Eczema
Eczema is a common skin condition in children and adolescents which causes dry, red, itchy areas of skin. They can become cracked, ‘weepy’ and crusted.
Eczema usually begins in the first year of life. Babies with eczema generally have a rash on their faces. The rash can also be on their scalp, body, arms, legs or behind the ears. In toddlers and older children, the rash often appears in skin creases at the wrists, elbows, ankles and knees.
We don't know the exact cause of eczema but we do know some factors that might increase the likelihood of developing eczema, such as a family history of eczema, asthma or hay fever. There are also some triggers that can bring on a flare of eczema or make eczema worse in some children. These include irritants including chemicals, detergents, soaps and shampoos, certain fabrics, hot or cold conditions and scratching; and allergens such as dust mites and pollen.
Food allergy is not a common trigger of eczema although occasionally food allergy can present with severe eczema in young babies. Some foods such as citrus, strawberries and stone fruits can act as irritants because they contain allergy releasing factors, however these are not food allergies.
Understanding the underlying cause may help us improve treatment or prevent this allergic disease.
Who does it affect?
Who does it affect?
- In Australia, about one in three infants aged one have eczema and while most will grow out of it, some may continue to be affected into adulthood.
- More than half of eczema sufferers show signs within their first year of life.
- Australian children have one of the highest incidences of eczema in the world and we found infants born in Australia to Asian parents have a much higher risk of developing eczema compared with children of Asian parents born in Asia or children born in Australia with non-Asian parents.
- Babies who develop eczema have an 80 per cent risk of developing a food allergy and are nine times more likely to develop asthma later in life.
Our eczema research
Our eczema research
- We are researching if a barrier cream containing the major building blocks of skin can prevent the development of childhood eczema and food allergies. Researchers believe allergens (substances than cause allergy) penetrate infant skin, increasing the risk of developing eczema, food allergies and asthma. Young babies have a relatively poor skin barrier and those with the poorest barrier are at higher risk of eczema and food allergies. We hope the cream will build a barrier and stop allergens from penetrating the skin. The Pebbles study involves 760 newborns whose parents or siblings have eczema, asthma, hay fever or food allergy.
- Another trial is investigating if the whooping cough vaccine can protect young children against eczema and food allergies. With Perth and Sydney colleagues, we are recruiting 1,500 infants aged six to 12 weeks.
- Our HealthNuts study that follows 5,300 children over many years aims to determine risk factors for developing eczema.
- Mutations in the filaggrin gene are linked to eczema development. Our research with colleagues found palmar hyperlinearity or ‘old man’s hands’ can identify young adults with these mutations. We hope that looking for this condition in the hands and feet of babies in our Pebbles study may predict who develops eczema.
Impacts of our research
Impacts of our research
- We led a first of its kind study which showed superfine merino wool may reduce rather than worsen eczema symptoms. This challenges the myth that wool irritates the skin of children with eczema.
- Our research found the BCG tuberculosis vaccine had a modest beneficial effect in preventing eczema in high-risk infants. Given soon after birth, it reduced eczema incidence by 25 per cent in infants whose parents had hay fever, asthma or eczema.
- We found caesarean birth was not linked to an increased risk of eczema, reassuring parents, and helped update infant feeding guidelines advising on risks of developing food allergy and eczema.
- We found that probiotic supplementation in the last 4 weeks of pregnancy did not prevent babies developing eczema. Another study of probiotic supplementation to premature babies in the first weeks of life also did not prevent the development of eczema.
- We found that babies who later develop eczema have altered microbiota patterns and lower levels of a particular bifidobacteria species from the first weeks of life, suggesting that a healthy microbiota plays an important role in protecting against eczema development.
- We found mutations in the eczema gene filaggrin lead to higher rates of food sensitisation (being sensitive to common allergic foods.) This supports the hypothesis that sensitisation to food can occur through the skin, and dry skin may increase the risk of becoming sensitised to certain food.
- Another study found infants with eczema were 11 times more likely to develop peanut allergy and six times more likely to have egg allergy than those without eczema.
- We found that a reduced variety and abundance of gut bacteria in infants may increase their risk of developing eczema.
Our vision
Our vision
A life free of itchy skin and rashes is what all children deserve. Our goals, including better treatment and measures to control flare-ups, aim to improve quality of life for children with eczema. Prevention is the ultimate goal.
Where to next?
Where to next?
Our focus is on developing better treatment options for children living with eczema. For example, we are analysing data from the PEBBLES study—a randomised controlled trial to prevent atopic dermatitis, food allergy and sensitisation in infants with a family history of allergic disease using a skin barrier improvement strategy.
We want to learn more about impaired skin barrier in early life, which allows allergens from the environment to pass through the skin to trigger the immune system to develop allergic sensitisation. The next step will be to extend the trial to assess the impact of our skin barrier intervention on asthma and lung function at age four.