My five-year-old son has been suffering from severe eczema since the age of six months. Now his attention and performance in school has also been reported as unsatisfactory. Please help.

My clinical impression is that your son is suffering from childhood eczema, which is medically known as atopic dermatitis (AD).

This type of eczema is believed to be mediated through the atopic gene – which also carries certain other potential risks of developing hay fever (allergic rhinitis), bronchial asthma or unexplained frequent eye or throat irritations.

Atopic dermatitis affects approximately 15-20 per cent of children throughout the globe. This incidence rate is more or less equal in all races and geographic areas. However, some degree of an increased incidence has been reported in the UK and in children of Arabic and Far East Asian background.

The skin manifestations of atopic dermatitis are mediated through quite a complex pathophysiological mechanism. However, the ultimate clinical outlook is in the form of an acutely inflamed, dry and severely itchy skin on different parts of a child’s body.

In severe cases it can involve almost the entire body. The affected children usually remain “restless” most of the time, even during their sleep.

This in turn results in finding these children with expressions of physical tiredness, mental fatigue and social disinterest (these all together might be the reason behind unsatisfactory performance reported from your son’s school).

The success of treatment can only be achieved through a comprehensive treatment strategy, shaped through a detailed discussion between the treating dermatologist and the parents. The nannies at home also need to be educated on the proper execution of the relevant treatment protocol.

My personal approach of treating these children is multi-dimensional: as a first step, I try to suppress the acute inflammatory phase of their dermatitis through topical applications of corticosteroids combined with emollients and other antipruritic preparations. After a few days, the steroidal component is gradually reduced in quantity as well as in frequency of its application.

The frequent daily emollient applications remain the mainstay of a long-term treatment plan.

In severe cases, a short course of low dose oral steroids together with oral anti-histamines usually proves quite helpful. In cases seen with secondary bacterial infection prescribing topical antibacterial preparations or even a short course of oral antibiotics could also seem necessary.

On the question of psychosocial sufferings induced by atopic dermatitis, this also needs a wisely created professional plan of management, again instituted through a team management strategy.

The treating doctor, parents, school nurse as well as the class teacher, all need to be included in this team to play their assigned roles in the management and progress of the child’s performance.