Allergic Skin Conditions in Children

Is your child's skin constantly dry and itchy? Do raised rashes that move from place to place appear on the body from time to time? Does sudden swelling develop on the lips or around the eyes?

Not every redness or rash that appears on a child's skin is an allergy. Viral infections, skin infections, irritation, medicines and different dermatological conditions can also cause similar appearances.

Among the allergy-related skin conditions, the pictures most commonly encountered in childhood include;

• Atopic dermatitis (eczema)
• Urticaria (hives)
• Angioedema

These conditions arise through different mechanisms and their treatments are not the same either.

For this reason, instead of only saying "my child has an allergy", it is necessary to identify correctly which skin condition is present.

What Is Atopic Dermatitis (Eczema) in Children?

Atopic dermatitis is a chronic or recurring skin condition that runs its course with disruption of the skin barrier, dryness, inflammation and intense itching.

It is one of the most common inflammatory skin conditions of childhood.

The condition may flare up from time to time and then settle down again.

The core features of atopic dermatitis are;

• Skin dryness
• Itching
• Redness
• Rough or flaking skin
• Recurring areas of eczema

The more the scratching increases, the more the skin barrier can be disrupted, and the itch-redness cycle can continue.

Where Does Eczema Appear in Babies?

The areas where atopic dermatitis appears may change according to the child's age.

In babies, particularly;

• The cheeks
• The face
• The scalp
• The trunk
• The outer surfaces of the arms and legs

may be affected.

Where Does Eczema Appear in Older Children?

As the child grows, the location of the eczema may change.

Particularly;

• The inner elbows
• The backs of the knees
• The neck
• The wrists
• The ankles

may be affected more often.

In areas that are long-standing or frequently scratched, the skin may thicken, its lines may become more pronounced and color changes may appear.

What Is the Most Important Symptom of Eczema?

Itching is one of the most characteristic symptoms of atopic dermatitis.

Itching may increase especially at night and may disturb the child's sleep.

The more the child scratches;

• The skin may become more irritated
• Sores may form
• Bleeding may be seen

The ground may be prepared for skin infections.

For this reason, treatment of eczema aims not only at clearing the redness but also at repairing the skin barrier and bringing the itching under control.

Why Does Atopic Dermatitis Occur?

Atopic dermatitis does not have a single cause.

In the development of the condition;

• Genetic predisposition
• Disturbances in the structure of the skin barrier
• The inflammatory response of the immune system
• Environmental factors

play a role together.

In children with atopic dermatitis, asthma or allergic rhinitis in the family, the predisposition to the condition may be greater.

However, atopic dermatitis can also develop in children with no allergic condition in the family.

What Can Trigger Eczema?

The factors that lead to flare-ups of atopic dermatitis are not the same in every child.

Commonly encountered triggers may include;

• Skin dryness
• Hot environments and sweating
• Irritant soaps and detergents
• Harsh or woolen clothing
• Certain infections
• Environmental factors specific to the child

There is an important distinction here:

An eczema trigger and an allergen are not the same thing.

For example, hot weather or an irritant soap may cause eczema to flare, but this does not mean the child is allergic to that substance.

Is Every Child With Eczema Allergic?

No.

There is a strong relationship between atopic dermatitis and allergic conditions, but not every child with eczema has a food or environmental allergy.

For this reason, carrying out broad allergy tests or removing a large number of foods from the diet on the basis of the presence of eczema alone is not correct.

Current pediatric atopic dermatitis guidelines also emphasize that routine dietary restrictions have no proven benefit in preventing or controlling eczema.

When Should Food Allergy Be Investigated in Children With Eczema?

It does not need to be investigated in every child.

Food allergy may come onto the agenda especially if;

• There is a recurring sudden reaction after a particular food
• Moderate-to-severe eczema cannot be brought under control despite appropriate skin care and treatment
• There is a problem with the child's growth and development

Tests should be chosen according to the child's history.

A positive test on its own does not show that the food is the cause of the child's eczema.

How Is Eczema Treated in Children?

Treatment is planned according to the child's age, the severity of the condition and the area affected.

Three approaches form the basis of treatment:

Protecting the skin barrier, controlling inflammation and reducing flare-ups.

Regular Moisturizing

The skin of children with atopic dermatitis tends to be drier than normal.

For this reason the regular use of a moisturizer is one of the fundamental parts of treatment.

A moisturizer;

• Supports the skin barrier
• Reduces dryness
• May help lessen itching

It may contribute to the control of flare-ups.

Current pediatric atopic dermatitis guidance lists moisturizers among the strongly recommended basic treatments.

Can the Child Have a Bath?

Yes.

A child with eczema does not have to avoid bathing.

Bathing can be done with lukewarm water, in a way that does not irritate the skin. After the bath the skin should be dried gently and a moisturizer applied.

Very hot water and cleansers that dry the skin excessively should be avoided.

Are Cortisone Creams Harmful?

Topical corticosteroids, that is the medicines known among the public as "cortisone creams", are among the first-line treatments during flare-up periods of atopic dermatitis.

The right medicine should be chosen according to;

• The child's age
• The area where the eczema is
• The severity of the condition

When used at the appropriate strength, on the appropriate area and for the appropriate length of time, it is not correct to avoid these medicines when they are actually needed.

On the other hand, using them for a long time and without supervision, without a doctor's recommendation, is also not appropriate.

In current childhood atopic dermatitis guidelines, topical corticosteroids are among the treatments that receive a strong recommendation.

Are There Eczema Treatments Without Cortisone?

Yes.

In some children and on some areas of the body;

• Topical calcineurin inhibitors
• Other non-steroid topical treatments

may be used.

In moderate and severe atopic dermatitis, phototherapy, biologic treatments or different systemic treatments may come onto the agenda depending on the child's age and the severity of the condition.

These treatments are not necessary for every child and should be planned by the relevant specialist.

Can Eczema Become Infected?

Yes.

A skin barrier disrupted by scratching can make it easier for bacterial or viral infections to develop.

If symptoms such as;

• Sudden worsening
• Increasing redness
• Pain
• Discharge
• Yellow crusting
• Fever

appear in the area of eczema, evaluation for infection may be needed.

What Is Urticaria (Hives) in Children?

Urticaria consists of rashes appearing suddenly on the skin that are;

• Raised
• Pink or red
• Usually intensely itchy
• Clearly bordered

It is known among the public as hives.

One of the important features of urticaria is that the lesions can move from place to place.

For example, a raised patch seen on the arm in the morning may disappear completely a few hours later, and then new rashes may appear on another part of the body.

Is Every Case of Hives an Allergy?

No.

Especially in children, one of the frequent causes of acute urticaria is infection.

Urticaria may develop in a child during or right after a viral infection.

In addition;

• Foods
• Medicines
• Insect stings
• Certain substances that are touched

can also cause urticaria.

For this reason a child having hives once does not automatically mean "he or she is allergic to a food".

What Is the Difference Between Acute and Chronic Urticaria?

Urticaria lasting less than 6 weeks is classified as acute urticaria, and urticaria recurring for longer than six weeks as chronic urticaria.

In chronic urticaria there is not always a specific allergen coming from outside.

For this reason it is not correct to test every food eaten by every child who has had urticaria for months, or to apply long elimination diets.

International urticaria guidelines emphasize that chronic urticaria is a condition related to mast cells and that diagnosis and treatment should be planned according to the type of urticaria.

Can Physical Factors Cause Hives?

Yes.

In some children urticaria may appear with physical stimuli such as;

• Cold
• Heat
• Pressure
• Exercise
• Sweating
• Sunlight

These pictures are evaluated under the heading of chronic inducible urticaria.

For example, in cold urticaria, contact with cold water can cause a serious systemic reaction, so the child needs to be evaluated separately with regard to going into the sea or a pool.

How Is Urticaria Treated in Children?

Treatment varies according to the cause and duration of the urticaria.

If a trigger has been identified, it is avoided as far as possible.

In the current approach to controlling symptoms, second-generation H1 antihistamines are the main drug group. Second-generation antihistamines are also used as the first step in the management of chronic urticaria.

The type and dose of the medicine should be determined by the doctor according to the child's age.

In long-lasting or treatment-resistant urticaria, further evaluation and different treatments may be needed.

What Is Angioedema?

Angioedema is sudden swelling appearing in the deeper layers of the skin.

It may be seen particularly;

• On the lips
• On the eyelids
• On the face
• On the hands
• On the feet

It may occur together with urticaria or may develop on its own.

When Is Angioedema Dangerous?

Limited swelling of the lips or around the eyes does not always mean a threat to life.

However, if there are symptoms such as;

• Swelling of the tongue
• A feeling of swelling in the throat
• Hoarseness
• Difficulty breathing
• Wheezing
• Fainting or change in consciousness

emergency care is required in terms of a serious allergic reaction or anaphylaxis.

Are Anaphylaxis and Hives the Same Thing?

No.

Urticaria on its own may be a reaction limited to the skin.

Anaphylaxis, on the other hand, is a serious allergic reaction that can affect more than one system and can progress rapidly.

For example, a child developing symptoms such as;

• Widespread urticaria
• Swelling of the lips or tongue
• Shortness of breath
• Wheezing
• Repeated vomiting
• Dizziness or fainting

after eating a particular food requires emergency evaluation for anaphylaxis.

The main emergency medicine in the treatment of anaphylaxis is adrenaline.

Is Testing Needed in Allergic Skin Conditions in Children?

It is not needed in every child.

Allergy tests are requested after evaluating;

• The child's medical history
• The timing of the reaction
• The suspected trigger
• The severity of the condition

Especially in atopic dermatitis, carrying out a broad food or environmental allergy panel in everyone is not correct.

In urticaria too, comprehensive allergy tests are mostly not needed, especially in acute, infection-related typical pictures.

When Should You See a Doctor for Allergic Skin Conditions in Children?

Evaluation by a pediatrician or the relevant specialist is needed especially if;

• Eczema cannot be brought under control despite appropriate care
• Itching seriously disturbs the child's sleep
• There are signs of infection on the skin
• Urticaria recurs frequently
• Urticaria lasts longer than six weeks
• There is a recurring reaction after a particular food or medicine
• Swelling of the lips or around the eyes recurs

If there is swelling of the tongue or throat, difficulty breathing, a change in voice, bluish discoloration, fainting or serious deterioration in the child's general condition, emergency medical care should be sought.