Children with eczema — and when to call us

In brief

• About 1 in 5 children in Singapore have eczema, and many improve as they grow older.
• Short nails, cotton mittens at night, short lukewarm baths and generous moisturising make a real difference.
• Routine food allergy tests are not recommended for most children with eczema, and broad elimination diets can cause nutritional problems.
• Come back if eczema hasn’t improved after 2 weeks of treatment, or is disrupting sleep or school.
• Get prompt attention for honey-coloured crusts, pus, rapidly spreading redness or fever with worsening eczema.
• Come in the same day if many small blisters or punched-out sores appear suddenly, as this may be eczema herpeticum.

We see children and teenagers with eczema at our Punggol clinic. See our care for children or book a skin appointment.

How eczema looks at different ages

Eczema affects about 1 in 5 children in Singapore, more than adults. Where it appears changes with age:

• Infants and young toddlers (under 2 years): usually the scalp and face, very often the cheeks, often spreading to the trunk and the outer (extensor) sides of the arms and legs. The nappy area is usually spared.
• Children (2 to 12 years): more often the neck and the flexural areas: the insides of the elbows, behind the knees, around the wrists, and sometimes around the eyes.
• Teenagers: the flexural pattern usually continues, but eczema may also appear in more localised areas, such as the hands, feet, nipples or eyelids.

In Asian skin, eczema can look drier and more scaly than images online, with inflamed patches brown, violet or grey rather than bright red.

Unsure whether a rash is eczema or something else, such as a fungal rash, contact dermatitis or a reaction to a new product? Bring your child in; diagnosis isn’t always straightforward from a photo.

Practical tips for children

Our guides to everyday skincare and managing a flare apply to children too. A few extra tips:

• Keep nails short and clean. Most skin damage comes from scratching, not from the eczema itself, and short nails reduce it significantly.
• Cotton mittens or gloves at night during a flare help younger children who scratch in their sleep. Keep the room cool, not cold.
• Teach older children to press, rub or cool an itchy spot rather than scratch.
• Moisturise more often than you think you need to: at least twice a day, and after every bath or hand-wash. As a rough guide, aim for about 125g per week for infants and 250g per week for older children. Keep a tub at the changing table, by the bath and by the bed.
• Short, lukewarm baths (not hot) with a fragrance-free, non-soap cleanser, then moisturise within minutes of patting dry.
• Cotton clothing and bedding. Wash new clothes before first wear. Use a fragrance-free detergent and skip fabric softener, both common irritants for young skin.
• Tell nursery and school about the eczema, the moisturiser routine and any triggers. A labelled moisturiser tube kept at childcare helps.

Other allergic conditions — what we now understand

Children with eczema have a somewhat higher risk of food allergy, asthma and allergic rhinitis. This was long called an “atopic march” with a fixed sequence, but research over the past decade shows a more varied picture. Only a small minority develop all three, in no fixed order. Food allergy, for example, can come before, alongside or after the eczema.

• About 1 in 4 children with eczema develop at least one other allergic condition over time; most do not.
• Early-onset, more severe or long-lasting eczema tends to carry a somewhat higher risk.
• Moisturising from birth to prevent eczema was once thought to help babies with a family history of eczema. A Japanese study (Horimukai et al, 2014) found that daily moisturising from birth reduced eczema in high-risk infants.¹ But two much larger trials in 2020 (BEEP² and PreventADALL³) found no benefit, and a 2022 Cochrane review concluded that it probably doesn’t prevent eczema and probably slightly increases the risk of skin infection.⁴ So we don’t recommend it to prevent eczema. If your baby develops dry skin or eczema, regular moisturising is a key part of treatment.

Manage eczema well, but try not to worry about everything that might come next. Most children with eczema lead ordinary lives, and many outgrow it.

Food allergies — and how we think about them

Worry about food allergy often runs ahead of the evidence.

Food allergy is more common in children with eczema, and a specific food may occasionally worsen a child’s eczema. Common culprits are cow’s milk, egg, peanut, tree nuts, wheat and soy. Food-related flares can happen quickly, within minutes to a couple of hours of eating. They can also appear as a delayed worsening over the next 24 to 48 hours. If you notice a clear pattern, repeatedly, tell us.

However, routine blood tests (specific IgE) or skin-prick tests for food allergy are not recommended in most children with eczema. Their high false-positive rates lead to unnecessary food avoidance and nutritional problems, particularly in young children, for whom dairy, egg and wheat are important calorie and protein sources. Broad elimination diets without clinical guidance can do more harm than good.

Our approach:

1. Optimise daily skincare and flare treatment first. Most children improve substantially with these alone, so earlier allergy testing is usually premature.
2. If a specific food is clearly linked to flares on careful history, we can discuss targeted testing or a short, supervised trial elimination, not a broad “cut everything out” approach.
3. If the eczema is severe or not responding, we may refer to a private dermatologist or via subsidised referral, depending on your preference and means. Rare severe cases may be referred to the emergency department for inpatient management.

Growing out of it

Many children’s eczema improves noticeably as they get older, especially through the primary school years, and some grow out of it entirely. A smaller proportion keep it into adulthood, often milder and more localised (most commonly hand eczema).

Two things influence the course:

• Consistent daily skincare. Children whose skin barrier is well supported throughout childhood generally do better.
• Early, effective flare treatment. Repeated severe flares can prolong the course.

Teenagers often find the routine harder: they manage their own care, and eczema can weigh heavily at that age. If your teenager’s eczema is flaring and their self-care has drifted, a consultation with the teenager themselves, not only the parent, is usually more productive.

Red-flag signs — call us promptly for any age

In a child or an adult, these signs need prompt attention, not a routine appointment.

Likely skin infection:

• Honey-coloured crusting, weeping or oozing on an eczema patch
• Yellow pus, increasing pain or rapidly spreading redness
• Fever or feeling generally unwell along with worsening eczema

Possible eczema herpeticum (urgent):

• Sudden appearance of many small, dome-shaped blisters or punched-out sores on the eczema skin
• Especially if unwell or feverish
• It can look like a sudden “chickenpox on the eczema”. Come in the same day, or go to a paediatric emergency department if out of hours.

Flare not settling:

• No improvement after 2 weeks of the treatment we prescribed. Come back for review rather than continuing indefinitely.

Impact on life:

• Significant impact on sleep (frequent waking from itch)
• Significant impact on school, work or psychosocial wellbeing
• A child stopping activities or avoiding social situations because of their skin. This is worth addressing, not tolerating.

For severe, widespread flares, or if your child looks unwell with an eczema-related problem, don’t wait. Call us, or go to the nearest emergency department.

Things that may not help

Families try many approaches. These common ones are not well supported by evidence and are unlikely to help:

• Probiotic supplements: very limited evidence for preventing or treating eczema.
• Polynucleotide or stem-cell injections sold privately: the evidence base is thin.
• “Hypoallergenic” baby products with added fragrance: fragrance is a common irritant. Look for “fragrance-free”, not “hypoallergenic”.
• Cutting out a whole food group (such as all dairy or all wheat) without clinical guidance: this risks nutritional deficiency, especially in children, often without improving the eczema.

The most reliable approach at every age remains consistent daily moisturising, appropriate flare treatment, avoiding known triggers, and coming back when something changes. If something else seems to help, tell us; we would rather know.

Get in touch

Punggol — 658 Punggol East, #01-04, Singapore 820658 · Tel 6312 4589

Joo Chiat — 172 Joo Chiat Road, #01-01, Singapore 427443 · Tel 6920 1952

Email — admin@ktmc.sg

References

• Agency for Care Effectiveness (ACE). Mild and moderate atopic dermatitis (eczema) — a journey from flare to care. ACE Clinical Guideline, Ministry of Health, Singapore. February 2026. ace-hta.gov.sg
• ¹ Horimukai K, Morita K, Narita M, et al. Application of moisturizer to neonates prevents development of atopic dermatitis. J Allergy Clin Immunol. 2014;134(4):824-830.e6. PubMed
• ² Chalmers JR, Haines RH, Bradshaw LE, et al. Daily emollient during infancy for prevention of eczema: the BEEP randomised controlled trial. Lancet. 2020;395(10228):962-972. PubMed
• ³ Skjerven HO, Rehbinder EM, Vettukattil R, et al. Skin emollient and early complementary feeding to prevent infant atopic dermatitis (PreventADALL): a factorial, multicentre, cluster-randomised trial. Lancet. 2020;395(10228):951-961. PubMed
• ⁴ Kelleher MM, Phillips R, Brown SJ, et al. Skin care interventions in infants for preventing eczema and food allergy. Cochrane Database Syst Rev. 2022;11:CD013534. PubMed
• Paller AS, Spergel JM, Mina-Osorio P, Irvine AD. The atopic march and atopic multimorbidity: many trajectories, many pathways. J Allergy Clin Immunol. 2019;143(1):46-55. jacionline.org

This information is for general education only and is not a substitute for medical advice. Paediatric eczema management depends on age, severity, and individual factors — please speak with our team about what’s right for your child. v1.1 · October 2026 (v1.0 April 2026) · Review due April 2028.