Eczema
DISCLAIMER: The following advice is of a general nature only. Information from online sources, including this one and the sites I link to, should always be confirmed by a medical doctor. There is not one remedy that suits everyone; advice has to be individualised.
ECZEMA
With thanks and acknowledgement to the wonderful work of DermNet NZ for the use of their images and for their generosity in sharing information under a Creative Commons Licence
Eczema
Very common in children = 15-20%
Less common as children get older
Also known as atopic dermatitis
More common if there is a family history of eczema, hay fever and/or asthma
More information
Eczema can look different depending upon the severity
Most typically, eczema is a red, itchy rash on the background of dry, easily irritated skin
Eczema typically occurs in different places at different ages
in babies, it usually starts on the cheeks but may be all over
the area under the nappy is usually spared due to the moisture, but nappy rash (a contact dermatitis) can still occur
in preschoolers, it usually affects the wrists, elbows, knees and ankles and typically is worse between the ages of 2 and 4
in primary school children, it usually affects the elbows and knees
in high school it often settles, but the skin is still sensitive, dry, more easily irritated
Eczema usually has an underlying genetic basis, but children from the same family may have anywhere from no eczema to very bad eczema and it can occur in children with no family history of eczema, asthma or hay fever!
Triggers
Eczema and bubble baths are a really BAD combination!
Eczema can be triggered by
an irritation, with soap, detergents, coarse fibres e.g. scratchy wool and some synthetics, perfume, sand, chlorine and dust. Creams may make things worse or better, depending upon the individual
infections, such as viral infections (e.g. molluscum contagiosum), bacterial infections (e.g. staphylococcus) and fungal infections (e.g. thrush and malassezia) and these may need to be specifically treated
climate, usually being worse in winter or in cold, dry climates and better in summer
stress, both physical, such as hay fever, introducing new foods, a cold or flu, or emotional, such as stress at home or school
What about allergies?
I’m glad you asked
Not as much of an issue as we used to think
Allergies often co-exist with eczema, especially hay fever (environmental triggers such as grass, dust, dust mite) and if hay fever is active, it may stress the body making the eczema worse.
Food allergies are common in children with eczema, affecting up to 1/3. The most common food allergies are egg, cow’s milk, soy, wheat, peanuts and fish, but the rashes from these are usually wheals (urticaria), rather than eczema. Foods can also trigger an irritation in the skin and, as children with eczema have sensitive skins, it is often worse for them. Redness and itch after contact with a new food, especially fruit, is usually an irritation rather than an allergy and it settles quickly.
If eczema is severe or control is difficult, allergies need to be considered.
More information here and here
An eczematous skin usually
feels dry and rough
is easily irritated
has been called “the itch that rashes” as even if there is nothing to see, if you start to scratch, a rash will appear
can have mild, moderate or severe redness
may become moist and weep, especially if infection sets in
Treatment
Bath
don’t use soap, use a substitute such as Cetaphil gentle skin cleanser, gentle cleansing bar or Epaderm ointment
some people find it helps to use bath oil daily such as QV or Alpha Keri oil, and this advice has been given for a long time, however research from the UK has recently challenged this, so perhaps save yourself the money and the slippery bath
use lukewarm water (30 C or less) not hot water
pat the skin dry, don’t rub, moisturise straight away
if infected, there are some simple solutions such as salt (ordinary salt is fine, you don’t need to use anything fancy or expensive) or (well diluted) bleach baths (yes, there is a cheap, safe and effective treatment with diluted household bleach—click on the link for specific instructions)
Moisturisers
use a thick one, often
keep it by the change mat and every time you change baby’s nappy, put some on
thick is best, especially in winter—so thick that you could hold it upside down on a hot Australian day and it would not run out of the tub. If it is thin enough to go through a pump, it is too thin
some of the good ones are Epaderm, Dermeze, QV intensive ointment. In summer, or if an ointment is just too heavy and is not tolerated by your child, lighter creams such as sorbelene (without perfume) or Cetaphil (the thick one, not the thin, perfumed one marketed for babies). Emerging research is supporting the use of ceremides, which are in ceraVe, Cetaphil Pro and QV intensive with ceremides
avoid perfume and babies are best to use a moisturiser that is not food related, in case of sensitisation. So, no to avocado, oats, cow’s milk and even paw paw based ones! Petroleum jelly by itself is ok
Clothes
soft cotton is best, perhaps a very fine, soft wool would be ok
avoid coarse, scratchy fabrics and synthetics
Stop the scratching = control the itch
heat makes itch worse and cooling makes it better
use cool water on a washer to help with itch
keeping a moisturiser or steroid ointment/cream in the fridge means it is cool when it goes on, which helps to reduce the itch
go for a cool bath or shower rather than a hot one
keep baby’s nails super short, as when they scratch, they will break the skin, increasing the risk of infection. And control the itch!
as they get older, if they HAVE to scratch, tell them to pat, not scratch = less likely to break the skin. But work on controlling the itch so they don’t have to scratch…
wet wraps can be very helpful, especially if the eczema is not well controlled with steroid creams
Using topical steroids in children
Terrific 2:14 video available here
Steroid creams and ointments
are safe, effective and under-utilised
would have to be used in a high dose for ages to thin or prematurely age the skin
uncontrolled eczema causes more damage to the skin than steroid creams
if used regularly, you will see pale patches which will recover. Eczema causes thickness, redness and itch, which is distracting and upsetting. Pale is better than thick, red and itchy
are not the same as steroids used in body building
can be safely used on broken skin (severe eczema often means broken skin and needs the control the topical steroids will bring)
don’t use sparingly, use enough to do the job properly — see the video above and the chart below for further instructions
ointments are better than creams for very dry skin, broken skin or severe eczema
manage well with clothing, bathing, moisturising, but if this is not enough, get in early with steroids, hitting hard and fast and then once it is under control, stop the steroid and go back to the basics = avoid triggers, moisturise, moisturise, moisturise
can be put on under or over moisturiser
for mild eczema or eczema on the face, 1% hydrocortisone or pimecrolimus (Elidel)
for moderate eczema, betamethasone valerate (Celestone M, Betnovate 1/5, Cortival, Antroquoril) or triamcinolone (Aristocort, Tricortone), or, if they are not working, methylprednisolone (Advantan)
for severe eczema, mometasone (Elocon) or, especially for thick skin such as the palms of hands and soles of feet, betamethasone dipropionate (Diprosone, Eleuphrat)
you will need to see your doctor for a prescription for all but the 1% hydrocortisone creams
Dose guide for topical steroids
Courtesy BPAC NZ
Out of control?
Get help
GP, paediatrician or dermatologist
Major hospitals have dedicated teams for eczema and online resources