With the first cold snap we all reach for our winter woollies, cosy socks and warm vests. Unfortunately for many children, winter also means painful, itchy, dry and cracked skin. The medical term is atopic dermatitis or eczema. For some children this bothersome skin condition is present all year round but major flare-ups happen more frequently in winter.
Children may outgrow eczema, or it might improve over time. My daughter has suffered from severe eczema her whole life. She was so hoping that by age 12 she would grow out of it but for her it is a condition that she still needs to manage. As a small child she was embarrassed to go to the hairdresser because they would always remark on her dry sculp even when my wife had informed them that it was eczema.
As an adult, when she has her nails done, the dryness of her hands, particularly in winter, comes up without fail. Over the years she has learnt to manage her eczema herself. She knows which foods make the condition worse, and what creams are needed for maintenance or for a bad flare-up.
According to the American Journal of Paediatrics, paediatricians are often the first physicians to diagnose and manage these patients and thus are relied on by families to answer questions about this disease.
There is so much information about eczema because the topic is complex with many factors affecting it. As a result, parents often feel overwhelmed when trying to find a solution. In my practice I teach my parents that eczema is not something we can just treat as a once off.
For many children it is about the correct management over a long period of time. Eczema usually runs in the family and tends to occur with other allergic conditions like asthma and rhinitis, so coming to terms with lifestyle changes and learning the triggers that lead to a flare up is very important.
What does eczema look like?
The eczema rash may differ for each child and it does certainly change with time.
- In babies: Eczema usually starts on the face, particularly the cheeks, forehead and around the mouth. It is a dry red rash. It may also be seen on the scalp, which is what we call cradle cap.
- In older children: Eczema often appears behind the knees, on the inside of the elbow, around the eyes or on the back of the neck. It can become really painful if the skin breaks down or gets infected. If a child or teenager has suffered from eczema for a long time, the skin may also become darker and thicker in the affected area. This is usually caused by the ongoing scratching because the flaky skin is itchy. This is known as lichenification.
Why do children get eczema?
Children who suffer from eczema are lacking a specific protein in their skin. The protein is called Filaggrin and its function is to help the skin to form an effective barrier between the environment and the body itself. It helps the skin to retain water and blocks out irritants and bacteria. Without Filaggrin the skin loses its moisture, becomes dry and often cracks. This then allows allergens or bacteria to attack the skin.
Since eczema often goes hand-in-hand with other allergies, these children are extremely sensitive to allergens in the environment. These allergens may include grass, pet hair, pollen and tobacco smoke.
For some children, food allergens may bring on a flare-up. Around 35% of children with eczema also have food allergies. My daughter is sensitive to food allergens, and we did allergy screens, but were never able to identify what the allergen was. She herself has worked out that preservatives like sodium benzoate and colourants like tartrazine are her major triggers. After birthday parties where sweets, colddrinks, chips and cake were on offer, she would really have a very bad flare-up.
Surprisingly, colourants and preservatives are found in many foods, so label reading has become really important to her. Other common food allergens are gluten, cow’s milk and peanuts.
Interestingly enough the American Journal of Paediatrics states that “Indiscriminate allergy testing without a history that suggests allergic triggers is not recommended, because these tests have low positive predictive values”.
Taking a good history and being sensitive to what triggers a flare-up is way more effective in managing eczema.
How do you treat eczema?
Treating eczema is a little like baking a cake – you have to put a whole lot of things together, in the right quantities and the correct order to get the best outcome.
Let’s look at the ingredients necessary to make the life of these little sufferers easier, bearing in mind we are not curing the eczema but managing it.
This is a very important part of managing eczema so follow these tips:
- Keep the water temperature lukewarm. Hot water dries the skin and activates the nerve endings, making the child more likely to scratch.
- Baths or showers should kept to a maximum of ten minutes.
- Do not use bubbles or scented soaps. These products are usually perfumed and this will irritate the skin and strip the skin of its natural oils.
- A non-soap cleanser is usually less drying than soap. If you need to use soap then you should choose a soap which is fragrant and deodorant free. These are called hypoallergenic soaps. Please avoid the anti-bacterial soaps as these contain chemicals which will irritate the skin.
- Only use a hypoallergenic, fragrance-free shampoo for washing hair.
- Once out of the bath, pat (not rub) your child with a cotton towel.
- While the skin is still damp apply a moisturiser.
- We are all spraying hand sanitisers continuously at present. Be aware that these will make eczema worse. Rather teach your child to wash hands with a hypoallergenic soap.
Ensuring that the skin gets a good layer of moisturiser is vital in the battle against eczema.
- Ointments contain a lot of oil and are preservative and fragrance free. In a bad flare-up ointments are absolutely necessary.
- During a bad flare up your doctor may prescribe an ointment that contains a corticosteroid which is safe to use on a child’s skin. This medication works really well to settle down the inflammation.
- Creams are thinner than ointments but still contain enough oil to seal moisture into the skin. They spread more easily than ointments so generally cover a bigger area. I recommend creams or fragrance free lotions for times when the eczema is under control.
- With my eczema sufferers I often prescribe a mixture where the base consists of a perfume free petroleum jelly. This is cheap, easy to spread and very oily so it does a great job at keeping the skin moist.
- Moisturisers should be applied to a damp skin. Straight after a bath or shower is the perfect time, otherwise use a light water spray to dampen the skin before putting on the moisturiser.
- The skin should be moisturised twice a day.
- Being consistent with moisturising will definitely reduce the frequency of flare-ups
Anything that comes into contact with your baby’s skin may aggravate the eczema. This means that you as the parent need to be mindful of the child’s clothes as well as bedding and towels. Over and above this be aware of your own clothes, especially when your baby is tiny and sleeps against your chest or in your arms. Your own clothes may worsen the eczema if it comes into contact with your baby’s skin.
- Choose cotton or bamboo fabrics. These are light and cool and will not irritate the skin.
- Avoid synthetic fabrics like nylon as these do not allow the skin to breathe. They trap heat which can cause sweating and skin irritation.
- Wool is a natural product but it can irritate the skin. It may be too warm or scratchy.
- Make sure you wash new clothes before wearing them. Clothes straight out of a factory may contain chemicals like bleach, starch or dye. All of these products are hard on the skin.
Make sure that all the laundry is washed in a fragrance free detergent. It won’t help to follow any of the tips above if perfume or chemically laden softeners are used in the laundry process. Instead of softener rather use two tablespoons of white vinegar in the wash. It can be added in the same place as you would add the softener. It doesn’t smell, keeps whites perfect and softens clothes.
Other helpful tips
- Humidify the environment as best you can.
- There are an infinite number of products on the market. If one isn’t working seek advice and try something different.
- Get your child to drink plenty of water to ensure the skin is hydrated from the inside out.
- Stress is known to bring on a flare-up, especially in older children. Exercise, rest, healthy food and deep breathing exercises are all helpful activities when it comes to stress management.
- Giving your child an oatmeal bath. It sounds strange but 100% oatmeal has wonderful healing qualities. Grind the oatmeal up in a grinder, add about 2 cups to a warm (not hot) bath and allow your child to lie in the water for 10 to 15 minutes. Remember to pat dry after the soak.
- Try to limit sugar in the diet. Sugar can cause inflammation and this will certainly aggravate the skin.
- Keeping cool is important, so make sure your child doesn’t get too hot when sleeping. During a bad flare-up avoid strenuous exercise where your child may overheat and sweat a lot.
- Watch out for infection. Since the skin is broken down it is vulnerable to bacteria and viruses. The rash may begin to weep or begin to produce pus. Please seek medical help urgently.
I will be the first to admit that eczema is a tough condition for the sufferer, the parents and the doctor. There is no quick fix and no cure. I can’t write a prescription for a patient and know that in a week the child will be back to normal. It is a condition that affects at least 10% of children and it does affect their quality of life.
Eczema sufferers are often embarrassed about the condition so may become withdrawn, they feel physically uncomfortable when the eczema is not under control and often struggle to sleep well because of the itch-scratch cycle. We all know what a lack of sleep does to a child. Not only are they irritable the next day but their performance at school is also affected. The light at the end of this very long tunnel is that the sufferer can learn to control the severity and frequency of flare-ups.
By avoiding the food triggers, keeping the skin moisturised and following the other tips, eczema can be managed. The proof is in the cake. Put all the correct ingredients together, be patient, don’t skip any of the steps and in the end you will have a child with a skin as close to peaches and cream as possible.
Affectionately known as “Dr Rico” by his patients, Dr Maraschin is passionate about preventative medicine and building trusted relationships with parents and patients is a priority to him. Well-known among the community, he is highly regarded with providing the best care for babies, toddlers and kids. He has played a pivotal role in creating his well-deserved prestige, with a particular interest in neonatology, allergies, immunology and vaccinology.