Eczema is one of the most common conditions in Australia. According to the Australasian Society of Clinical Immunology and Allergy, it occurs in 1 in 5 children under the age of 5. So if your child has eczema, don’t worry! You’re definitely not alone.
What is it?
Eczema can present itself as an itchy, dry, red rash over the forearms, back of the knees, face or neck in young children. It can look different in different people, so it’s always best to check with your doctor if you’re not sure, or if you’re worried!
What causes it?
This is a difficult question to answer, despite what you may have read on the Internet. Eczema often comes hand-in-hand with allergies and asthma, so researchers believe that there is probably a genetic component behind getting eczema, associated with allergies. This does not always mean that allergies are the?cause for the eczema, but they may have a role to play in making it worse.
How do allergies affect eczema?
Children with eczema often also have what we call the ‘atopic triad’- allergies, asthma, and eczema. These allergies can be food allergies or environmental allergies. From experience, house dustmite allergy is probably the most commonly associated with worsening eczema. If you suspect your child is allergic to house dustmite, or concerned about any other allergies, allergy tests can be arranged to confirm this, which is important because allergies can be treated. This does not necessarily mean that avoiding the allergen will cure the eczema, but it may improve the symptoms.
What about food?
A lot of mums tell me that their child’s eczema improved when they excluded particular food such as sugar, gluten or cow’s milk. This may or may not be true, but really the exclusion of any food group should always be undertaken with the advice of a paediatrician and paediatric dietitian to ensure that the child has adequate nutrition for energy, growth and metabolism (except for sugar. Most kids could use a little less sugar!). Food may have more of an impact on eczema in infants, so if your infant has severe eczema, it may be worthwhile seeing a paediatrician to trial food elimination.
How is it treated?
People with eczema have skin that is different to people without eczema. It does not retain moisture well, and it tends to dry out more easily and react to things in the environment more than the skin of other people. These irritants make the skin itchy, and scratching in turn makes the skin even worse. So the two principle aims in treating eczema is A) improving moisture in the skin and B) reducing the itchiness. We do this using moisturizing creams, antihistamines, and corticosteroid creams.
A word about steroid creams.
I often get mums really concerned about giving their child steroid creams. They hear things from other people and get really worried that their child’s skin will be thinned or permanently scarred.
The way I explain is it is like this: Yes, steroid creams do cause thinning of the skin. But this is only a problem in normal skin. In eczema, the skin is inflamed and thickened. It needs to be treated. Steroid creams are anti-inflammatory, and work to reduce the inflammation and itching in the skin. The most common thing I see are kids who are being undertreated with steroid creams- they continue to be itchy and scratch, and after a long time of constant scratching, the skin responds to this trauma by becoming thick and dry. And that thickness can be disfiguring, and worse, is often irreversible. So steroid creams are safe to use – as long as there is a reason to use them.
The problem is when the strongest steroid creams no longer produce an effect. In those cases, I will often refer the child to a specialist dermatologist to consider UV light therapy or strong oral medications, which can only be prescribed and monitored by a specialist.
What moisturising creams should I be using for my child?
Any moisturizing cream you find that works well for your child is fine. You can use basic moisturizing creams such as Sorbolene cream, or QV cream for sensitive skin, or Dermeze ointment- which is this excellent thick moisturizing gel-like ointment which does a great job at protecting the skin from the elements, particularly in winter and in windy weather. I also get a lot of parents asking me about MooGoo, which is a good natural moisturizer for eczema as well. Just remember, if your child has a cow’s milk protein allergy to check the ingredients on the MooGoo cream and opt for creams that do not contain milk protein.
Are antihistamines safe for long term use?
Antihistamines are great for treating the itchiness of eczema, especially if your child’s eczema is allergy-related. Parents often get concerned about using antihistamines for a long period of time. There are no known long term side effects to using second generation antihistamines such as Claratyne, Zyrtec and Telfast. The main concern is that sometimes the child can develop tolerance to them and they can lose their effect. I generally suggest using anthistamines sparingly for that reason, or to cycle the different brands on a weekly basis.
Other tips:
- Avoid things you know will irritate your child’s eczema. Often you will know anyway, but these are most commonly sand, grass, scratchy coarse clothing and towels.
- Try not to let your child soak in a hot bath for too long as the hot water can dry out the skin. Short, tepid showers are best.
- Pat down rather than rub with a soft towel.
- Wet dressing can sometimes be used if eczema is severe. Click here for information on how to use wet dressings.
- Do allergy testing to see if there is an allergy component to your child’s eczema.