Myth: "Eczema is caused by dirt"

The myth

Some think a child with eczema is not being washed enough.

The facts: how it really works

Eczema is linked to inherited differences in the skin barrier (such as filaggrin) and an overactive immune response. Soap and frequent hot bathing strip natural oils and worsen it.

Why it matters on darker skin

On dark skin eczema looks brown, grey or purple and often appears as bumps around hair follicles.

Where the myth comes from

Rough, dry patches can look dirty; stigma persists.

What actually helps — and why

Emollient twice daily: barrier repair. Expected timeline: days. Soap substitute: protects oils. Expected timeline: immediate.

More detail

Children with eczema are sometimes teased, or parents are blamed, because rough, dark or scaly patches are mistaken for dirt. Eczema runs in families and is closely linked with asthma and hay fever. Many children have inherited differences in proteins such as filaggrin that help hold the skin barrier together, so water escapes and irritants get in. The immune system then reacts more strongly than usual, which causes the itch. Scratching damages the barrier further and leads to thickened, darker skin, which can look 'unwashed' but is not. Washing more often, especially with soap, antiseptic or hot water, removes the skin's natural fats and makes eczema worse. The best routine is a short, lukewarm bath with a soap substitute, patting dry and applying emollient straight afterwards — plus prescribed treatments for flares. Schools should understand that eczema is not catching.

What to avoid and why

Avoid antiseptics, perfumed soaps and scrubbing.

Common mistakes

• Blaming the parent.

Caring for children's skin

Children's skin is thinner, loses water faster and absorbs more of what is applied to it relative to body size, so simpler is safer. For most children a short lukewarm bath, a fragrance-free soap substitute and a plain emollient are all that is needed, plus shade, clothing and sunscreen from six months of age. Avoid adult products, essential oils, antiseptics in bath water, bleaching or 'toning' creams, and cosmetic treatments such as relaxers and gel nails. Medicines and medicated creams should be used only as a doctor, nurse or pharmacist advises, and in children Melanin & Me does not offer photo checks: a clinician should see the child. Trust your instincts as a parent: a child who is unusually sleepy, floppy, not feeding, breathing fast or has a rash that does not fade when pressed with a glass needs urgent care. Keep a simple record — photos and dates — of rashes that come and go, as this helps the doctor.

Products, medicines and when to worry

When choosing products for children, look for fragrance-free formulas with short ingredient lists, and avoid adult acne, anti-ageing or lightening products, essential oils and talc. Medicated creams — including steroid creams, antifungals and antibiotics — are safe and helpful when prescribed for the right condition and used for the right length of time, but mixed creams sold over the counter can contain strong steroids that are unsafe for children. Sunscreen is suitable from six months of age; younger babies should be kept in the shade and covered. Do not give medicines intended for adults, and ask a pharmacist about the right medicine for a child's age and weight. Seek urgent care for any rash with fever and a very unwell child, a rash that does not fade under a glass, swelling of the face or lips, or blistering of the mouth or eyes.

Questions to ask your doctor or pharmacist

Useful questions include: What do you think is causing this? Is it likely to come back, and how can I prevent it? Which products should I stop? How long before I should expect improvement, and when should I come back if it isn't better? Are there side effects to watch for? Is this treatment safe if I am pregnant, breastfeeding or for my child? Writing your questions down, bringing your products (or photos of their labels) and taking dated photos of the problem make an appointment much more useful.