Clinical Review

Childhood atopic eczema

BMJ 2002; 324 doi: https://doi.org/10.1136/bmj.324.7350.1376 (Published 08 June 2002) Cite this as: BMJ 2002;324:1376
  1. Ross St C Barnetson, professor of dermatologya (ross@canc.rpa.cs.nsw.gov.au),
  2. Maureen Rogers, paediatric dermatologistb
  1. a Department of Dermatology, Royal Prince Alfred Hospital, Camperdown NSW 2050, Australia
  2. b Department of Dermatology, New Children's Hospital, Westmead, Sydney, Australia
  1. Correspondence: R St C Barnetson

    Introduction

    Atopic eczema is a common condition that affects more than one in ten children in developed countries, and the incidence is increasing. There are probably several reasons for this, including higher exposure to air pollution, smaller families with less exposure to infections, more pets, higher maternal age, and a wider range of foods. There is clearly also an important hereditary component to atopic eczema. This is complex because not all affected children are atopic, though the genes implicated in atopy are likely to be involved, together with others as yet unknown. Atopic eczema usually presents during the first year of life, and when it is severe it is extremely disabling. It may also cause major psychological problems. Most affected children are also allergic to house dust mite, and this is probably a major cause of exacerbation of the condition. Probably less than 10% overall have IgE mediated food allergy, but some have late phase reactions with positive results on patch tests to foods.

    Summary points

    Atopic eczema in children is a complex condition

    Four in five children with atopic eczema have IgE mediated allergy to inhalants or foods

    House dust mite exacerbates atopic eczema

    Food allergy exacerbates eczema in less than one in ten children

    To reduce the need for admission to hospital children with severe eczema can be treated with topical or oral immunosuppression

    Methods

    We searched Medline for entries on atopic eczema and atopic dermatitis in children and adults. We also relied on our personal experience in treating children with atopic eczema over the past 30 years.

    Clinical features

    Atopic eczema is usually the first manifestation of atopy and may coincide with food allergy; asthma often follows, then allergic rhinitis (fig 1).

    Fig 1.

    Incidence of different types of atopy by age (adapted with permission from W B Saunders1)

    There is a …

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