Conditions We Treat

Eczema (Paediatric)

At Livingstone Dermatology, we understand that your skin is a reflection of your health and well-being. We are committed to the latest advancements in dermatological science, and dedicated to providing you with quality care.

Eczema, particularly atopic dermatitis, has emerged as one of the most prevalent chronic skin conditions among children in Singapore. Studies indicate that Singapore has one of the highest rates of paediatric eczema globally, with approximately 20% of children affected.

The condition frequently manifests in early childhood, with nearly 90% of cases appearing before the age of five. Among school-aged children in Singapore, eczema remains a common diagnosis, which causes both physical discomfort and emotional stress for young patients and their families. The humid tropical climate, combined with high exposure to environmental allergens such as dust mites and pollutants, is believed to exacerbate symptoms in susceptible children.

What is eczema?

Eczema, also known as atopic dermatitis, is a chronic inflammatory skin condition that causes redness, dryness, and intense itching. It occurs when the skin’s natural barrier is compromised, which makes it less effective at retaining moisture and protecting against irritants and allergens. Eczema is not contagious, but it is influenced by genetic, environmental, and immunological factors, often running in families with a history of allergies, asthma, or hay fever. The condition tends to flare up periodically, triggered by factors such as irritants, allergens, heat, or stress.

In children, eczema can be particularly challenging due to its recurring nature and the discomfort it causes. The condition presents differently depending on the child’s age, with variations in appearance, affected areas, and how it impacts daily life.

How eczema varies by age

Age Group	Common Features	Affected Areas	Key Challenges
Infants (0–2 years)	Red, scaly, and weepy rashes Oozing or crusting lesions Widespread dryness	Cheeks, scalp, and forehead	Intense itching leading to fussiness Difficulty sleeping Increased infection risk from scratching/rubbing
Toddlers (2–5 years)	Thickened, dry, and scaly patches Hyperpigmentation or hypopigmentation	Elbows, knees, wrists, ankles, and hands	Worsening with sweat and irritants Interrupted sleep Frequent scratching due to itching
Older Children (5+ years)	Lichenification (thickened, leathery skin) Smaller, well-defined patches Dry, cracked skin	Neck, inner elbows, behind knees, hands, feet	Psychological and social impacts (e.g., self-esteem issues) Chronic dryness and occasional bleeding

With age-specific presentations, eczema demands a personalised treatment approach. At Livingstone Dermatology, we specialise in providing customised solutions to manage eczema in children at every stage, so that we can help families in managing this condition effectively.

What causes eczema in children?

Eczema in children is primarily caused by a compromised skin barrier and an overactive immune response. The skin barrier is responsible for retaining moisture and protecting against external irritants, allergens, and pathogens. In children with eczema, this barrier is weaker due to genetic and biochemical factors, allowing excessive water loss and increased permeability to irritants. This disruption leads to dry, cracked skin that becomes vulnerable to inflammation and infection.

The immune system also plays a pivotal role in eczema. When exposed to harmless substances, such as dust mites or certain proteins in food, the immune system in children with eczema responds as though these are threats, triggering an inflammatory reaction. This overreaction leads to the hallmark symptoms of redness, swelling, and itching. The chronic nature of eczema arises from this persistent immune activation, which creates a cycle of itching and scratching. Scratching further damages the skin barrier, which may worsen the inflammation and create opportunities for secondary infections.

What are the symptoms of eczema in children?

Eczema manifests in various ways in children, with symptoms that can differ based on the severity of the condition and the child’s age. Common symptoms include:

Itchy skin — the hallmark of eczema, often severe and persistent.
Red or inflamed patches — typically seen on the cheeks, scalp, elbows, knees, and creases of the body.
Dry and scaly skin — affected areas often appear rough, flaky, and dehydrated.
Small, raised bumps — the small and raised bumps may leak fluid or crust over when scratched.
Thickened or leathery skin — prolonged scratching can cause the skin to thicken (lichenification).
Skin discolouration — chronic inflammation may lead to lighter or darker patches in affected areas.
Oozing or crusting — during flare-ups, the skin may weep fluid or form scabs, increasing the risk of infection.
Raw or sensitive skin — excessive scratching can leave the skin raw and tender.

Who is at risk of eczema among children in Singapore?

While eczema can affect any child, certain factors make some children more likely to develop the condition. These include:

Children with a family history of atopic conditions — such as eczema, asthma, or hay fever, as these conditions often run in families.
Children living in urban environments — Singapore’s highly urbanised setting exposes children to air pollution, allergens, and stress, which can trigger eczema.
Infants born to mothers with eczema — prenatal and genetic influences can increase the risk of eczema in children.
Children with early exposure to irritants — such as soaps, detergents, and certain fabrics that can damage the skin barrier.
Children with food allergies — those who are sensitive to certain foods may also be prone to eczema flare-ups.
Babies born prematurely — premature infants often have underdeveloped skin barriers, which makes them more susceptible to eczema.

Understanding these risk factors can help parents and caregivers take proactive steps to reduce triggers and seek early intervention. At Livingstone Dermatology, we provide comprehensive care to manage eczema and support families in minimising its impact.

How is eczema diagnosed in children?

At Livingstone Dermatology, we understand that every child’s skin is different, which is why we take a thorough and personalised approach to diagnosing eczema. Our diagnostic process focuses on identifying the specific characteristics of your child’s condition to ensure effective treatment. We utilise the following methods for diagnosing eczema among children:

Clinical examination — a detailed assessment of your child’s skin, including identifying redness, dryness, inflammation, and any patterns of rashes.
Patient history — discussing your child’s symptoms, triggers, and any family history of eczema, asthma, or allergies to uncover potential links.
Exclusion of other conditions — ruling out similar conditions like psoriasis, fungal infections, or allergic reactions to ensure an accurate diagnosis.
Allergy testing — when necessary, we may recommend patch testing or other allergy evaluations to determine specific triggers.
Skin assessment for infection — checking for signs of secondary infections, which can often accompany severe eczema flare-ups.

What are the treatment options for eczema among children in Singapore?

At Livingstone Dermatology, we offer comprehensive care to help manage eczema effectively, focusing on reducing symptoms and improving your child’s quality of life. Our treatment options include:

Emollients and moisturisers — our expert dermatologist recommends using these daily to repair the skin’s barrier and maintain hydration, which is essential for preventing flare-ups.
Topical corticosteroids — we prescribe these to reduce inflammation and redness during active flare-ups, while also ensuring they are used safely and appropriately.
Non-steroidal creams — our team suggests these for sensitive areas, like the face, to manage inflammation without the side effects of steroids.
Antihistamines — we provide these to relieve intense itching and help children sleep more comfortably during flare-ups.
Wet wrap therapy — our dermatologists recommend this method for severe cases, where medicated creams are applied under specialised wraps to soothe and protect the skin.
Phototherapy — we may suggest light therapy for moderate to severe eczema when topical treatments are not sufficient.
Trigger management — our team advises parents on how to minimise exposure to irritants, allergens, and environmental factors common in Singapore’s tropical climate.

Our team is committed to providing effective treatments to help your child manage eczema comfortably and confidently. If you are concerned about your child’s eczema, schedule a consultation with Livingstone Dermatology today to explore the best solutions for their skin health.

Frequently Asked Questions (FAQs)

Can my child outgrow eczema?

Many children experience an improvement in eczema symptoms as they age, with some outgrowing the condition entirely. However, others may continue to have flare-ups into adulthood. Regular dermatological care can help manage and potentially reduce symptoms over time.

How can I prevent my child's eczema from worsening?

Maintaining a consistent skincare routine with regular moisturising, avoiding known triggers (such as certain soaps or fabrics), and keeping your child’s nails trimmed to prevent skin damage from scratching can help prevent flare-ups. It’s also beneficial to dress your child in soft, breathable clothing to reduce irritation.

Is eczema contagious?

No, eczema is not contagious. It cannot be spread from person to person through contact. Eczema is a result of genetic and environmental factors affecting the skin’s barrier and immune response.

Can diet affect my child’s eczema?

While food allergies can trigger eczema flare-ups in some children, diet is not the primary cause of eczema. It’s important to consult with a healthcare professional before making any significant dietary changes or eliminations.

How should I bathe my child with eczema?

Use lukewarm water and limit bath time to 5–10 minutes. Avoid using harsh soaps; instead, opt for gentle, fragrance-free cleansers. After bathing, gently pat the skin dry and apply a moisturiser immediately to lock in moisture.

Can swimming worsen my child’s eczema?

Chlorinated water can sometimes irritate eczema-prone skin. It’s advisable to apply a barrier cream before swimming and rinse off with fresh water immediately after. Moisturising the skin thoroughly post-swim can also help mitigate irritation.

What should I do if my child’s eczema becomes infected?

Signs of infection include increased redness, warmth, pus, or yellow crusting. If you suspect an infection, seek medical attention promptly. A healthcare provider may prescribe antibiotics or other treatments to address the infection.

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