My Child's Eczema Won't Go Away—What Am I Missing?

Why does eczema keep coming back?

Many parents assume eczema is simply dry skin—but eczema is much more complex than that. It can affect a child's sleep, comfort, confidence, and quality of life.

In this episode of Healthy Beginnings, Dr. Edgar Kalimba explains what eczema really is, why some children develop it, and what parents can do to reduce flare-ups and better manage symptoms.

From genetics and environmental triggers to bathing routines and moisturizers, this episode gives parents practical, evidence-based guidance for caring for children with eczema.

In this episode we discuss:

• What eczema actually is
 • The signs and symptoms of eczema in babies and young children
 • How eczema differs from ordinary dry skin
 • Why some children develop eczema and the role of family history
 • Common triggers including dust, heat, soaps, fabrics, stress, and certain foods
 • The itch-scratch cycle and why eczema gets worse
 • How to bathe and moisturize correctly
 • Choosing the right skin products and clothing
 • How weather affects eczema symptoms
 • When eczema becomes serious and needs medical attention 

Healthy Beginnings offers clear and evidence-based conversations about children’s health, family wellbeing, and the systems that shape our lives. 

New episodes every Monday 

Have a question? Email: healthybeginningspodcast@gmail.com

Produced by LF Media

Transcript

SPEAKER_00 0:00

My child is always scratching. The skin gets better, and then suddenly it flares up again. We've tried many creams, but it keeps it keeps coming back. If this sounds familiar, you're definitely not alone. And today I would like to discuss what eczema actually is, how to recognize it, why some children develop it, a little bit on common triggers and some of the practical ways that parents can manage it. So, what is eczema? What is atopic dermatitis, as we call it medically, and eczema really is a chronic allergic inflammatory condition of the skin. This means the skin barrier is weaker than normal, the skin loses moisture more easily, as I'm going to explain, and the skin becomes inflamed and often very, very itchy. So, if you think about healthy skin as a brick wall, the skin cells are the bricks, and the natural oils between the cells are the cement holding everything together. So in eczema, the wall develops tiny gaps, and these gaps allow moisture to escape, and irritants and allergens to easily enter and penetrate the skin. And generally the results would be a very, very dry skin, itching and irritation. You can get a lot of redness, which is associated with inflammation. So it should be clear that eczema is not an infection. Eczema is also not caused by poor hygiene. So it looks different depending on age, and in infants, or infants meaning in babies less than one year, it commonly affects the face, the cheeks, you know, the forehead, the scalp, and then the arms and the legs. It can also be on the trunk and other parts of the body, but these are much more frequently affected. And you'll often notice red patches, very dry, rough skin, and in some cases, a level of oozing or crusting. And again, scratching is really, really the hallmark. Scratching is very common because it's very itchy. In older children, it would commonly affect elbows, behind the knees, the neck, the wrists, the ankles, basically the joint areas. But that doesn't really mean that it can't affect pretty much any part of the body. And again, the hallmark symptom is itching. In fact, uh many dermatologists would say that if it doesn't itch, think twice before calling it eczema. So, how about eczema versus ordinary dry skin? So some people generally have a dry skin that is not necessarily eczema or related to eczema. And dry skin may feel rough, usually improves obviously with appropriate moisturization and causes little discomfort. As opposed to eczema, that is actually intensely itchy, it comes and goes in flares and often causes redness and inflammation and can even interfere with sleep, especially due to the itchiness. So obviously, with all of that, the sleep disturbance, the skin becomes damaged because they are scratching away, they are really peeling and scratching and scratching. And because of that, it actually exposes the skin to secondary bacterial infections, this might occur. Not just bacterial infections, but other infections like fungal skin infections and so on and so forth. So one of the most common questions that parents ask are what caused my child to have eczema? And the answer is really a combination of genetics and environment. Children are more likely to develop eczema if there is a family history of eczema, indeed, the parents, the older siblings, or if there's a family history of asthma, which is an allergic respiratory condition affecting the bronchi and the smaller the smaller airways in the lungs that close up as a response to different triggers, or allergic rhinitis, typically called hay fever, uh, which is sneezing, rubbing, itchiness of the nose and the eyes. Um, so basically, all these other allergic conditions, uh, when they run predominantly in the family, you have what we refer to as an allergic tendency or an atopic tendency. And children with allergic tendency have a much higher risk of developing eczema than those who don't. And then this brings me to the triggers. What are the common triggers? So, although eczema is chronic, certain things can trigger flare-ups or what we could call acute attacks. And very commonly is what we call house dust mites. There's different types of house dust mites, and these are small microscopic uh organisms that harbor in areas where there's dust, particularly indoors inside the house, whether it's on carpets or in uh um chairs and beds and upholstery, so any place that can collect dust can have the potential to harbor house dust mites, and these can trigger eczema. Then weather conditions also can play a role, especially when it's hot. When it's hot and you're sweating, that can increase uh irritation and itchiness. And the more you scratch, the more you really uh trigger or further worsen the flare-up. The other thing that can be a trigger is very harsh sops and cosmetics in general. So medicated SOP, antibacterial sops, uh very perfumed, nice smelling cosmetics and sops and detergents, all of those can be a source of uh flare-ups. Now, for some children, when they are food allergic, if they are allergic to a specific type of food, yes, when they get exposed to that, they can get hives, uh which is the acute allergic reaction, but this can also be low-key and actually trigger uh eczema flare-ups. So, for example, sometimes parents will tell me that when my child eats a certain type of meat or a certain type of fish or seafood or egg or dairy, then they will start to scratch and scratch and scratch and flare up. And when they actually stop that thing or that particular food item, they notice a difference. That is an observation that can already tell you that maybe your child is allergic to a certain food type. If they've been well and they eat something and all of a sudden the eczema flares up, then that could be an indication that they're actually food allergic to that particular element. And then, of course, we usually want to do an allergy test and confirm so that you don't just exclude uh food groups or food items without proper guidance. The other potential trigger is certain types of fabrics. So we know, for example, wool, clothing made out of wool, or fabrics that are generally synthetic and very rough, those uh often can irritate the skin. Then stress in older children, especially, you know, they can get emotional stress for one reason or another, and that can also worsen uh the eczema or be a trigger for flare-ups. There is what we call the itch scratch cycle. And this is important as a concept to understand because the cycle works like this. So the skin is itchy because of the tendency to eczema, the child scratches, and because of extensive scratching and further breaking the skin, the skin becomes more inflamed. And then because it's more inflamed, the itchiness also worsens. So it's really uh a vicious cycle. One thing leads to another, and this other thing leads to the same initial thing, and then becomes a cycle of each scratch, each scratch, each scratch, um, which further complicates and makes things much worse. So now to some practical parenting advice and what should be done. Um, first of all, uh baths. Taking a bath should generally be short and should be lukewarm, not very hot, you know, like long soaking baths in soap are not very helpful because they further dry the skin. Um, and also, like I said, very harsh sops are not helpful. So um it's usually good to have a gentle bath, avoid scratching, avoid very hot water, and very importantly, very, very importantly, is the moisturizing. You know, after a bath, you should apply a moisturizer and apply it uh very generously. We always say that you know, moisturizers are really the components that are going to help to repair the skin barrier. And most of the time, when you use a good moisturizer that is intended for allergic skin that is thick, thick, thick, thick, thick, not thin, um, that does not have a scent, is not perfumed, because often the perfumes and the other scents added to the to the lotions are actually potentially triggers for flare-ups. So it's these plain, plain um non-scented, non-perfumed, uh, thick moisturizers that should be applied generously and should be applied at least twice a day. That helps to rebuild a skin barrier and reduces the need for use of corticosteroids and other treatment options. So, you know, it's it's always important to remember that for eczema skin, the go-to products are really the most gentle, the mildest fragrance-free products. Those are really what is uh designed for sensitive skin. What about flare-ups? If your child is having a flare-up, you know, we continue moisturizing, very important. And then uh often we prescribe corticosteroid creams, um, and these are extremely helpful, they really help, but these obviously should be used under medical prescription and medical guidance. Now, if uh in terms of the clothing and the clothing recommendations, I already alluded to the fact that wool and other rough synthetic clothing materials are bad, they're irritating, and the best choice is really soft cotton and you know, kind of loose fitting clothes, because our setup or environment is often warm most of the year. So loose fitting clothing that is preferably made out of cotton is really the go-to uh type of fabric. And then, of course, as I already alluded to, weather is very important. You know, when it's very hot, we sweat a lot, and that triggers the feeling, the sensation of wanting to scratch the itchiness. And when it's very cold or windy, especially in countries where there is cold weather or whether uh whether it's winter or other cold seasons, this actually dries the skin. And very dry skin, again, can also be a trigger for eczema flare. So uh this should be kept in mind uh based on the prevalent weather conditions. So at times, eczema becomes very serious, uh, meaning that it is so bad that the skin is breaking down, it's very painful, they are scratching sometimes, even bleeding. Um, the itchiness is so bad that it's even difficult to sleep at night. They are restless and turning and sweating and scratching. So you you need to seek uh medical attention uh in such circumstances. And obviously, when there is fever or any sign of skin infection, maybe there's pus or pastules or yellow crusting, um, all of that calls for um a need to consult and get um medical care that's appropriate. So there's a couple of myths that I just want to briefly clear up. One is eczema is contagious. So sometimes parents uh look at a child with eczema, uh, maybe that goes to the same class as your child, and you're like, oh no, no, my child's friend has this skin condition, and I think they're going to infect my child. So eczema is not contagious. You cannot spread, um, you cannot get infected, so to speak. It does not get passed on from one child to another. The second uh thing is that corticosteroids, those creams that we use as treatment during flare-ups or during severe um episodes, the corticosteroid creams, some people think that they always damage the skin. And the truth really is that when prescribed appropriately, meaning the potency that is being used, for example, on the skin, which is very thin, uh on the face, which is very thin skin, uh, or in younger children. So it should be prescribed appropriately and used correctly. And when it's done like that, steroid creams are very safe and they're highly effective. So what you should avoid is um, for example, taking a cream that was prescribed for a relative, and maybe it is too strong for your child, depending on their age, uh that can be problematic. Or uh continuing very prolonged periods of application without supervision, that can also be a problem. But outside of that, uh corticosteroids are actually pretty safe. Um, there's another myth where parents say, you know, my child will automatically automatically outgrow the eczema. And there is some truth to that, in the sense that many children improve with age. However, um, there is a portion of children that will still have to deal with eczema into adolescence and even adulthood. It really depends on their phenotype, what we call a phenotype, how severe their allergies are, you know, their immune triggers, and every child is different from the other. Every child is an individual. So it is not uh correct um to state as a sweeping statement that it will automatically go away and your child will outgrow the eczema. The one thing that we know from uh medical science is that some children uh get what we call uh they develop what we call tolerance. So, what used to be a trigger or an allergen, whether it's a food item, whether it's environmental, they tend to adapt and they're able to tolerate it without getting an allergic reaction. So that happens, and that's when actually uh the times when uh not just eczema but other allergies get better. So again, when it's treated well with very good control and doing things correctly from early on, that sort of improves the long-term outcomes, understandably. And obviously, some people think you know, diet is always the cause or the things that we eat. Again, diet is only a cause if your child with eczema is actually allergic to a particular food item or food groups. So, and this is really a minority of eczema cases because most children with eczema will eat any food without getting flare-ups. And maybe they just flare up from the environment, from conditions, from you know, other environmental triggers. So, most children with eczema do not need any dietary restrictions, and unnecessary food elimination can sometimes do more harm than good. So, before I respond to some of the questions from the listeners, um, the take home is that eczema is extremely common. Actually, it is the most common childhood skin condition globally, not just in Africa. And it is caused by a combination of genetics and skin barrier dysfunction and environmental triggers. And uh itchiness is really, really the hallmark uh symptom, and moisturizing an appropriate moisturizer is uh the most important first step treatment. So I hope that makes sense and that is helpful, and that you'll be able to tell the difference a bit better between eczema and other common skin rushes, and be able to also handle them appropriately in terms of the day-to-day management to improve your child's comfort. Before we leave, I would like to answer some of the questions that were sent to us by the listeners.

SPEAKER_01 21:40

We have our first question from Vanessa 27 from Nairobi. Some people say babies need early morning sunlight for strength and bones, while others fear exposing infants outside too early. What role does sunlight actually play in infant health?

SPEAKER_00 21:56

Very good question. Um In fact, the question. question on sun exposing, the benefit of being exposed to the sun, how much, how much time, and all of that starts actually from uh the newborn period, uh immediately after after birth. Most listeners would know that maybe one quarter of newborns, healthy newborns, have what we call jaundice. You know, it's this yellow skin color that happens as part of the blood uh adaptation, breakdown of uh uh hemoglobin, and then your baby becomes yellow the first week of life, sometimes even up to the second week of life. And this is what we call physiologic jaundice. It's part of adaptation, but sometimes the jaundice becomes a little bit too much and we need to treat it. Because it can be dangerous. When it's really very high, your child is not just yellow, but they become very sleepy, very lethargic, they struggle to breastfeed or to feed in general. And then we have to take a blood test, confirm, and treat the jaundice. And the way we treat it is actually putting them under lights. Those who have had children with jaundice, you've seen how we treat it. We put the child, we undress them and put them under lights for a day or two or three, depending how high it is. And then the light will actually break down the jaundice and help to treat it. And often babies have some level of jaundice that doesn't need to be treated in the hospital. And parents are advised okay you need to expose your baby let's say for 10 to 15 minutes in the morning not very early so that it's not cold because you need to expose their skin and it's not yet very hot. So maybe 9 or 10 a.m depending on the season. So that is one importance of sun exposure that is very practical that many people already know. The other thing is that it is our easiest most appropriate source of vitamin D. Now vitamin D is not easy to get in the diet because you need to eat um what we call animal source protein. So things like eggs or fish specific types of meats have uh a bit more vitamin D than plant sources and uh sometimes in our society we don't eat a lot of these which means that we become deficient. And then with a lifestyle where people leave their homes very early the children go to school very early they are indoors most of the day and then they go back home very late and then you realize you've actually not been out in the sun for a long time. And we have more and more people becoming vitamin D deficient despite having plenty of sunlight plenty of sunlight so generally sun exposure is important. We want children to play outside um you know just play and be exposed to the sun obviously not for prolonged periods and not for and not during the times where the sun is extremely hot because that can also cause problems. But by and large a 15 to 30 minute sun exposure a couple of times a week three to five times a week is very important because that will help the body to absorb vitamin D, strengthen the bonds, improve the immune system, and support overall health we have our last question from Emmanuel 34 from Kigali.

SPEAKER_01 26:16

Traditionally fathers are seen mainly as providers but how important is emotional bonding between fathers and infants in child development very good question very good question and one that I often realize that as fathers being a father myself we don't realize the importance of emotional bonding with our children.

SPEAKER_00 26:39

At every age in fact there is even evidence that even before your child is born when you bond with your spouse with the mother and you speak to them and you touch them and they already start to know your your voice. And from really early on um babies and infants have very strong uh reflexes and primitive reflexes and adaptability so they know our voices they know our touch they know all of these things and it's very important for fathers us as fathers to be involved not only does it help the child to feel loved to feel safe and supported it also promotes emotional regulation and resilience and confidence. And believe it or not there's scientific evidence that shows that it actually supports cognitive social and language development. And this is why I always encourage fathers to for example read bedtime stories to their children because that actually has a very important positive impact in the development in the growth and development of your child um there's many other things you know my first child is a girl for example is a daughter she's a she's a teenager now and um I have a very strong relationship with her and this really started very early as a baby because we've had that relationship from the beginning and that has actually helped us to navigate the adolescent years relatively smoothly which I'm very grateful for. We know that when girls have a very strong relationship a very positive relationship with their dads and they are affirmed they are supported they're emotionally connected it has a huge advantage on how your daughter will grow and adapt to the environment how they will perform in school how they will relate to boys and men when they grow up so it's really far reaching and it's very important to be emotionally present. Even though we are busy and we have to work just being intentional and connecting emotionally for even just 20 to 30 minutes a day, asking them about their day, playing a board game with them I mean when they're a little bit older when they're younger reading a story to them and really finding opportunities will have far, far reaching benefits. And I also believe it's not just for our children but also for us as fathers. It also has uh a lot of benefits for us and and can actually be a paternal stress reducer as well in many ways. So I hope that was uh useful and once again it's such a pleasure for me to have these weekly conversations we will keep them coming and I look forward to our next conversation.

SPEAKER_01 30:28

This podcast is for general informational and educational purposes only do not make health decisions without consulting your doctor this podcast is brought to you by LF Media, home of great African podcasts