The most common cause of eczema is atopic dermatitis, sometimes called infantile eczema although it occurs in infants and older children.
Despite you moisturizing techniques used and you say that it get better then come again then there might be a trigger such as allergy exacerbating it ,In many cases, eczema goes into remission and symptoms may disappear altogether for months or even years and then may come when the trigger comes again .eczema is thought to be inherited .
They may also experience circular, slightly raised, itchy, and scaly rashes in the bends of the elbows, behind the knees, or on the backs of the wrists and ankles.
As kids get older, the rash is usually less oozy and scalier than it was when the eczema first began, and the skin is extremely itchy and dry. These symptoms also tend to worsen and improve over time, with flare-ups occurring periodically.
flare-ups can be prevented or improved by avoiding possible triggers such as:
-dry winter air with little moisture-allowing the skin to become too dry
-certain harsh soaps and detergents
-certain fabrics (such as wool or coarsely woven materials LIKE THE ONE IN YOUR DAUGHTER CASE BUT SEE IF OTHER UNDERLYING TRIGGER THOUGH ADDED
-certain skin care products, perfumes, and colognes (particularly those that contain alcohol)
-some foods (this depends on the person, but dairy products and acidic foods like tomatoes seem to be common culprits)
-emotional stress,excessive heat,sweating
Also, curbing the tendency to scratch the rash can prevent the condition from worsening and progressing to cause more severe skin damage or secondary infection
An allergist can test to see if the rash is an allergic reaction to a substance. This might involve one or more of the following :
>a blood test
>a patch test (placing a patch of suspected allergen, such as dyes or fragrances, on the skin)
>scratch/prick tests (placing suspected allergens on the skin or injecting them into the skin)
Your doctor may also ask you to eliminate certain foods (such as eggs, milk, soy, or nuts) from your child's diet, switch detergents or soaps, or make other changes for a time to find out whether your child has a reaction to something.
TREATMENTS includes :
-Topical corticosteroids, also called cortisone or steroid creams or ointments, are commonly used to treat eczema applied directly to the affected areas twice a day ,continue to apply the corticosteroids for as long as the doctor suggests.
It's also important not to use a topical steroid prescribed for someone else. These creams and ointments vary in strength, and using the wrong strength in sensitive areas can damage the skin, especially in infants.
-antihistamines (to help to control itching)
-oral or topical antibiotics (to prevent or treat secondary infections, which are common in kids with eczema)
TIPS TO FOLLOW AND TO LESS THE TRIGGERS :
>Avoid giving your child frequent hot baths, which tend to dry the skin.
>Use warm water with mild soaps or nonsoap cleansers when bathing your child.
>Avoid using scented soaps.
>Ask your doctor if it's OK to use oatmeal soaking products in the bath to help control the itching.
>Avoid excessive scrubbing and toweling after bathing your child. Instead, gently pat your child's skin dry.
>Avoid dressing your child in harsh or irritating clothing, such as wool or coarsely woven materials. Dress your child in soft clothes that "breathe," such as those made from cotton.
>Apply moisturizing ointments (such as petroleum jelly), lotions, or creams to your child's
skin regularly and always within a few minutes of bathing, after a very light towel dry.
Even if your child is using a corticosteroid cream prescribed by the doctor, apply moisturizers or lotions frequently (ideally, two to three times a day).
But avoid alcohol-containing lotions and moisturizers, which can make skin drier. Some baby products can also contribute to dry skin.
>Apply cool compresses (such as a wet, cool washcloth) on the irritated areas of skin to ease itching.
>Keep your child's fingernails short to minimize any skin damage caused by scratching.
>Try having your child wear comfortable, light gloves to bed if scratching at night is a problem.
>Help your child avoid becoming overheated, which can lead to flare-ups.
>Eliminate any known allergens such as certain foods, dust, or pet dander from your household. (This has been shown to help some young kids.)
>Have your child drink plenty of water, which adds moisture to the skin.
Therefore ,the good news is that more than half of the kids who have eczema today will be over it by the time they're teenagers.
Eczema is not an allergy itself, but allergies can trigger eczema. Some environmental factors (such as excessive heat or emotional stress) can also trigger the condition which can be prevented
Typically, symptoms appear within the first few months of life, and almost always before a child turns 5,following the treatment instructions and lifestyle lessen the eczema flare ups.
Elocon is a mometasone-based cream (mometasone is a high potency topical steroid). Topical corticosteroids are indeed the first line of treatment in eczema. .. Usually, therapy is started with a low potency steroid, which could be escalated to higher potency in case of poor or no response to therapy. Emollients should be abundantly used multiple times per day in conjunction with topical corticosteroids.
For your daughter’s case, since she seems to be responding poorly to mometasone, we could shift to betamethasone dipropionate 0.05%-based cream (like Dirpolene) which are safe for use for up to two weeks and then replaced with lower potency preparations until the lesions fade away.
The face and skin folds are areas at high risk for atrophy with corticosteroids, so high potency topical corticosteroids are generally avoided in these areas; however, limited brief use (five to seven days) is allowed, after which switching back to low potency steroids is done.
As of the age of 2 years, you may start using agents like topical calcineurin inhibitors, which belong to the class of immunomodulating agents (act by modulating the local skin activity of the immune system). Unlike topical corticosteroids, they do not result in skin. They can be a second line treatment for mild to moderate atopic dermatitis involving the face, including the eyelids, neck, and skin folds.
Examples include Tacrolimus ointment and pimecrolimus cream, to be applied twice daily. The Tacrolimus 0.03% formulation is safe for use in children. In patients who cannot tolerate tacrolimus because of burning or stinging, pimecrolimus may be better tolerated.
Both tacrolimus and pimecrolimus topical preparations are approved by the US Food and Drug Administration (FDA) for use in children over the age of two years.
Maintenance and prevention of flare up or relapses are key:
In infants and young children with moderate to severe atopic dermatitis who suffer from frequent flares, proactive intermittent therapy with low potency topical corticosteroids (like Betasone 1% or Betnovate1%) may be beneficial in preventing relapse. The cream should be applied once daily to previously affected skin areas for two consecutive days per week (ie, weekends) and may be continued for up to 16 weeks. Flares of atopic dermatitis that occur during intermittent treatment may be treated by resuming continuous use of topical corticosteroids that have been effective for the patient in the past.
Probiotic therapy with Lactobacillus and other organisms may be helpful bur seems to be of limited benefit in the treatment of atopic dermatitis in infants and children.
In some cases, children younger than three years with refractory atopic dermatitis may have undiagnosed food and/or environmental allergies that are worsening their disease.
Patients with atopic dermatitis (AD) are known to have higher rates of allergic diseases than the general population. In fact, up to 80 % of children with AD develop asthma and/or allergic rhinitis later in childhood, and 10- 20 % of patients with AD has food-induced significant to severe allergic reactions like urticaria (diffuse itchy skin allergy).
A number of studies have demonstrated a higher rate of sensitization to both food and aeroallergens (allergens in the air) in patients with atopic dermatitis (AD): on average, 50% of children with AD are sensitized to common allergens. This needs to be confirmed with clinical reactivity.
Infants and young children with AD are more commonly sensitized to foods (wheat and egg sensitization are most prevalent), while children over five years and adults are more commonly sensitized to aeroallergens (dust mite sensitization is most prevalent in both children and adults).
To make the diagnosis of food allergy, there must be:
- identification of the food sensitization: by history taking (food allergy is a more likely trigger if the onset or worsening of AD correlates with exposure to the food), and
-confirmation of clinical allergy: food allergy can be tested for by either prick skin testing or testing for food-specific IgE (a kind of antibodies with a role in allergic reactions) in blood.
ENVIRONMENTAL ALLERGIES are a trigger of AD in a small subset of children and adults; this is less likely to be the case in your daughter’s condition seeing that she is only 1 year of age.