From the Guidelines
Childhood facial eczema, also known as atopic dermatitis, is primarily associated with a family history of atopy and loss of function mutations in the filaggrin (FLG) gene, as highlighted in the 2014 guidelines of care for the management of atopic dermatitis 1. The key risk factors for childhood facial eczema include:
- A family history of eczema, asthma, or allergies, with approximately 70% of AD patients having a positive family history of atopic diseases 1
- Loss of function mutations in the filaggrin (FLG) gene, which confer a risk for earlier-onset AD and more severe, persistent disease 1
- Environmental triggers such as harsh soaps, detergents, certain fabrics, dust mites, pet dander, pollen, and extreme temperatures or humidity
- Food allergies, particularly to dairy, eggs, nuts, soy, wheat, and fish, which can trigger or worsen facial eczema in susceptible children
- Skin barrier dysfunction, where the skin cannot retain moisture effectively, often indicated by generally dry skin
According to the most recent guidelines, breastfeeding for the first 6 months is recommended, and regular use of emollients has a short- and long-term steroid-sparing effect in mild to moderate AD 1. Additionally, topical corticosteroids (TCSs) are considered the first-line treatment for flare-ups and are effective in reducing the inflammatory immune response in AD 1. It is essential to note that the type of delivery during childbirth (caesarean or vaginal) does not appear to alter AD risk, and elevated birth weights may be a risk factor for disease development, but the effect size is likely small 1. Furthermore, exposure to pets, particularly cats, may enhance the effect of filaggrin mutations in promoting the development of AD, but the evidence is conflicting 1. Overall, early identification of these risk factors and implementation of preventive measures can help reduce the incidence and severity of childhood facial eczema.
From the Research
Childhood Facial Eczema Risk Factors
- Atopic dermatitis (AD) is a chronic inflammatory skin condition that can affect children, with risk factors including:
- Family history of atopic disease, such as asthma, allergic rhinitis, or eczema 2, 3
- Parental history of eczema, which increases the risk of AD in children, regardless of its association with immunoglobulin E (IgE) 2
- Environmental factors, such as microbial imbalance of skin microbiota, immunoglobulin-E-induced sensitization, and neuro-inflammation 4
- The risk of AD in children is higher when both parents have a history of atopic disease, with an odds ratio of 2.08 compared to having one atopic parent 3
- A history of eczema in older siblings is also a risk indicator for AD in children, with an odds ratio of 2.1 2
- Other factors, such as epidermal barrier destruction and T-helper 2 cell-mediated pathways, can also contribute to the development of AD in children 4