Pediatric Infectious Diseases: Open Access

Introduction

The forearms, extensor portions of the knees, and ankle flexures are frequently impacted in crawling newborns. The flexor elements of the elbows and knees are mostly affected in older children. Eczema can be wet and swollen, or thickened (lichenified) and dry. The rash may be papular in nature in youngsters with darker skin. Scratches are always visible. The course of the ailment varies, and the causes of exacerbations may or may not be obvious.

Infectious problems are a regular occurrence. Staphylococcal infection can cause traditional bullous impetigo or merely aggravate dermatitis with greater redness and leaking. Occlusion from oily emollients or moist bandages can lead to staphylococcal folliculitis. Increased redness and erosion of the skin, as well as pustular lesions, are signs of streptococcal infection. Atopic children are particularly vulnerable to severe herpes simplex infections; the disorder is primarily systemic in nature, but the areas most affected are those with active eczema.

Atopic eczema affects the majority of children, who are allergic to inhalants such as house dust mites (Dermatophagoides Pteronyssinus), grass pollens, and animal dander. During pollen season, some youngsters get eczema on their faces, and many parents say that their child's eczema gets worse following close contact with pets. The most IgE is created in response to house dust mites, which must be the most relevant allergen in eczema exacerbation.

House dust mites can be found in huge numbers in children's beds, and in addition to causing asthma, they can also induce eczema flare-ups. Efforts to minimise dust mite populations have been linked to eczema improvement in several studies. This is unsurprising, given that skin contact with mites causes eczema in children who are strongly allergic to them. It's also possible that delayed hypersensitivity to house dust mites has a role. Patch tests and lymphoproliferative responses to the mite are both positive in people with atopic eczema. Unfortunately, reducing the number of house dust mites in bedding is difficult to achieve in everyday life.

Food intolerance, on the other hand, is not caused by immunological mechanisms. Food intolerance is relatively common: some compounds in foods, such as tartrazine or other food colorings, may aggravate eczema through unknown mechanisms. Food allergies are age-related. It may be severe in the infant and less so as the child grows older. Some food allergies (such as egg and cow's milk) are temporary, but allergies to peanuts and shellfish can last a lifetime.

The link between atopic eczema and food allergy is complicated, while food allergy is most common in children with severe atopic dermatitis. When the diagnosis is clear from the immediacy of the symptoms and can be verified by a wheal >5 mm in diameter after a skin prick, probably less than 10% of all children with atopic eczema have IgE mediated food allergy with angioedema and urticaria.

Severe atopic eczema is a dangerous disorder that causes a significant reduction in a child's quality of life, comparable to juvenile rheumatoid arthritis. As a result, it is critical that such youngsters receive proper care. Because of the strong resurgence of eczema after withdrawal, the eczema becoming unstable after numerous courses, and the long-term side effects, oral steroids should be avoided. Cyclosporin and azathioprine are the two most common treatments for severe eczema.

Azathioprine is a safer medicine to take for a long time, although it does have certain adverse effects, such as nausea, fatigue, myalgia, and liver failure. Paediatric dermatologists in the United Kingdom utilise it. It's critical to check for thiopurine methyl transferase before starting treatment since children lacking this enzyme will have severe bone marrow suppression. It is successful in the majority of youngsters at low doses. The development of lymphoma is the most serious long-term side effect that might theoretically occur (as with ciclosporin). This medicine has the advantage of being able to be used indefinitely.