looks at eczema, the disease of the skin.

It starts with dry skin, from which comes the itching, scratching and then the condition known as eczema.

The vicious itch-scratch cycle of atopic eczema has begun, with the intense itching being the major symptom. There are few other skin diseases that provoke such intense itching, and in an attempt to relieve the itching children who have atopic eczema will do what seems natural to them...scratch their skin in search of relief.

Excessive scratching leads to bleeding.

"This is extremely distressing for them and their parents,'' said Dr. Michael Cork, Senior Lecturer/Honorary Consultant Dermatologist at the Paediatric Atopic Eczema Clinic of the Sheffield Children's Hospital in Sheffield, England.

"Itching is often worst at night when there is no distraction by other activities,'' Dr. Cork estimated.

"This can result in severe sleep disturbance for children and parents. I have met parents who fall asleep at night desperately holding their child's clawing hands away from their skin.

"Each time a child scratches, this provokes the release of pro-inflammatory mediators such as cytokines that make the itching worse and lead to the development of eczematous lesions. These lesions are even more pruritic and so a vicious itch-scratch cycle is set up.'' Many factors contribute to the development of pruritus in atopic eczema. The dryness of the skin is a manifestation of a defective epidermal barrier and central to the development of pruritus and eczematous lesions.

The stratum corneum is the natural barrier to water loss from the skin.

Water is retained in the skin by the barrier lipid lamellae and natural moisturising factor which contains water-retaining substances such as urea.

The high water content of healthy skin keeps the corneocytes swollen so that they have no cracks between them. The skin's pliability and elasticity is directly related to its water content. In patients with atopic eczema the epidermal barrier is impaired. The key to preventing eczema is to keep the skin moist at all times. And the good news is inexpensive ointments or creams can produce very good results when applied to the affected areas.

Two of the best are Emulsifying Ointment and Aqueous Cream. According to the Nurses' Practice, the Aqueous Cream is also good if the skin is not too dry, far better than E45 which contains lanolin to which many allergic babies react.

Only if the skin is sore should you use 0.5 percent hydrocortisone cream sparingly twice a day every third day, the Nurses' Practice advises.

"Doctors so often dish out hydrocortisone cream but that, basically, is just putting the fire out, it's not preventing,'' believes Liz Boden of the Nurses' Practice.

"We're much more about preventing because hydrocortisone, in the end, will make the skin thinner and do more damage. You have to try to create a barrier to hold the moisture in and very cheap creams are those two creams, Emulsifying Ointment and Aqueous Cream. Hamilton, Clarendon and People's Pharmacy are the pharmacies I know that definitely have them.

"What they do is create an emollient which traps the moisture and keeps the skin moist. That's the whole secret of getting rid of eczema.

Michael (not his real name) had severe eczema as a boy. He remembers scratching so much behind his knees that his mother resorted to putting socks on his hands.

"The itching was more than I could bear and scratching did provide some relief even though my skin was raw,'' recalls Michael.

Thankfully Michael, now in his 40s, has not had a flareup of eczema in adulthood though he still suffers occasionally from asthma which he developed as a child.

Mrs. Boden, who also has a diploma in asthma care, noted that many people with eczema also had food allergies.

"Basically my role is teaching not treating, Doctors are for treating,'' she stressed.

"My role with eczema is to try to get people to come and learn what's causing it. It's not just a matter of going to the Doctor and getting a prescription.

Maybe you have to look at your diet.'' The Nurse Educator advised that breast-feeding is best during the first six to 12 months of the baby's life. And that nursing mothers should not drink milk or eat any dairy products such as cheeses, ice cream, yogurt, etc. and should avoid all nuts and shell fish and limit eggs to two each week.

"Breast milk is recommended for the first six months and if formula is used it should be Soya based,'' she adds.

"Between four and six months introduce one food at a time and use only fresh foods. Do not give any wheat before 10 months, eggs, shellfish or berry fruits before one year and no peanuts before seven years.'' Her advice on providing special skin care for the baby includes avoiding detergents, fabric softeners and Clorox to wash the baby's clothes. Use Napisan or Dreft instead.

Mrs. Boden also tries to discourage the use of aerosols and sprays in the home, overheating the baby and smoking in the home.

"Dress your baby in 100 percent cotton,'' she encourages. "Synthetics and elastic can irritate eczematous skin. Keep dust mites down, no carpets in the bedroom and put soft toys in the deep freeze once a week for six hours (to kill dust mites).'' She also suggests opening the windows every day and using a damp cloth with just vinegar and water to clean.