There are two types of eczema: allergic or atopic eczema, and contact hypersensivity or contact eczema (this is also referred to as contact dermatitis). Allergic eczema is a common skin disorder. Some 65% of allergic eczema occurs in infants who are younger than six months old and up to 80% occurs during the first year of life. For many children, eczema is the start of the ‘allergic march’, whereby the child first develops eczema and then goes on to develop asthma and then rhinitis. Many children grow out of their eczema spontaneously and only 1-2% of adults are affected by it.

Acute eczema usually covers a large area of a child’s body, often including the face, and looks like hundreds of tiny papules that are red and very dry. The skin is intensely itchy and the papules can become infected as a result of scratching. One area that is often affected is behind the ears.

Effects of Eczema

Eczema can severely restrict the lives of those who have it, particularly teenagers and adults. For example, playing sports can aggravate eczema because of clothing chafing over affected areas of skin. Chlorine in swimming pools can also react with skin that has flared due to acute eczema, and sweat can also act as an irritant. For some young girls and boys, eczema can be a source of embarrassment and often causes excessive shyness. Summer clothing that reveals affected areas are usually avoided by sufferers and this can be a concern for young, fashion-conscious teenagers.

Alternative Treatments – Diet

While steroids, emollients and antibiotics are the mainstays of treatment, some research suggests that other, less aggressive treatments may be worth investigating. Functional foods such as probiotics have received some attention for their beneficial effects, as have herbal remedies and diet.
There is no clear agreement on the role of diet in eczema. However, there is some indication that egg and milk proteins are common triggers.

Eggs
One study set out to establish the value of a four-week egg exclusion diet for children with atopic eczema. The study examined 55 children, all of whom had atopic eczema and a positive blood test showing a problem with eggs. At the start of the study, all of the children’s eczema had been brought under control using conventional topical steroids, and changes in their eczema were recorded as the study progressed. Children were assessed at their initial visit, again immediately before the dietary treatment began, and on a third occasion after the fourth week of the diet.

The results of this study showed a significant improvement in eczema symptoms in the group of children who avoided egg. Eczema symptoms improved significantly in the group who followed the special diet compared to those who did not follow any special diet. This study suggests that children with atopic eczema and sensitivity to eggs benefited from a special diet in which mothers were advised to exclude egg and egg products such as cakes, biscuits and some breads from their child’s diet.

Although there is still much debate as to the importance of dietary treatment in atopic eczema, this study shows that there are clear beneficial effects of egg avoidance for eczema sufferers who have a proven allergy to egg. In order to diagnose egg allergy, a special blood test is necessary whereby specific sensitivity to egg is measured.

Interestingly, the mothers of affected children in this study were surprised to learn that egg was a problem food for their child. Usually, if a food is causing a problem like eczema a mother will pick this up quite quickly and will be aware of trigger foods.
This study was small and a larger study over a longer period of time would be helpful in validating these findings.

Milk Proteins
Some children with eczema have an allergy to the protein in milk. Children usually outgrow milk allergy (as well as their eczema) and by age three the allergy should be gone. Milk allergy can be diagnosed with a special blood test where specific sensitivity to milk is measured. Other allergens can be identified using a patch test.

Children who are allergic to cows’ milk protein need a special milk formula containing extensively hydrolysed protein. These formulas are available from the pharmacy without a prescription, and are available free to those with a medical card. Goat, sheep and soya milk are not suitable alternatives because many young children also react to the proteins in these milks.

While eggs and cows’ milk are the most common ‘problem foods’ for children with eczema, their exclusion from any diet must be supervised by a dietitian.