Childhood Eczema: An Environmental Scan
Table of Contents
3.2 Topic Areas
The term atopic dermatitis is a general reference to many different types of skin disorders whereas ‘atopic’ refers to the preponderance to develop allergic sensitizations. Specifically, eczema presents as eruptions of the skin that are red, inflamed areas with or without scaling. As the eruption continues, it may progress into a thick grooved patch that can blister or crack. The most rampant symptom of eczema is itching that can be very severe. A common form of eczema is atopic eczema that affects the entire body especially creases or folds in the skin and is frequently found on the face, behind the ears, front of the elbows, hands, back of the knees and trunk area of the body.
When a child is initially afflicted with eczema as an infant, eczema often appears between 2 and 4 months of age and frequently occurs on the facial area. As the child grows older, other areas of the body become affected such as the arms and legs, particularly behind the knees, in elbow creases and in the hand and wrist area. A rash begins and the most irritating and frequent symptom is itching. The itch-scratch cycle then breaks the skin, inflaming and irritating the skin even further and importantly allowing the penetration of foreign substances into the body through the broken skin barrier. Commonly, a child who is going to develop eczema will show symptoms by the age of 2 years. Furthermore, approximately 70% of children who suffer from eczema are expected to out-grow the condition by age 11 and show no permanent scarring (6) but this is not the case for all children and some individuals will continue to have the disease into adulthood (See Appendix F: ‘Types of Atopic Dermatitis’ for a list of common types).
Worldwide, approximately 12-25% of children between the ages of 6 months and 5 years are afflicted with eczema (4;8). Studies have demonstrated that approximately 50-75% of children are symptomatic before the age of 6 months and up to 90% by the age of 5 years. Furthermore, 60% of those children will have eczema after puberty and nearly 15% will continue to remain afflicted with eczema into adulthood. Alarmingly, the prevalence of childhood eczema has almost tripled since the early 1970’s (9). Additionally, the past 10 years have seen rapid increases in the prevalence of eczema, which researchers now suggest are likely impacted by environmental factors (10). The largest epidemiological study ever completed in child health is the International Study of Asthma and Allergies in Childhood (ISAAC), lead by Professor Williams at The University of Nottingham. The purpose of the study was to examine allergic disease through the analyses of information derived from survey data between 1991 and 2001 of over 450,000 children in 55 countries. The children were 6-7 and 13-14 years of age at the time of data collection. Results showed a less rapid increase in the number of children ages 13 and 14 who have eczema along with a decrease in some previously high geographical areas such as the United Kingdom and New Zealand. However, across developing countries and among younger children ages 6 and 7, the prevalence of eczema continues to increase. In concluding the results of the ISAAC study, Professor Williams stated that the cause of eczema, although not fully understood is a multi-factorial issue and attention to both genetic and environmental factors are necessary. Additionally, he stressed the possibility of eczema being a preventable disease with better understanding and that effective management strategies are known thus, it is important to remain vigilant in the evaluation of eczema components globally in order to illuminate how patients, clinicians and researchers may successful understand, cope and manage eczema.