Paediatric Eczema

Paediatric eczema, also known as childhood eczema or atopic dermatitis, is a chronic skin condition that causes the skin to become dry, itchy and inflamed. It develops when the skin barrier is weaker than normal, making it harder to retain moisture and easier for irritants to penetrate. This leads to skin that is more reactive and prone to flare-ups.

The condition is not an infection and cannot be passed from child to child. It is often linked to a genetic tendency toward allergies or immune sensitivity, which is why it frequently appears in families with asthma or hay fever. However, some children develop eczema without any family history.

Eczema can appear at any age during childhood. For some, it improves or disappears with age. For others, it may persist in adolescence or adulthood, sometimes changing in appearance or becoming more localised.

What are the different types of Paediatric Eczema?

The skin condition can be present in several forms. Each form has its patterns and triggers, such as:

• Atopic dermatitis – the most common type in children. It is often linked to a family history of eczema, asthma or allergies. It can start in infancy and cause recurring flares triggered by heat, sweat or irritants.
• Contact dermatitis – caused by direct contact with irritants or allergens such as soaps, detergents, fragrances or certain metals. It may appear as red and itchy patches in the area of contact.
• Dyshidrotic eczema – causes small and itchy blisters on the hands or feet. It is typically triggered by sweating or certain allergens. However, it is less common in children.
• Nummular eczema – appears as round and coin-shaped patches that may ooze or crust. It is sometimes mistaken for fungal infections.
• Seborrhoeic dermatitis – manifests as  “cradle cap” in babies, causing greasy and yellowish scales or flaky skin. It can also affect the face and ears.

What causes Paediatric Eczema?

There is no single cause for paediatric eczema. It results from a combination of genetics, immune system sensitivity and environmental triggers that weaken the skin barrier. When the skin barrier is impaired, moisture escapes more easily — and irritants, allergens and microbes can enter more easily. This leads to dryness, itching and inflammation.

Some of the potential causes are:

• Genetics – a child with a parent or sibling who has eczema, asthma or allergic rhinitis is at higher risk. Certain inherited changes in the skin’s structure reduce its ability to lock in moisture and block irritants.
• Dry skin – naturally dry skin offers less protection against irritants. Low humidity, frequent bathing without moisturising or using harsh cleaners can make dryness worse.
• Immune sensitivity – in some children, the immune system reacts strongly to substances that are normally harmless. This overreaction leads to inflammation, redness and itch.
• Irritants – detergents, soaps, fragranced lotions and rough fabrics such as wool can aggravate sensitive skin and start a flare-up.
• Environmental factors – heat, sweat, dust mites, pollen, pet dander and pollution are common triggers that can worsen symptoms. Sudden temperature changes may also cause flares.

What are the symptoms of Paediatric Eczema?

The signs of eczema can vary depending on a child’s age and skin type. This includes:

Babies (0 to 12 months)

• Red, dry and scaly patches on the cheeks, scalp and trunk
• Rash may spread to arms, legs and nappy areas
• Rough or uneven skin texture
• Oozing or crusting if the skin is scratched
• Irritability or difficulty sleeping due to an itch

Toddlers (1 to 3 years old)

• Itchy and dry patches in the creases of the elbows and knees
• Rash may also appear on the wrists, ankles, eyelids and around the mouth
• Skin thickening from frequent scratching
• Flare-ups triggered by heat, sweat, teething or exposure to irritants
• Scratching until bleeding, increasing the risk of infection

Young Children (4 to 6 years old)

• Dry and inflamed areas on the inside of the elbows, behind the knees and on the hands or feet
• Rash may appear on the neck, around the eyes and on the scalp
• Repeated scratching causes lichenification (thick and leathery skin)
• Darkening or lightening of skin after healing
• Increased itching during changes in weather or after physical activity

Older Children (7 to 12 years old)

• Persistent dry and itchy skin that may be widespread or localised
• Lichenified patches from long-term scratching
• Post-inflammatory changes in skin colour, especially in children with darker skin
• Itch is often worse at night, disrupting sleep and concentration
• Emotional effects such as embarrassment or self-consciousness about visible rashes

Who is at risk of Paediatric Eczema?

Some children are more likely to develop eczema due to a combination of inherited traits and environmental influences. This includes:

• Family history (genetic predisposition) – children with a parent or sibling who has eczema, asthma or allergies often inherit a tendency for their immune system to overreact to triggers. This genetic link also increases the likelihood of a naturally weaker skin barrier.
• History of allergies (atopic tendency) – children who develop eczema early in life may be more likely to develop other allergic conditions, such as asthma, allergic rhinitis or food allergies as they grow. This progression is known as the “atopic march,” where one allergic condition can increase the risk of subsequent allergic diseases over time.
• Skin barrier weakness (filaggrin gene or dry, sensitive skin) – some children naturally have dry, sensitive skin that loses moisture easily. This is often linked to filaggrin gene mutations, which weaken the skin barrier and make flare-ups more likely. Sensitive skin reacts more strongly to everyday products, fabrics, or weather changes. 
• Early-life environment and skin care habits – while these factors do not directly cause eczema, they can trigger flares in children with underlying risk:
  • Frequent contact with harsh soaps, detergents, fragranced products or rough fabrics can weaken the skin barrier.
  • Dry or excessively humid climates, excessive bathing without moisturising or exposure to irritants like dust mites, mould, or pollution can aggravate sensitive skin.

How is Paediatric Eczema diagnosed in Singapore?

There is no single test for eczema in children. Diagnosis is based on a careful review of symptoms, skin appearance and possible triggers. A thorough assessment helps rule out other skin problems and ensures the right treatment.

The diagnostic process consists of:

• Medical history – our dermatologist will ask about when the symptoms began, how often flare-ups occur and if there are any patterns or triggers. Family history is important, especially if parents or siblings have eczema, asthma or allergies. Questions about bathing routines, skincare products, clothing, diet, sleep habits and any previous treatment may also be included.
• Skin examination – a close look at the affected areas helps identify where the rash appears, how severe it is and whether there are signs of infection. Some rashes in children can look like eczema but have different causes. A careful examination helps ensure the correct diagnosis.
• Allergy testing — if contact allergies are suspected, our dermatologist may recommend patch testing. This involves placing small amounts of allergens on the skin to check for delayed reactions. In children, this can help detect triggers like metals, fragrances or preservatives in skincare products. For environmental or food allergies, additional tests may be advised, including skin prick tests or blood tests, to pinpoint the specific allergen and guide effective management.
• Skin swabs or biopsies — a swab may be tested for bacteria such as Staphylococcus aureus if the skin does not show improvement with standard treatment and Herpes  Simplex Virus (HSV) swabs may be taken when eczema herpeticum is suspected. In rare cases, a tiny skin sample (biopsy) is used to confirm the diagnosis and rule out other skin conditions.

Treatment aims to repair the skin barrier, reduce inflammation and keep flare-ups under control. Every child’s skin is different, so treatment is tailored to age, severity and triggers.

Generally, a comprehensive treatment plan consists of:

Skin barrier repair — the foundation of care

• Moisturisers — applied multiple times daily and generously to lock in hydration
• Gentle cleansers — avoid harsh soaps that strip natural oils
• Bath additives — such as colloidal oatmeal or bath oils to soothe irritation

Anti-inflammatory creams — calming the rash

• Topical corticosteroids — strength chosen according to the child’s age and the affected area
• Topical calcineurin inhibitors — for delicate skin areas or as a steroid-sparing option
• Topical PDE4 inhibitors — for mild to moderate cases as a steroid-sparing option

Infection control — protecting the skin

• Topical antibiotics — for small, infected patches
• Oral antibiotics — if the infection is more widespread
• Antiseptic washes — such as dilute bleach baths to lower bacterial load
• Antivirals — for viral infections like eczema herpeticum

Advanced treatments — for severe cases

• Phototherapy — narrowband UVB treatment under medical supervision for stubborn eczema
• Systemic immunosuppressants — short courses of oral corticosteroids or, in selected older children, immunosuppressants under specialist care
• Biologics – targeted therapies such as dupilumab (approved for babies 6 months and older) and lebrikizumab (approved for children over 12 years old) can help control severe eczema by modulating specific immune pathways.
• JAK inhibitors — for eligible adolescents with severe eczema unresponsive to other treatments, always monitored closely

Trigger and lifestyle management — preventing flare-ups

• Avoid fragranced products, rough fabrics and known allergens
• Manage heat, sweat and dry air to reduce irritation
• Maintain a consistent skincare routine even when the skin looks clear
• Address emotional well-being, as stress can aggravate eczema in some children