointment "PDE4 inhibitors".
Dr. Chen Yi-Chun
Honorary Clinical Assistant Professor, Department of Paediatrics and Adolescent Medicine, The University of Hong Kong
Bachelor of Medicine and Bachelor of Surgery (MBBS), The Chinese University of Hong Kong
Fellow of the Royal College of Paediatrics and Child Health
Diploma in Paediatrics from the Royal College of Physicians and Surgeons of Ireland
Master of Public Health, The Chinese University of Hong Kong
Fellow of the Hong Kong College of Paediatricians
Fellow of the Hong Kong Academy of Medicine (Paediatrics)
問1：How many children in Hong Kong suffer from eczema? 問2What are the causes of eczema? 問3Children's eczema symptoms include itchy, dry, red, and inflamed skin. It can appear as rashes, blisters, or thickened skin. 問4What impact does eczema have on physical and mental development? 問5What are the treatments for eczema? 問6：What are the ways to prevent eczema? 問7What are some common myths about steroid treatment?
A: 香港有多少兒童患有濕疹？ There are no official statistics at the moment. However, judging by clinical experience, it is estimated that about 15 to 20 out of every 100 newborn babies will develop eczema to varying degrees.
What are the causes of eczema? The causes can be divided into congenital and acquired. Congenital factors include family heredity, such as a history of allergic diseases like allergic rhinitis and asthma in parents, siblings, or immediate relatives, which can increase the risk of children developing eczema. Some infants are born with a deficiency in their skin's ability to produce protective oils, making their skin more prone to moisture loss, dryness, and itching. Over time, when the weather changes and humidity drops, this can more easily trigger eczema.
Environmental factors refer to allergens, which can be broadly divided into two main categories. The first category includes food allergens such as milk, egg white, egg yolk, and peanuts. The second category refers to environmental allergens, the most common being dust mites or cat and dog dander. It is worth noting that among children in Hong Kong who suffer from allergic diseases and undergo environmental allergen testing, 70% are sensitive to dust mites.
What are the symptoms of eczema in children? When newborn babies first develop eczema, it is more common to see red patches, described as "in patches" rather than "in spots," on their cheeks, neck, and the inside of their limbs. Some people refer to this as "milk rash." Parents will notice that the affected skin feels noticeably dry and rough to the touch. Some babies with more severe eczema may also develop cradle cap.As babies with eczema may not be able to express itching or scratch directly, parents should pay special attention to whether the baby is shaking their head for no reason.(* "Milia" is not usually eczema; it may be a viral rash, chickenpox, or hives.)
As babies with eczema may not be able to express itching or scratch directly, parents should pay special attention to whether the baby is shaking their head for no reason.
Answer: What impact does eczema have on a child's physical and mental development? Infants with severe eczema may become irritable and cry frequently due to uncontrollable itching. Night-time itching can also affect sleep quality, and chronic sleep deprivation can lead to a reduced appetite, impacting long-term development. By school age, poor sleep quality can affect a child's mood, making them more prone to tantrums and difficulties concentrating in class, thus lowering learning efficiency. Furthermore, poorly managed eczema may lead to scarring and affect appearance. Adolescents might subsequently reduce their participation in group activities or even miss school. If they are teased by peers, their self-esteem and confidence can be further diminished.
Poor sleep quality in children not only affects their mood, leading to a quicker temper, but also makes it harder for them to concentrate in class, reducing learning efficiency.
A: 濕疹有哪些治療方法？ Chan There are many treatments, which can be divided into topical or oral medications, and topical medications alone can be divided into three grades. Firstly, it is to enhance children's skin's ability to moisturise and protect, especially during the autumn and winter seasons when humidity is lower. It is recommended to apply moisturising ointment to children as soon as possible within 15 minutes after bathing every day. Secondly, once a child is diagnosed with eczema, in addition to applying moisturising ointments, doctors may prescribe low-dose steroid ointments to reduce inflammation, which can generally improve eczema within a few days. Parents should note that steroid medications must be used according to the doctor's instructions and should not be used for more than a week if possible.Third, in recent years, a new eczema treatment called "PDE4 inhibitors" has emerged. These are anti-inflammatory drugs that do not contain steroids.
Regarding oral medication, doctors can prescribe oral anti-allergy medication for children with moderate to severe eczema to reduce the itchiness of the affected areas. It is worth noting that eczema can indeed have complications. The most common one is when children constantly scratch, transferring bacteria from their fingers to the eczema-affected areas, leading to bacterial infection, inflammation, and pus. At this point, doctors will prescribe topical or oral antibiotics to kill the bacteria.
Question:Eczema allergies in childrenWhat are the preventative measures? Chan Pay more attention to the humidity at home, especially during summer when air conditioning is used for extended periods, as indoor environments can easily become dry. Parents can consider purchasing a humidifier to maintain indoor humidity. The oral or topical medications previously mentioned are only temporary solutions; when a child's eczema is recurrent, finding and controlling allergens is the most effective method. For infants aged 6 months or older who have persistent eczema, allergen testing is recommended. There are two types of allergen testing: skin prick testing and Immunoglobulin E (IgE) allergy testing. For example, if testing reveals a child is sensitive to dust mites, parents can focus on environmental control, such as frequent vacuuming, using an air purifier with dust mite filtration, and avoiding placing long-pile carpets or stuffed animals at home. They can also consider using anti-dust mite bedding to reduce the risk of eczema triggered by allergen exposure during sleep. If testing reveals sensitivity to specific foods, dietary restrictions can be considered.
In the last 10 years, "desensitisation therapy" has also become popular. If a child is aged 4 or above and suffers from severe eczema, for whom various drug treatments have not been very effective, desensitisation therapy can be considered a new hope. Children only need to place the oral solution under their tongue for 5 minutes each night. Although the treatment period is as long as 3 years, it can significantly reduce a child's allergic reactions to specific allergens for their entire life.
It's worth noting that eczema is related to stress. Some children may only develop eczema for the first time when they start primary or secondary school. Parents can talk more with their children or let them participate in extracurricular activities to relieve stress, which can indirectly help children's eczema from worsening.
Eczema is related to stress, and taking children on outings is also a good choice.
What are parents' misconceptions about steroid treatment for eczema? Chen: There is a widespread belief that the use of steroids can affect children’s growth, development and height. Some parents, out of concern for the side effects of steroids, avoid them at all costs; even when their child has severe eczema, they insist on using only basic moisturising ointments, which can actually cause the condition to worsen.In fact, there are many forms of steroids; amongst these, injections and oral preparations carry greater risks of side effects, whilst topical applications have relatively fewer side effects. As long as they are not used continuously for more than a week, the risk of side effects can be significantly reduced.
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