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Introduction
This report will be discussing eczema in children, specifically causes and treatment of eczema. According to James McIntosh (2017) eczema is defined as a condition where the skin becomes inflamed, flaky and red causing the child to be itchy and can sometimes result in bleeding. The main aim of this report is to determine whether eczema can affect a childs life in terms of sleeping patterns, sleep quality and sleep deprivation, and the effects these will have on the child daily. This report will also discuss factors that could affect the severity of eczema e.g., gender, age and ethnic background. To fully understand eczema, this report uses articles, journals and medical definitions in order to fully explain what eczema is. Eczema can interfere with a childs life so its important for others to understand this for people to become knowledgeable and more understanding.
Background
According to Thomsen (2014) there are different types of eczema, atopic eczema being the most common, although not easily manageable there are many ways of treatment. This condition affects one fifth of individuals in their entire lifespan. Between 1950-2000 eczema had become an epidemic which was labelled the allergic epidemic due to pollution from industrialisation, causing allergies. In developing countries there are higher chances of developing the disease due to poor sanitation and pollution from factories. The effects of eczema in children up to the age of 11 years is from 5%-20%. Research suggests that this causes severe disruption to the child and their families, which leads to stress and anxiety. According to Tennesy et al (2019) this also has an impact on the health care system. Research suggests that a study conducted by Ninan and Russel, showed a high rate of atopic eczema over the past 30 years, therefore from 1964-1989 there was an increase to 12% from 5.3%. In a Danish study, research suggests there was a 3% risk of developing eczema between the ages of 0-7 between 1960-1964 birth cohort compared to 1970-1974 which was 10%. However younger children may be affected by food allergens which contribute to their atopic eczema. Teenagers are affected by allergens caused from grass, pollen, birch and dust. 7.4% of teenagers are triggered by cows milk and eggs from hens Ricci et al (2011). Eczema in adulthood is less common than in childhood, this is due to the disease not being cured in childhood and progressing into adulthood. In adults, eczema can also be caused by smoking Lee C H et al (2011) this suggests that passive smoking in childhood leads to onset of adulthood eczema. Research suggests that eczema is a genetic disorder passed down to families via genetics. A questionnaire was conducted by professional networks who were recruited by collaborators, to do research in different countries where a selection of children aged 7 years completed the questionnaire describing their symptoms and 13-14-year-old children completed their questionnaires in their classrooms. In result of the questionnaires, researchers found that in a particular population; the number of cases of atopic eczema were higher in countries like Urban Africa, Australasia, The Baltics, Northern and Western Europe (above 15%) and the lowest was found in Eastern Europe, China and Central Asia (under 5%) (William H et al 1999).
Given that the main cause of eczema is currently unknown, researchers and scientists have found a link between genes that are passed on from parents and asthma. So, families that have 1 parent with eczema or asthma are more likely to inherit eczema National Health Service (2019). Eczema makes it so that the person cannot keep enough moisture in their skin making it dry and flaky causing irritation and the child itches as a result. Other causes could be a problem with the immune system and even the environment can cause eczema Stephanie Watson (2017). This is relevant to sleep deprivation as the itching can be very irritating and can persist for hours, leaving the child itching more than they sleep, which can have numerous impacts on their day; for example, being too tired to be able to take part in school activities, having to leave constantly to moisturise, pain and bruising on bad days. Research shows that children with eczema are more likely to suffer from depression and bullying along with social withdrawal, changes in eating patterns and irritability National Eczema Association (2020).
As eczema effects between 15-20% of children in the UK (Hoare C 2000), there are many types of treatment as eczema affects so many, some of the treatments are simple, for instance: moisturising many times throughout the day, or avoiding trigger foods or limiting how much skin irritants you use e.g. fabric softener. However, for people who do not show improvement with simpler treatment, need stronger medication called corticosteroids this help reduce inflammation of the skin and comes in different dosage levels from over the counter to prescribed by a professional. However, some people with eczema do not show any response to these types of medicines and must undergo more serious measures, for example phototherapy, which uses UV light. UV light can help stop the skin from overreacting but too much exposure can age the skin which increases likelihood of skin cancer in the patient, so professionals minimise the exposure to reduce the risk of causing cancer. But there is another type of treatment called PUVA treatment that uses psoralen, a medicine that must be prescribed making the skin more sensitive to the UV rays in an attempt to heal the eczema however this also increases sensitivity to UV light in the environment also meaning that you are more at risk from getting skin cancer (Gardner 2020).
Methodology
To collect information, doctors reports, journals and experiments were taken into account, these were chosen as doctors reports are overseen, reviewed and corrected by other doctors that have first-hand knowledge on eczema, as far as reliable goes they had the highest reliability in the matter. Then articles were taken into consideration after doctors reports as sometimes articles can be altered by the public which is not reliable as the information might not always be correct. In addition, some of the articles were written over 20 years ago, therefore it is hard to ensure that all the information in the articles match up today (in terms of quantitative data/statistics) due to advancements in medicine. Most of the data collected is qualitative as eczema is a subject where pain can alter from person to person, meaning questionnaires can only give a rough measure, therefore quantitative data was required to set a standard and use qualitative along side other pieces of data.
Case study
This case study will be focussing on eczema in boys compared to girls, covering topics such as which gender develops eczema faster, who is more effected by eczema and if ethnic background of the child has any link with eczema. However, to fully understand eczema, its necessary to understand that there are many types but for this report, atopic eczema will be considered the main type, any other form of eczema for this report will be addressed as non-atopic eczema. A German study, investigated whether sex of the child had any effect on the type of eczema on children aged 5-7,the process consisted of a full dermatological exam along with a questionnaire that the children filled out, the tests used skin samples and used the 5 most common triggers that can cause a flare up (Morenschlanger et al 2000). Out of the 2693 girls examined 8.7% of them had exhibited signs of irritation on the first day of experimentation; regarding the boys (2783) 6.1% of them had portrayed signs of irritation on the first day. Therefore, regarding who is more likely to get irritated first from the most common irritants, the scientists were able to conclude that in their sample it would be the girls. The scientists were also able to link this with early onset eczema, suggesting that girls who already had eczema who were under the age of 2 had a strong link to atopy in children aged 5-7, but girls who developed eczema after the age of 2 didnt have a link to atopy. In simple terms, girls who had eczema from age 0-2 are more likely to develop atopic eczema, but girls who developed eczema after the age of 2 are less likely to have atopic eczema later in life. The study also showed that there were more boys who had developed atopic eczema, with a ratio of 28.3%:20.6%. Assuming if both genders had a similar lifestyle, boys are more at risk of developing atopic eczema but did not have a link to early onset eczema like the females in the sample. The investigation was able to reveal that atopic and non-atopic eczema develops in girls and boys differently, whereas boys are more likely to exhibit atopic eczema, girls predominantly are impacted more by eczema that is not related to atopy. The report was also able to determine that different lifestyles also have an impact on eczema as the girls in the sample predominantly played inside which is more related with eczema (Noiesen et al 2008).
Although atopic eczema can affect anyone, studies have found that it is most common in people with African descent, with 19.3% African American 16.1% Caucasian and 7.8% Asian (Kaufman, 2020). However, another study showed that African Americans are 1.7 times more likely to develop more serious cases of atopic eczema as shown below.
The figure shows prevalence of more serious cases of eczema, the darker shades show geographically where the worst cases are in the world and the darker shades are situated around Africa with some also in South america and the UK (Brunner, 2018). Certain races and ethnic backgrounds are more susceptible to atopic eczema if their lifestyle and family history is associated with atopic diseases. As genetic mutations occur,this can effect skin cells and if the person is able to survive it means they are able to reproduce making the genes with atopic eczema more easy to pass onto their children, which is the theory of evolution, as proven by Charles Darwin (1859). Mutations occur randomly but can happen in certain ethnic backgrounds more often which can aid in the explanation of the differences in eczema of different races.
Conclusion
After much research, doctors and other trained professionals have concluded that eczema can be very serious both physically and mentally. As there is a direct link between depression, and children who have eczema resulting from bullying, social withdrawal or lack of sufficient sleep. Eczema also varies from child to child, each child requires a different type of treatment whether that be conventional methods like moisturising or limiting exposure to irritants and a controlled diet steering clear of trigger foods; or more serious ways of treatment, like phototherapy or using steroid medication as explained in the background. Each of these factors contribute to the fact that having eczema can have a traumatic experience on a child. Even getting treatment such as phototherapy can have a traumatic effect on a child, as they may be frightened of the equipment or even the staff especially in younger children. Aswell as varying from person to person, eczema varies from gender to gender and race, as some races are more susceptible to inheriting eczema through family memebers and other atopic diseases (e.g. asthma). This was proven on a scientific level aswell as an explorative method through research and through scientific principles like natural selection and the hardy-weinberg principle. These scientific laws explain that if there are certain genes that people possess over time they will become more apparent in more people in the world. This explains why eczema has risen up to 40% in the last four years (Devlin 2020). Also in terms of gender neither gender has it easier as males are more at risk of eczema linked to atopy after a certain age, meaning that there will be more children in the future who will be more depressed than the average child (assuming that there will be no big changes that will affect the field of medicine). However on the other hand, females are more at risk of carrying eczema from birth into childhood and through to adulthood. Given that there is no cure for eczema at the moment, and no certain way to prevent eczema it is quite apparent that eczema will increase in the future and may continue to do so, especially in places where medicine is not a luxury eg less economically developed countries. By providing information on eczema and making people understand the severity that comes with eczema will lead to a positive change.
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