Dr Phil Kieran: Does my three-year-old son have eczema?

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My three-year-old son has developed painful red patches behind his ears. Could they be related to eczema? Also, is there an over-the-counter treatment you could recommend?

Eczema is widespread and affects about one in five children in Ireland. It is a red rash which most commonly affects the areas over the joints.

The skin condition usually comes and goes and can mostly be treated with over-the-counter moisturisers. It may well get worse or flare when the child has an infection, such as a cold.

We often prescribe a steroid ointment for children with more severe eczema and recommend avoiding soap. I usually suggest parents get Hydromol ointment as this can be used as a soap substitute, moisturiser or emollient. You can also add it to baths, so it’s useful to have around.

Eczema is itchy primarily rather than sore and the worry is it might become infected. You can tell this is the case when the rash gets red and angry, looking wet rather than dry and becoming painful. If this happens, seeing your doctor for advice and treatment is a good idea.

This question about the red patches behind the ears is interesting in a few ways. It could be eczema but it is not a typical place to get it.

If your child has a rash on other parts of the body and is going through a flare, then it’s more likely to be eczema. Rash behind the ears is commonly caused by cradle cap in infants and contact dermatitis or psoriasis in older kids.

Due to vaccination, we don’t see measles or rubella any more, which also cause a rash behind the ears.

Contact dermatitis is an allergic type of skin reaction due to an irritant being in contact with the skin.

In the area behind the ears, the most common cause nowadays is wearing face masks but that’s not likely in a three-year-old. I would look at products that can leave residue on the skin after bathing, like a new shampoo or soap or a new bath additive/bubble bath. This is particularly true with scented substances, which can irritate the skin.

If bathroom products are not the cause, and the child is pulling on the ears or rubbing them a lot, it could be friction dermatitis.

Again, if the skin is wet and sore, it could be infected and you should have it reviewed.

Psoriasis is a skin condition that causes the skin to thicken and form a greyish-scaly look. If this is what you see, have your GP look.

Overall a simple over-the-counter moisturiser is always a good place to start and you can apply it four or five times per day (if you can manage with a three-year-old), but if it’s not settling then it’s best to visit your doctor.

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