When Amanda Cresswell-Melville’s son, Nathan, was about three months old, his skin began periodically breaking out in red, angry-looking patches that were obviously itchy and uncomfortable. “We could tell he was miserable—he was cranky, he would cry, and he would try to scratch and rub his skin,” recalls the Toronto-area mother of two. “At his worst, we would find blood on his sheets; we would find him in his car seat having scratched his face until it was bleeding.”
Eczema (also known as atopic dermatitis) affects an estimated 10 to 20 percent of Canadian kids, and while the symptoms aren’t always as severe as Nathan’s, they are chronic and can be long-lasting. To diagnose eczema in children, doctors look for one or more clues, like a red, scaly rash that may be crusty or weepy; itchiness (even where there isn’t a rash); dry skin; and skin that’s easily irritated, says Miriam Weinstein, a paediatric dermatologist at Toronto’s Hospital for Sick Children.
In babies, it often appears on the forehead, cheeks and scalp; in toddlers, it crops up most commonly in body folds, like the crook of the elbow. That said, “the rash can be anywhere you have skin,” Weinstein says.
Who gets it
If you have hay fever, asthma or allergies in the family, there’s a stronger chance your kid will have eczema, but kids with no family history of allergies can develop it, too. Eczema in children commonly shows up before age two. “The good news is that about 60 to 70 percent of kids will grow out of eczema by their teenage years,” says Janice Heard, a Calgary paediatrician.
What causes eczema
Normal skin acts as a barrier—it holds water in while at the same time protecting what’s beneath from the outside world. Due to defects in certain genes, people with eczema have a faulty skin barrier. Moisture can escape, and irritants like scents and dyes can get in and “turn on” the skin’s immune cells. This is what triggers inflammation and leads to the itching and rash. (Certain viruses and bacteria can also slip in, making babies and kids with eczema more vulnerable to skin infections.)
What you can do
“We can’t cure eczema, but it’s absolutely a controllable disease,” stresses Weinstein. Experts recommend a daily 15-minute soak in a warm, water-only bath, which will add moisture back to the skin. Avoid hot water, harsh soaps and bubble baths, which can irritate the skin, causing itchiness, redness and kick off an eczema flare-up. Use plain water to wash all but the visibly soiled areas, like the hands, feet and diaper area. On those, use a gentle, non-irritating soap or cleanser.
When your kid gets out of the bath, gently pat away excess water just until the skin is damp, and generously apply a thick, unscented, non-irritating moisturizing cream (see “Moisturizers for Eczema” below) to seal in the water. (These, like other so-called moisturizers, don’t really add water to the skin—they contain fats that soften skin and stop moisture from escaping.) Shore up that replacement barrier by reapplying the lotion two or three more times a day.
While coating a wiggly, fussy baby in greasy cream can be a struggle at first, it’s one of the keys to controlling your kid’s eczema, and it gets easier with practice. (Heard suggests turning moisturizing into a relaxing ritual, especially for babies, by making baby massage part of the package.) “After his bath, when Nathan was still on the changing table, we’d coat him with moisturizer,” Cresswell-Melville says. “We also got into the habit of applying it every time we changed his diaper.”
As long as it doesn’t irritate your kid’s skin, your choice of cream comes down to what you’re willing and able to apply in large enough amounts—faithfully sticking to a moisturizing routine is more important than using a particular brand. Some experts believe if this barrier-repair regimen is begun early enough, it may improve the odds of outgrowing eczema and perhaps may even prevent often-related food allergies.
You’ll also need to figure out what’s causing your kid’s eczema to erupt into the itchy rash. Culprits might include scents and dyes in products like shampoo, soap, laundry detergent and dryer sheets, as well as rough fabrics like wool. “I learned very quickly that fragranced products weren’t suitable for Nathan,” Cresswell-Melville says. “He also reacted to animal dander—whenever he was around a dog, he would flare up from head to toe.” Scratching can also cause symptoms to spiral, so keep babies’ nails short and smooth. (An antihistamine like Benadryl can relieve itchiness at night, but talk to your doctor first.)
For some kids, heat and humidity or dry, heated indoor air are triggers. While these often can’t be avoided, strategies like rinsing off sweat (another potential irritant) and applying moisturizer more often may help. “We always dressed Nathan in really light layers of cotton to avoid overheating,” says Cresswell-Melville. Unfortunately, some triggers can’t be identified. “Many flares happen for no clear reason,” Weinstein says.
Treating the rash
No matter how diligent you are about applying cream and avoiding irritants, your kid’s eczema may still show up in a rash. The trick is to nip these flare-ups in the bud by using medications that calm overactive immune cells as soon as you notice the redness, rash or dry, rough patches. Many parents are afraid to use prescription creams, like topical corticosteroids, but they’re very safe, says Michele Ramien, a paediatric dermatologist at the Children’s Hospital of Eastern Ontario in Ottawa. “Parents worry about things such as absorption and thinning out of the skin, and while those side effects are theoretically possible, they’re rare.” (And no, these creams can’t cause your kid to gain weight—that’s a different kind of steroid.) “We were a bit scared to use medication at first,” confesses Cresswell-Melville, “so Nathan suffered needlessly.”
If you’re worried, though, be upfront with your doctor about your concerns—she may be able to ease your fears or prescribe a different type of medication, like Protopic or Elidel (though some of these are much more expensive and not recommended for kids under two). And make sure you have a plan in place before leaving the office: You’ll want to ask how much medication to use, how often and for how long, and when to return if the rash doesn’t start clearing up. (Topical cortico-steroids are meant to be used for a limited period of time, not on an ongoing basis.)
While some kids may ultimately need other treatments, such as more potent steroid creams, to get a handle on their symptoms, the biggest culprit behind uncontrolled eczema in children is undertreatment. “I see hundreds and hundreds of patients every year who are using inadequate amounts of medication,” says Weinstein, “and the consequences of undertreated eczema can be far worse than the rare risks of the medications.” On the other hand, adds Ramien, “when we give them the right information and tools, most parents can manage very well.”
Nathan’s parents were able to get his eczema under control, and when his little sister, Vanessa, started showing the telltale symptoms as a baby, they knew what to do. Today, at age eight, Vanessa’s eczema has nearly disappeared. “Thankfully, because of our awareness, she never suffered the same way he did,” says Cresswell-Melville.
The food-eczema connection
Parents often wonder if something in their kid’s diet is causing eczema, but experts say that’s very rare. And while food allergies were long thought to be a common cause of eczema, based on recent research, many experts now believe the reverse is true—eczema can lead to food allergies, says Edmond Chan, head of allergy and immunology at BC Children’s Hospital in Vancouver. The thinking goes that if particles of peanut protein, for example, slip through the dry, cracked skin before a kid regularly starts eating foods containing peanut, this may program his immune system to develop an allergy to peanut. On the other hand, good eczema control reinforces the skin barrier, which in turn may reduce the risk of developing a food allergy.
While it’s true that for kids with both severe eczema and a food allergy, eating the offending food may worsen the symptoms of the skin condition, this situation isn’t very common. (Reddened skin around the mouth after eating a food like tomatoes or strawberries typically isn’t a sign of food allergy, Chan emphasizes, but is far more likely to be caused by acids irritating sensitive skin.) Because limiting foods is unlikely to help eczema and can lead to nutritional deficiencies, it’s not recommended unless advised by your allergist or dermatologist. The same goes for cutting foods out of your own diet if you’re breastfeeding.
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