Dermatitis (Eczema) in Children

Dermatitis is a general term used to describe inflamed, itchy skin.

The most common form seen in children is atopic dermatitis, often referred to as eczema.

Other types of dermatitis that may be seen in children include:

• Contact dermatitis, due to irritation or allergy

• Seborrhoeic dermatitis, such as cradle cap in infants

Each type of dermatitis has different triggers and management considerations.

Symptoms can vary between children and over time and may include:

• Dry, itchy skin

• Red or inflamed patches

• Rough or scaly areas

• Weeping or crusting during flares

• Thickened skin with long-standing disease

Eczema often follows a relapsing and remitting pattern, with periods of flare and improvement.

Management requires a tailored approach that takes into account the child’s age, severity of eczema, and impact on daily life.

Management may include:

• Regular moisturising to support the skin barrier

• Anti-inflammatory treatments to control active flares

• Identification and avoidance of triggers where possible

• Advice on gentle skincare and bathing routines

Treatment plans are reviewed and adjusted over time as the skin improves or changes.

Eczema is a chronic condition, and it is common for the skin to improve and then flare again later.

Setbacks can occur for a variety of reasons, including:

• Skin irritation (for example from soaps, saliva, friction, or environmental exposure)

• Skin infection

• External or environmental triggers

• Changes in routine, skincare, or treatment adherence

Identifying the reason for a flare is an important part of management, as different causes may require different treatment approaches. A dermatologist can help determine whether a flare is due to ongoing inflammation, irritation, infection, or another contributing factor and adjust treatment accordingly.

Topical corticosteroids are a key treatment for controlling skin inflammation during eczema flares and are recommended when the skin is actively inflamed.

Best practice use focuses on:

·       Using the lowest effective potency appropriate for the child’s age and the body site

·       Applying treatment for an adequate but limited duration to achieve good disease control

·       Stepping down or ceasing treatment once inflammation has settled

When used correctly, topical corticosteroids are effective and safe. Clear instructions on where, how often, and for how long to apply treatment help optimise outcomes and reduce the risk of both under-treatment and over-treatment.

Where appropriate, non-steroid (steroid-sparing) anti-inflammatory treatments may be used, particularly:

·       In sensitive areas such as the face or skin folds

·       As part of maintenance therapy once eczema is controlled

A dermatologist helps tailor treatment to disease activity over time, adjusting therapy as the child’s skin improves or flares.

Regular moisturising is a cornerstone of eczema management and supports the skin barrier.

Modern moisturisers often contain:

• Ceramides, which help repair the skin barrier

• Humectants, which attract and retain moisture

• Emollients that reduce water loss and dryness

Moisturisers may be sufficient for mild eczema or maintenance between flares but are often used alongside anti-inflammatory treatments during active disease.

Not necessarily. While eczema is more common in children who also have allergies, having eczema does not automatically mean a child has food allergies or requires allergy testing.

Eczema is primarily a condition of skin barrier dysfunction and inflammation. Allergy testing is most helpful when there is a clear history of immediate allergic reactions rather than as routine screening.

A dermatologist can help determine when allergies are likely to be contributing and when standard eczema management should remain the focus.

In most cases, routine skin prick testing or immunology review is not required for children with eczema.

Referral or testing may be considered in selected situations, such as:

• A history of immediate allergic reactions

• Poor growth or feeding difficulties

• Severe or difficult-to-control eczema despite appropriate treatment

• Recurrent infections or features raising concern for an underlying immune issue

Testing is most useful when there is a specific clinical question rather than as routine screening.

Eczema-affected skin is more vulnerable to infection because the skin barrier is disrupted.

Common infections seen in children with eczema include:

• Bacterial infection, most commonly Staphylococcus aureus (staph)

• Herpes simplex virus (HSV), which can cause painful clustered blisters and requires prompt medical review

• Enteroviral infections, including hand, foot and mouth disease

• Molluscum contagiosum, which may be more widespread or inflamed in children with eczema

Signs of infection can include increased redness, pain, crusting, weeping, rapid worsening of eczema, new blisters, or a child appearing unwell.

Medical review is important if infection is suspected, as management may need to be adjusted alongside ongoing eczema care.

For children with moderate to severe eczema that does not respond adequately to topical treatments alone, additional therapies may be considered under specialist care.

These options are discussed carefully with families and monitored regularly to ensure safety and effectiveness.

At Ready Dermatology, North Shore Health Hub, St Leonards, our dermatologist provides assessment and management of childhood eczema in accordance with Australian clinical guidelines. Care is individualised and focuses on safe treatment use, long-term disease control, and supporting children and families through both flares and maintenance.