Atopic eczema (atopic dermatitis) affects approximately 1 in 5 children in the UK, making it one of the most common childhood conditions. While it cannot be cured, it can be managed very effectively — and for most children, it improves significantly or resolves by adulthood. Understanding the condition and its management reduces both the child’s suffering and the enormous stress it places on families.
What Causes Childhood Eczema
Atopic eczema has two interacting causes. Skin barrier dysfunction: mutations in the gene encoding filaggrin (a key skin barrier protein) are found in approximately 30–40% of children with eczema. Deficient filaggrin leads to a “leaky” skin barrier — increased transepidermal water loss (dry skin), greater susceptibility to irritants, and easier penetration of allergens. Immune dysregulation: an overactive Th2 immune response drives the allergic inflammation characteristic of eczema. This immune profile also underlies the “atopic march” — the tendency for eczema to be followed by food allergies, asthma, and allergic rhinitis. Triggers don’t cause eczema but provoke flares in susceptible skin: heat, sweating, certain fabrics (wool, synthetic), fragrance in products, soap, hard water, certain foods, and infections.
The Stepwise Management Approach
Emollients — the foundation of all eczema management: emollients restore the skin barrier, reduce water loss, and reduce the frequency and severity of flares. They should be applied generously, frequently (at least twice daily and after every bath), to the whole body — not just affected areas. “Moisturise first, then treat” is the principle. Ointments (Epaderm, Zerocream, Diprobase ointment) are most effective but feel greasy; creams are better tolerated by children during the day. The 500g rule: a child with moderate-severe eczema may need 500g of emollient per week. If a small tub is lasting a month, it’s not being applied enough. Topical corticosteroids (TCS): hydrocortisone 1% (weakest, available OTC, appropriate for mild eczema on face and body in children) to stronger prescription TCS for moderate-severe eczema. Apply once daily to affected (not clear) skin during flares; stop when skin has been clear for 2 days. Potency matching to severity and location is important — overuse is a risk but also underuse (insufficient strength). Topical calcineurin inhibitors (tacrolimus, pimecrolimus): steroid-sparing options for sensitive areas (face, neck, skin folds) when TCS concerns exist.
Bathing and Skincare
Daily lukewarm (not hot) baths or showers. Add emollient to bath water (bath emollients reduce water hardness irritation). Avoid all soap and bubble bath — use soap substitute emollient wash instead. Pat dry gently, never rub. Apply emollient immediately (within 3 minutes of bathing, while skin is slightly damp).
Frequently Asked Questions About Childhood Eczema
Should I change my child’s diet if they have eczema?
Dietary modification is appropriate only when food allergy is identified as a trigger through proper assessment — not on suspicion alone. Eliminating foods without clear evidence causes nutritional harm and rarely improves eczema. Food allergy testing (skin prick or specific IgE blood tests) via GP or allergy clinic is the evidence-based route. The most commonly implicated foods in young children with moderate-severe eczema are cow’s milk, egg, wheat, soy, and peanut.
Will my child grow out of eczema?
Most children with atopic eczema do improve significantly over time — approximately 60–70% see substantial improvement or resolution by their teens. However, a minority continue into adulthood, and some adults develop eczema for the first time. Effective management now reduces the risk of sensitisation and allergic progression.
Browse eczema skincare products and emollients at Huncoat Pharmacy. Related: Allergy Guide.
At Huncoat Pharmacy: Avène children’s eczema range, Pharmacy First skin advice, Browse eczema treatments for children.