Introduction
One person in ten has eczema at some time in their life, usually during childhood and the majority of these children will attend mainstream schools. It is therefore very likely that in every school there will be a number of children who have eczema in varying degrees of severity.
In the majority of cases eczema can be managed well within the school environment. By making use of the following information and guidelines most children should be able to lead and active and fulfilling school life.
Eczema is a skin condition which can result in dry, inflamed and sometimes weeping or infected skin. There is no cure - only different ways of managing the condition.
The main type is atopic eczema, which is usually inherited, and often allied to asthma and hay fever.
Eczema is a highly individual condition which may differ from child to child and also within the same child from time to time. It can appear anywhere on the body though it is commonly seen on the backs of the knees, elbows, wrists, ankle and neck. Some children who are severely effected may have eczema which covers the whole body and face.
Eczema is a dry skin condition which needs regular moisturising. Dry skin will itch and this leads to scratching which will damage the skin and cause bleeding. Dry skin can also crack and fissure making movement difficult. Sometimes it hurts even to smile because the skin cracks open; and fingers may be too sore to hold a pencil. Soreness and stiff limbs can make children miserable and moody.
A hot, itchy skin is the predominant symptom. The greater the itch, the greater is the desire to scratch. This can cause pain and bleeding, but the need to scratch remains. For some children this itch is almost constant and it may be unreasonable to expect a child always to resist the need to scratch in the classroom.
Constant itching and scratching, with sleepless nights, is often the pattern for a child with eczema. Children may be late for school, may have difficulty concentrating during lessons and may fall behind with work. Some children who are severely effected may also have periods of absence.
Eczema is not contagious, but children with eczema can be the butt of cruel teasing. Even very small children can he made to feel rejected - some children may not want to hold their hands for example.
Eczema often improves as the child grows older, although it can reappear at any time (for example, in adolescence and at times of stress). The condition fluctuates and can move in its own cycles - some children are worse than others in spite of excellent care.
Children with eczema are more susceptible to some infections. It is essential to prevent contact between a child with eczema and a child or adult with any of the following infections:
Cold sores (herpes simplex) as this can lead to a very serious viral illness (eczema herpeticum).
Impetigo (a contagious pustular skin disease) as this can lead to the development of infected eczema which may need antibiotics to clear it.
The National Eczema Society can give general guidelines for managing eczema but every child is different, so eczema may vary from one individual to another. Contact between school and parents is therefore essential to the effective management of the condition and the comfort of the child.
Many parents find it helpful to discuss their child’s condition and treatments with their child's teacher at the beginning of the school year. It is important to remember that eczema can change quite dramatically in a short period of time and a continuous dialogue is therefore vital.
The following treatments may be necessary during the school day to keep a child's eczema under control. All children should be using emollients though the frequency with which they apply them may differ. Other treatments mentioned are more likely to be used in children with more severe eczema.
These keep dry skin moisturised and lubricated and are essential to minimise itchiness. Ideally, a pot of cream (emollient) should be kept at school. Younger children may like to keep their emollients in a brightly coloured pot which they have decorated themselves.
Emollients are safe for the child or teacher to use in accordance with general instructions from the parents, and with the following guidelines:
Use frequently, especially when the skin feels dry and itchy.
Apply with clean hands - it is very easy for children with eczema to develop infected skin and pots of cream or ointment are an ideal breeding ground for bacteria.
Gently apply a thin even layer, taking care not to rub the skin too hard as this can set off itching.
Use the dot method for thick preparations. From a small amount on a clean spoon, apply small pinches where required, starting from the top downwards. Smooth in gently.
Each child with eczema should have a separate supply of emollient, to avoid cross-infection.
Topical steroids are steroids applied to the skin and act to reduce inflammation. In the majority of children eczema can be controlled by the use of emollients alone but some children may need topical steroids if their eczema is troublesome.
It is unlikely that children will need to have topical steroids applied during the school day. Most topical steroids are applied once or twice a day and this is usually done morning and evening. However, in the unlikely event that they have to be used during school they should be as directed by the parent or a health professional. Topical steroids should always be applied thinly to the skin on inflamed areas only.
Those who are applying the steroid should wash their hands both before and after the application.
Some children may take anti-histamines at night to help them sleep and this can result in a residual drowsiness the following morning. Children are unlikely to need to take them during the day.
Children with eczema may sometimes need a course of antibiotics even in the absence of mild infection and may have to bring tablets to school.
Children with severe eczema may have special "wet wrap" bandages, or bandages impregnated with a soothing, but messy, paste. These will be applied at home but may need tidying at school. They will undoubtedly draw more attention to a child with eczema as they will show under clothes. Children wearing bandages may need additional support from teachers and other school staff to help them to deal with comments from other children who may not understand why the child is wearing them.
There are certain factors in a school environment which may make eczema worse or which may make a child with eczema feel more comfortable. These factors will differ for each individual child and it is very useful for teachers if parents can give details of situations to avoid and also of methods which are effective helping a child to calm down or to stop scratching.
A child's atopic eczema may be made worse by:
woollen clothing, ordinary soap, laundry powders, chemicals, metals;
pollen, dust, certain foods, colourings and preservatives, pets;
worry over family problems, schoolwork or the physical discomfort of eczema and its effects on lifestyle and appearance.
cold weather, heat and sweating.
Eczema can be a difficult condition to handle in the classroom. The child with severe eczema may have periods of frenzied itching and scratching once or twice a day, breaking their concentration and that of other pupils. Implications will vary for different age groups. The following guidelines may be useful.
It is impossible for a child not to scratch. Saying 'Don't scratch!' to a child will probably create guilt, make the child feel unbearably uncomfortable or promote a feeling of resentment. Encourage rubbing or pinching which may bring some relief without damaging the skin.
To avoid disrupting a large class, or occupying staff time unduly, it may be advisable for the child to leave the classroom to calm down. Some emollient cream, a glass of water and a cooling damp flannel may all help, though there may also be times where there is nothing to be done but to let the child scratch. The child and their parents will know the best ways of dealing with these moments.
Distraction and talk can sometimes calm an itchy child, together with the acknowledgement that the child may be in genuine distress rather than attention seeking. For a younger child, reading a book, a change of activity, or a special job, can all work as distraction from an itch.
It is best if children with eczema can be seated well away from sunny windows and radiators, as itching increases with overheating. A cotton pillowcase, piece of cotton material or folded towel to sit on helps to minimise the irritation from plastic seats.
Some children can be sensitive to dusty conditions or animal fur. Children with eczema may need to keep away from guinea pigs, hamsters or rabbits; in extreme cases they may not even be able to share a classroom with any pet. Sitting or playing on a carpet may also aggravate eczema.
Soaps, detergents, washing-up liquids and paints can all be irritant to the hands. Children may wish to bring their own special soap, or emollient washing cream, and plastic or cotton gloves.
Children with eczema are usually most comfortable in cotton clothing, particularly next to the skin. As it is not always easy to find non-irritant fabrics which match school uniform colours exactly, it is helpful if schools can be flexible in this respect.
Diet is sometimes an important factor in the management of eczema. Some children may find that certain foods may make their eczema worse and a small number of children may also have severe anaphylactic reactions to foods. Parents should make these details known to staff.
Flexibility will be needed for children with known food allergies- for instance, permission to bring orange juice if they have a milk allergy. There may also be times when children receive food unexpectedly, for example at Christmas, and care needs to be taken at these times too.
Children with eczema should be encouraged to participate as fully as possible in sporting activities, though sometimes stiff, sore or infected skin may prevent this. Children with eczema can take part in swimming but may need additional time to apply emollients before and after they swim.
Taking part in sports can be particularly distressing for children with eczema, as areas of skin which they have been able to hide may be exposed to their classmates when they are wearing shorts and T-shirt or a swimming costume. Chilren may need help to overcome feelings of embarrassment or anger and to deal with comments from other children.
There are several school activities which could cause problems for children with eczema. The following list is not inclusive but will give some idea of areas which may require extra vigilance.
Art and Pottery. Paint and glue may irritate eczema on the hands as may the clay and water used in pottery. Children can wear gloves for art but may have to miss out on pottery.
Craft, Design & Technology. Children may experience problems with metals, chemicals, plastics and oils. Gloves may be needed and an emollient can be applied before and after the lesson.
Home Economics. Children with food allergies should avoid contact with the food in question and those who find some foods such as oranges and onions irritating should avoid contact.
School trips, Work and Residential experience. Extra care may need to be taken in circumstances that are not a part of usual school routine. Care needs to be taken when allocating children to work experience placements.