Eczema frequently becomes infected, and in such cases oral antibiotics may be very useful. In general it is better to treat infection with oral antibiotics than with antibiotic creams. More potent cortisone-based creams are of course sometimes necessary, but they should be reserved for sparing and infrequent use on the more severely affected areas of the skin. This is because of
their well-known local and internal side-effects, which will be discussed elsewhere.
It is still unknown what the place of diet is in the management of these children. Some workers have found that breastfeeding for as long as possible may delay the onset of atopic eczema in some so predisposed children. This work has as yet not been confirmed. Some children improve when goats’ milk or soya-based milk is substituted for cows milk. This is usually only of benefit to children that show other evidence of milk-protein allergy, and rarely has any prolonged benefit for children with eczema alone. Occasionally the parents will notice that the ingestion of one or two specific foods is followed by severe itching, and it seems sensible for them then to avoid these foods. However the withdrawal of potentially essential nutrients, in the hope that a cure for eczema might be found, it ill advised.
The hospitalization of those cases of severe generalized eczema which do not respond to normal treatment is often extremely beneficial. This enables one to remove the child from a potential area of stress, and allows more adequate reassessment and the introduction of a controlled, supervised treatment programme. In particular it is very useful to be able to bandage the child adequately, so that the skin which has been scratched has an opportunity to heal and regain its normal function. This can only be done by skilled nursing staff, who can then train the parents to follow this regimen at home if necessary. In hospital surroundings ‘messy’ creams and potions (which are often very useful) may be used without the parents becoming too upset about the appearance of their child’s bed linen. In hospital surroundings it is also much easier to reintroduce a normal diet for children who have been unnecessarily restricted in this regard. It is common experience for parents who may never have seen their child’s skin normal and clear to be astounded, after one week’s hospitalization, at the sight of their child with normal skin, astounded at how the skin ‘really looks’. Of course once the skin is back to normal it is much easier to keep it that way, and the parents should now have the confidence and skills required to do so.
What future or prognosis do these children have? It is often stated, quite correctly I believe, that children usually ‘grow out of eczema. This is because their oil and sweat glands mature and begin to function normally. Consequently their skin becomes less dry, less easily overheated and irritable; consequently the attacks of eczema become less and less frequent. More specifically however, the prognosis is related to whether the genetic pie-disposition is present in one or both parents. Statistically, many children have cleared by the age of 2 years, and at least 50 per cent are clear by the age of 6. Of the remaining 60 per cent, 30 per cent will clear by the age of 12, and a further 10 per cent by the age of 15.
This, however, does leave some 10 per cent of individuals who still get eczema over the age of 15. The older child or adult with persistent eczema may have it localized to just the hands, the creases, or some other less important area. This group must avoid contact with sufferers of active cold sores, and should not receive smallpox vaccinations as complications of a severe kind may result. They would be best advised to avoid those occupations which involve contact with irritant chemicals, including; oils, degreasing agents, and various hairdressing solutions. Other than this, it is important that affected children lead a normal life.
It must be stressed that children with eczema require continuing support and careful explanation of how they can learn to live within their skin’s capabilities; they need reassurance that their life can be made more comfortable, and that no permanent disfigurement will result. Worrying, especially about such things as these, will lower the individual’s threshold to skin irritation, and lead to more scratching and aggravation of the eczema.
Although the family must give a child with eczema special attention, it is important that the child not be allowed to ‘rule the roost’; rather firmness, with love, should be employed by the parents. When the child is older he must become an active participant in life rather than a passive recipient of treatment.
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