Eczema is a chronic inflammatory disease of the skin that affects persons of all ages and is particularly common in infants and young children. Until recently it was considered the most common skin disorder. Many disorders which previously were diagnosed as eczema are no longer so classified. More and more has been learned about the causes of these various eruptions, and at the present time there remains very little to represent the old-fashioned eczema. Some authors even class this as "sensitization dermatitis," thus entirely disposing of it.
Eczema is non-infectious and is produced by both external and internal agents in an individual whose skin is sensitized to these agents. Very little is known concerning the internal factors of most importance which are capable of producing eczema. Eczema, therefore, is a form of sensitization dermatitis, and in any given case one might also find that there is a history of the individual having other sensitization disorders, such as asthma, hay fever, and hives.
Foods of all kinds, carbohydrates and fats as well as proteins, may be important causative factors. Not uncommonly a mother observes that her child's condition is aggravated by the eating of eggs, foods containing eggs, or other foods, but usually it remains for the physician to make such a discovery. Although a physician can ascertain by skin tests the foods to which the individual is sensitive, the elimination of these from the diet often does not remedy the trouble. The disorder is by no means entirely due to food sensitization, as it is too generally regarded to be.
Eczema in infants and children occurs as a redness, scaling, swelling, and crusting in large, ill-defined areas. It usually affects most markedly the face, the neck, the front surfaces of the upper extremities, and the back surfaces of the lower extremities. A particularly common site is the bed of the elbows and knees. However, any and all surfaces of the body are susceptible to it, and there are all grades of severity. Itching is a very prominent and distressing symptom.
The disorder usually begins within the first few weeks of life, and in a large percentage of the cases, either because of treatment or in spite of it, the disorder clears up permanently by the time the child is a few months or a few years old. In a small percentage of the cases, however - perhaps 10 per cent - the individual is troubled to some degree for many years or throughout life although the eruption tends to be more or less periodic.
Internal treatment is based on the determination of the causative factors. The care of the general health is important. Lotions, ointments, and other local measures should be suggested by the physician since entirely different measures are necessary in the different stages and types of the disorder. Soap and water should not be allowed to touch the involved areas, these parts being cleansed only with oils.
by Clark W. Finnerud
Common Skin Diseases of Children
