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Diagnosing atopic eczema

A diagnosis of eczema is made if the patient has itchy skin plus three or more of the following:

  • Onset before two years of age
  • History of dry skin
  • History of eczema in the skin creases, and also the cheeks in children under 10 years of age
  • Visible flexural eczema, which, in children under four years of age, appears inside elbows, behind knees or on the cheeks, forehead and outer limbs
  • Personal history of other atopic disease, or history of any atopic disease in a first-degree relative if the child is less than four years of age.

Eczema can vary considerably in severity and frequency of flare-ups. It can have a profound impact on quality of life. Sleep disturbance is common because of night-time itching and this can lead to poor performance at school due to day-time sleepiness. Bullying and social rejection because of skin appearance can make life difficult for children with atopic eczema. 

Infections & infestations

Infected eczema can be associated with rapidly worsening eczema – more than a normal flare-up – and sometimes with fever and malaise. Weeping, pustules and crusts suggest bacterial infection (relatively common), clustered blisters like early cold sores suggest herpes virus infection (rare). In either case, prompt referral to a GP is required for antibiotic or antiviral treatment. 

A scabies infestation can look like eczema and the severe itching that accompanies an established infestation adds to the confusion. Scabies, along with head lice, can also precipitate local flare-ups of eczema.