Atopic Eczema: Dinuki's story and a doctor's note

As a doctor, a major part of my daily life is listening to patients who come to the clinic and treating their health problems. But it is a completely different experience to intervene when the child of one of my closest friends falls ill. This story is very close to my heart, both as a doctor and as a dear friend named Priya.

One morning, my friend Shalini called me. Her voice was filled with fatigue and worry. Her one-year-old daughter, Dinuki, had been suffering from a red, scaly rash on her cheeks and hands for several weeks.

This condition worsens at night and little Dinuki scratches herself until she cries. As a result, Shalini and her husband have not had a good night's sleep in weeks. As a friend, I understood her helplessness, so I went to Shalini's house that same evening. And so we began our journey to control Dinuki's atopic eczema .

What is Atopic Eczema?

Atopic dermatitis is a chronic skin condition that causes severe dryness, redness, and unbearable itching of the skin.

This is very common among young children, with between 5% and 10% of infants experiencing it early in their lives.

Causes of atopic eczema

The main cause of eczema is a weakening of the outer layer of our skin that retains moisture (the skin barrier). The main reasons for this are:

• Genetics: If family members have asthma, hay fever, or other allergies, the child is at higher risk of developing eczema. "Oh yes, Priya, I have asthma," Shalini recalled when I asked about her family background.
• Environmental factors: In addition to genetic predisposition, this can also be triggered by allergens in the surrounding environment.

Atopic eczema symptoms in children

The symptoms on Dinuki's body were consistent with atopic eczema:

• The skin becomes excessively dry and flaky or peeling.
• Red spots or rashes appear on the cheeks, forehead, and around the scalp (in older children, these are most common on the inside of the elbows and behind the knees).
• Unbearable severe itching (the child feels the itching more especially at night when it is quiet, and the itching is also aggravated by sweating).
• Constant scratching causes the skin to become damaged, thickened (lichenification) and blisters to appear.

Triggers that worsen eczema

Because eczema-prone skin is very sensitive, it can be quickly flared up by the following factors:

• Dry skin: Skin without moisture dries out quickly.
• Irritants:Perfumes, harsh soaps, washing powders containing chemicals, clothes made from wool and synthetic fabrics.
• Allergens: House dust mites, animal dander/saliva, and some allergenic foods (e.g., cow's milk, eggs, peanuts).
• Other factors: sweating due to excessive heat, extreme cold and dry wind, contact with sand on playgrounds.

🚨 Red Flags that require immediate medical attention

Since there is a risk of bacterial or viral infections on eczematous skin, medical attention should be sought immediately if the following symptoms occur:

• Skin discharge or yellow flakes: This is a sign of a bacterial infection (Impetigo) on the surface of the skin.
• Small fluid-filled blisters: If you develop painful, chickenpox-like blisters, especially around the face, it could be a dangerous viral infection called Eczema Herpeticum . This is a medical emergency.
• The child has a fever and refuses food.

How to control atopic eczema? (Skincare Routine)

Although there is no specific medicine to completely cure eczema, it can be completely controlled with a regular skincare routine.

1. Bathing Guidelines

• Bathe your child in warm water for about 10-15 minutes daily (too hot water will further dry out the skin).
• Use only emollient soap substitutes that do not contain perfumes or dyes and are recommended by doctors for bathing.
• After bathing, pat your skin gently, not rubbing it hard with a towel.

2. Moisturizing (3 Minute Rule)

• After bathing, apply a good thick moisturizer (emollient) to your entire body within 3 minutes , before your skin is completely dry.
• Apply this moisturizer at least 2-3 times a day, whenever the skin feels dry. This creates a protective layer on the skin.

3. Medical Treatment

• Topical Corticosteroids: Apply mild topical steroids prescribed by your doctor for only the prescribed number of days to reduce redness and severe swelling of the skin.
• Itching medications: If excessive scratching at night disrupts sleep, the doctor will prescribe an antihistamine medication suitable for the child for nighttime use only.

Do's & Don'ts

Scientific sources (References)

• 📚 Atopic eczema - NHS
• 📚 Steroid-sparing effect of emollients in atopic dermatitis and psoriasis - PMC