The bright-eyed toddler in the doctor’s exam room looks perfectly healthy — apart from dry, angry red patches marring her cheeks and around the creases of her elbows. She scratches the raw, scaly skin as the doctor delivers the news that the culprit isn’t some kind of scary infection (whew!) — it’s eczema. But that opens up a whole new set of questions for the little girl’s anxious parents. Here’s what parents need to know about this common childhood complaint.
Q: What is eczema?
A: “Eczema is a skin disorder that causes extreme itchiness and irritation,” explains John Dean, head of the division of allergy at BC Children’s Hospital in Vancouver. There are several types — the rash some people get from wearing nickel jewellery (a.k.a. contact dermatitis) is one form. However, the most common is called atopic dermatitis, which tends to run in families with a history of hay fever, asthma and food allergies — though kids with no such background can still develop it. And when we say it’s common, we mean it. “About 25 percent of Canadian children will have eczema at some point in their lives,” notes Charles Lynde, a dermatologist and assistant professor of medicine at the University of Toronto.
Q: What causes atopic dermatitis?
A: Unfortunately, we don’t yet have clear answers. What we do know is the cause is probably a combination of inherited factors and environment. Recent research suggests one key element may be a mistake in the gene responsible for making the “glue” that binds skin cells together. Normal skin is like a brick wall that keeps water from leaking out, and prevents tiny bits of dirt and other material from getting in. Many people with eczema are missing the mortar that seals the cracks between the bricks.
That means water and natural oils escape, leaving the skin very dry, which in itself causes itchiness. Scratching releases chemicals that cause more irritation, inflammation — and itching. “It’s a vicious cycle,” explains Elena Pope, a paediatric dermatologist at Toronto’s Hospital for Sick Children. At worst, the skin can become so raw that bacteria gains a foothold, causing infection.
Tiny bits of matter that sneak inside the skin may compound the problem by tripping an alarm system that’s intended to protect the body against harmful invaders. This prompts infection-fighting cells to pour out more chemicals that fuel swelling, redness and itching. There’s some evidence that this process may actually cause the body to become abnormally sensitive or even allergic to certain substances. (More on that later.) According to Dean, many kids with eczema seem to be unusually sensitive to the byproducts of bacteria that normally live on skin, and even to their own sweat.
Q: Can eczema be cured?
A: “Currently, there’s no cure,” Pope acknowledges. However, “we can use measures to keep the skin under control so the child can grow and develop and enjoy life,” she adds.
Q: So what can I do to manage my child’s eczema?
A: The first step is to make sure that’s really what you’re dealing with, since eczema can be mistaken for other skin disorders like psoriasis, Lynde says. In most cases, your family physician or paediatrician will be able to make that call.
Q: What then? Can I prevent my baby’s eczema from flaring up?
A: Yes. You may not be able to eliminate flare-ups entirely, but some simple strategies can help keep that itch/scratch cycle from starting up in the first place.
The first step is avoiding things that irritate or dry the skin. That list varies from child to child, but common triggers include temperature extremes, pollen, dust, pet dander and products (lotions, soaps, even laundry detergents and fabric softener) containing fragrances or dyes. In winter, protect your baby’s skin from cold, drying winds — but don’t over-bundle either, since sweat and excess heat can also cause irritation. In warmer weather, choose clothing made from breathable fabrics, such as cotton, which won’t trap heat and moisture next to the skin.
Steps two and three are a little like refilling a swimming pool, then covering it so water won’t evaporate. “The only way you can actually bring that water back into the skin is by bathing and moisturizing,” explains Pope. While prolonged soaks in hot water strip away the skin’s protective oils (ditto for harsh soaps and rubbing), short, lukewarm baths actually replenish lost moisture, removing any irritants at the same time. (Doctors are divided over whether more than plain water is needed to rinse away anything but the most stubborn grime. If you must use cleanser, opt for a gentle, non-soap product such as Cetaphil or Spectro.) Consequently, most experts now suggest bathing children with eczema every day. If you’re pressed for time, a sponge-down works nearly as well.
Pope recommends adding emulsifier oils, which mix with the bathwater rather than floating on top. These help seal water into the skin (Keri and Aveeno are two such products).
After washing, gently blot your baby with a soft towel, leaving some moisture on the skin. And here’s where that pool cover comes in. Applying a layer of a lubricant or moisturizer does double duty — locking in moisture and keeping irritants out. Petroleum jelly works best, but some parents prefer not to use it because it’s greasy and messy. Alternatives include fragrance-free products such as Aquaphor; your doctor can suggest others. The important thing is to find a product you — and your little one — like. (Tip: Try storing moisturizer in the fridge — some toddlers enjoy the cooling sensation, Lynde notes.)
Q: Are food allergies or sensitivities a common cause of flare-ups?
A: “Generally speaking, food is not a major problem,” says Dean. While eczema and food allergies are linked — both are allergy-related conditions and often run in families — food allergies are rarely responsible for triggering eczema symptoms. The link is a bit like the one between red hair and sensitive skin: While the two often go hand in hand, fiery tresses don’t cause skin flare-ups.
Q: How are flare-ups treated?
A: “If the skin is red and inflamed, you’ve got to put the fire out and keep it out,” Dean stresses. Two different types of medicated creams — topical corticosteroids and immunomodulators (also known as calcineurin inhibitors, these medications include Protopic and Elidel) — help do just that. Both classes of medication essentially calm cells that stoke the flames, albeit in different ways. Mild corticosteroid creams are the most widely used and least expensive option, and in most cases work very well. “Used appropriately, they don’t cause any problems — even if you have to use them all over, and for an extended period,” Pope reassures.
As with firefighting, the trick is smothering any sparks before they begin burning out of control, and using enough “water” to drown smoldering embers. Using too little cream only allows skin to get accustomed to the medication, so that either a stronger concentration or different formulation is needed to get the same effect, Pope says. That’s why she teaches the “all or nothing” rule: During a flare-up, apply the cream generously two or three times a day. Once the redness and swelling subside, stop.
And if creams don’t completely quell the itch, your doctor may recommend an antihistamine such as Benadryl. “If the eczema is well controlled, you might use it just at night (when a slightly higher body temperature might cause itching) to allow the child to sleep properly,” says Pope.
Q: Obviously, controlling my baby’s eczema can help keep her happy and comfortable. Are there other benefits as well?
A: According to Lynde, there is some suggestion that keeping eczema well controlled may prevent kids with the condition from going on to develop hay fever, asthma and other allergies. He’s involved in an ongoing trial aimed at answering that very question. While the jury is still out, we should know more in a few years, when the study results are slated to be released.
Q: Will my baby grow out of his eczema?
A: Unfortunately, we can’t predict whether a particular child will outgrow eczema. However, since only about 10 percent of kids carry eczema into adulthood, “odds are on your child’s side,” says Lynde.