Constitutional eczema in Skin. Constitutional eczema is a skin condition with mainly redness, flaking, and itching. It is often seen in people with an atopic constitution (the predisposition to be able to react allergically). About 10 percent of the Dutch have an atopic constitution and 3 to 5 percent of them have constitutional eczema. Other names for this form of eczema are dewworm, atopic dermatitis, atopic eczema, and neurodermatitis.
Symptoms of constitutional eczema
Constitutional eczema can be recognized by a number of characteristics, in particular by its combination. The onset of symptoms, the type of skin changes, the severe itching and the varying course are the most important.
The beginning Constitutional eczema usually develops between the first and fourth months of life, with a peak in the third. Of the people with constitutional eczema, 80 percent received complaints before their first birthday. It has recently become clear that constitutional eczema increasingly often only develops in adulthood. The reason for this is still unclear.
Skin changes In infants, eczema is found primarily in the face and scalp. The area around the mouth and nose, the so-called anesthetic cap, remains free of eczema. These children often have a small tear at the transition from the ear lobe to the face.
In babies, eczema is often wet, which means that blisters arise from which moisture seeps out. This is called dewworm and can occur overnight. As the child grows older and starts to crawl, eczema spots also appear in the body folds of the neck, neck, elbows, knees and sometimes the hands. Eczema becomes drier from the second birthday. This image sometimes persists until the young adult age.
Itching Constitutional eczema gives an overpowering, very severe itch that often occurs in attacks. The itching can play, especially in the evenings and at night. The child must scratch and cannot suppress the tendency to do so. It scratches or rubs as long, often unknowingly, until the skin is broken. These children are restless at night and sleep poorly. You can read more about itching in the doctordokter.nl information folder ‘Itch’.
Changing picture Constitutional eczema is always accompanied by exacerbations (flare-ups, aggravations) and remissions (reductions) of skin disorders.
It is a mixed picture where one week can be much more intense than the other. Parents often experience that this causes confusion and incomprehension in people from the environment (for example, school, family, friends and acquaintances).
How does constitutional eczema arise?
Constitutional eczema can result from an allergic reaction, although an allergy is not always detectable. This reaction can occur in children with an allergic disposition, also called the atopic constitution. There are factors that can aggravate eczema.
Allergic reaction In children with constitutional eczema based on an allergy, the immune system wrongly responds to normal, harmless substances.
Foods, particles that are inhaled or substances that enter the body through the skin are wrongly perceived by the body’s immune system as intruders. There will be an inflammatory reaction that releases histamine. This substance is partly responsible for the characteristic skin symptoms of constitutional eczema. There are very many other substances involved in the skin reaction that doctors are gradually gaining more insight into.
Atopic Constitution In constitutional eczema, genetic predisposition to react allergically plays an important role. This is called the atopic constitution. In addition to constitutional eczema, these children may also be confronted with allergic nose complaints, hay fever, asthma, and food hypersensitivity.
If (one of) the parents and / or an older brother or sister suffer from an allergy, it is more likely that a child will have an atopic constitution at birth. This chance increases further as more family members have (had) such complaints.
Influencing factors Factors that can affect eczema are:
- Stress For children who experience an exciting event, for example for the first time to a new babysitter, eczema can get worse. For older children, tensions or crowds at school or around the holidays (for example Sinterklaas) can make eczema worse. The influence of stress is also clearly present in adults
- Hormones Women clearly notice changes in skin abnormalities around menstruation or during pregnancy
- Seasons The cold, dry freezing air in the winter can aggravate eczema, but also in autumn and spring, when the weather is wet, eczema can flare up more often. In the summer, and especially in sunny periods, the eczema is often calm, although some patients suffer more from the heat. Sunlight and seawater usually have a beneficial effect
- Sweating Perspiration when it dries up on the skin can aggravate eczema and in particular itching
- Clothing Garments made from wool or synthetic fabrics can aggravate eczema and itching; cotton is usually better tolerated
- Degreasing agents Soap, detergent, detergents, and all-purpose cleaners degrease the skin and thereby aggravate eczema
- Dry skin The eczema skin is often very dry. Dry skin is more sensitive, itches faster and often lead to eczema flashing due to scratching
Is it serious and what can you expect?
The course of the eczema Constitutional eczema is usually a self-limiting disease, meaning that it goes away on its own. About 30 percent of these children no longer have symptoms when they are two years old. At the age of five, 65 percent have no complaints anymore and at the age of fifteen, that percentage has risen to 90.
In principle, eczema disappears without leaving any scars. However, if there is so much scratching that there are serious wounds, scars may be left behind. Color difference (dark or lighter spots) is also often seen, especially with pigmented skin, which often gradually changes over the years. Many people who have ever had constitutional eczema suffer from dry, sensitive skin that flakes quickly.
Treatment options Constitutional eczema can be unsightly and itchy. The doctor can prescribe various ointments to combat these symptoms. When the eczema is wet (dewworm), your child usually gets a zinc oil or cream that dries the skin. However, if the eczema is dry, a greasy cream or ointment is often prescribed.
Itching and redness can be reduced by using a tar ointment or a hormone ointment. Tar ointment is used less and less because it smells very dirty and causes stains in clothing and bedding.
Hormone ointments can do no harm if you use them properly. Your child’s growth is not affected by proper use. However, with intensive lubrication the skin may discolor or become thinner; this often recovers when lubrication is stopped. If your child has eczema on the hairy scalp, a lotion is prescribed instead of an ointment.
The treatment of constitutional eczema is tailor-made and can, therefore, differ per child. For children under two years of age where none of the ointments provide sufficient help, the doctor or possibly the consultation doctor will check whether there is a possible food allergy, for example, a cow’s milk allergy.
Increased risk of skin infections The skin of a child with constitutional eczema is somewhat more sensitive to skin infections. Eczema can become infected with a virus or bacteria. This is not serious and can be treated by the doctor.
Greater risk of other allergies Children with constitutional eczema may have an atopic constitution, the predisposition to react allergically. As a result, they have an increased chance of developing multiple allergic reactions.
For example, about 30 percent of children with constitutional eczema are hypersensitive to cow’s milk protein. Asthma and hay fever are also more common, both around 50 percent of these children. These disorders often occur at a somewhat later age.
Contagiousness Constitutional eczema is never contagious in itself. If there is an infection of eczema with a bacterium (wounds where pus comes out), this is usually due to bacteria that in others, with undamaged skin, does not lead to an infection.
When to the doctor?
If you suspect that your child is suffering from constitutional eczema, it is wise to make an appointment with your doctor or with the childcare center. The doctor can view eczema and, in a conversation with you, check whether there is a possible question of constitutional eczema. The doctor can possibly start treatment if your child has many complaints. If your child has already been diagnosed with constitutional eczema, it is advisable to go to the general practice if:
- the prescribed treatment does not help (sufficiently). Possibly another ointment helps better or there is a food allergy that causes the eczema
- blisters or yellow crusts filled with pus to appear on eczema. The eczema is infected and can be treated by the doctor
- your child becomes breathless or oppressive in seizures and makes a squeaky sound when breathing. These symptoms may indicate asthma
- your child has other symptoms or symptoms that you are concerned about
What can you do about it yourself?
You can do the following to prevent eczema worsening as much as possible.
Preventing scratching Small children, in particular, can scratch their skin completely. They often do this unconsciously in their sleep. Try to keep the nails as short as possible by regularly filing or cutting them. You can optionally put your child’s socks on at night.
To minimize itching as much as possible, it is advisable not to dress your child too warm or to put it in bed.
Trying to reduce stress Stress aggravates eczema. Unfortunately, it is not always possible to prevent tensions. Special events and holidays remain exciting for children. Possibly with such an event, you can keep the skin extra fat.
Tasty in the sun Eczema usually diminishes in the sun. With small children, however, you have to sunbathe responsibly. For adults, light therapy in the hospital can reduce eczema.
Showering after exercise Perspiration that dries on the skin aggravates eczema. You can prevent this by taking a short shower with your water after playing sports or playing outside.
To prevent sweating, it is important that you do not dress your child too warmly. For children who swim it is good to add extra fat to the skin before they enter the water and to do so immediately after swimming.
Cotton clothing and bedding Wool and synthetic clothing and bedding can aggravate eczema. Therefore choose cotton products as much as possible. This substance is airy and has no influence on eczema.
Use few degreasing agents Soap, detergents, dishwashing detergents, and all-purpose cleaners degrease the skin, making it more sensitive to eczema. Therefore, try to avoid using these products as much as possible. Instead of bath foam, you can, for example, add mild baby oil to the bath. The pharmacy can advise you on this.
As a detergent, you can choose a neutral product that has been dermatologically tested. Fabric softener can be irritating and should therefore not be used. Adults should leave the washing up and cleaning to someone else or wear protective gloves.
General advice and precautions
You cannot prevent constitutional eczema. You can try to limit the severity of the symptoms, but this is often very difficult. You should therefore not feel guilty about your child’s eczema; it’s just the way you do what you can. Acceptance of the skin condition is often very difficult for the patient and for the parents but makes it easier to deal with the condition.
Constitutional eczema in Skin