How To Spot And Care For Children’s Skin Conditions

In the beginning, when Jennifer’s daughter Everleigh started developing rashes as a toddler, the Toronto mother wasn’t too concerned.

“When Everleigh was under 18 months, she started getting little spots in the folds of her skin. My older daughter had that as well and they disappeared when she was between two and three years old, never to come back. So, I thought it would be the same,” Jennifer says.

But Everleigh’s rashes didn’t go away, and the unbearable itching only got worse. “She used to cry and scrape at her skin with her toys,” Jennifer says. “At night, when it was really bad, she’d wake up screaming and trying to scrape her skin off.”

Jennifer consulted her daughter’s paediatrician regularly, and followed every recommendation—topical treatments, prescriptions and lifestyle adjustments—while also trying changes of her own.

“She was wearing 100 percent cotton clothing. We would only use certain laundry soap, zero fabric softener. We used all of the ointments and creams her physician prescribed. We even installed a costly water filtration system,” recalls Jennifer. But years of trying different things without significant improvement took their toll.

“Everleigh looked at me before her annual physical this year and said, ‘I don’t want to live like this anymore.’ Hearing that from a now-almost-eight-year-old was heartbreaking,” says Jennifer. At that point, she knew she needed more definitive answers and insisted on a referral to a specialist.

Not-so-typical rashes

Most parents have seen their kids develop a rash at some point. But as was the case with Jennifer’s older daughter, many such irritations are common and go away on their own. When dermatologist Dr. Sam Hanna first saw Everleigh, he knew at first glance she was not dealing with a condition that would resolve easily.

“Atopic dermatitis, often called eczema, is the most common dermatitis in children,” Dr. Hanna says. “It’s a chronic inflammatory condition caused by an imbalance of the immune system, not an allergy. Some people with AD carry a genetic mutation in a protein that plays a role in their skin. This creates a barrier dysfunction that allows environmental challenges like irritants or allergens to get in when they shouldn’t. This starts an inflammatory cycle that creates the rash and itch. It’s intrinsic. It’s written in their genetic code when they’re conceived.”

This means lifestyle changes, like the many Jennifer tried, aren’t enough on their own. That’s why getting an accurate diagnosis is key.

“The hallmark of the condition is this rash,” says Dr. Hanna. “It’s very, very itchy, even in very young babies. I often see infants with bald spots on the back of their heads from rubbing because of the itchiness.”

Although atopic dermatitis is commonly the culprit, skin inflammation can be a symptom of other conditions, too. Dr. Hanna notes that seborrheic dermatitis—the same condition behind what parents may know as cradle cap—is another type of inflammatory skin condition parents may encounter, which can present as flaky, greasy skin patches on the scalp. “Seborrheic dermatitis is also chronic and typically appears in areas where there is higher oil production as the child ages to adolescence. But it doesn’t have the same genetic predisposition, and the presentation is different from atopic dermatitis. Itch can certainly be a component, but it isn’t that same gnawing intensity of itch. Seborrheic dermatitis is not contagious and has nothing to do with poor hygiene, but because it’s visible, it can bring unwanted attention.”

Because atopic dermatitis and seborrheic dermatitis can look similar—and to the untrained eye, may also look like other skin irritations—Dr. Hanna advises parents pay attention to the details to help speed up a diagnosis when they see their healthcare provider. “Number one, you want to think about onset. At what age did it begin?” he says. “Are there things that seem to make [the] worse? Is it worse in cold, dry weather and better in warm, moist weather?”

Finding relief

Often atopic dermatitis is so uncomfortable it can result in sleep and behavioural issues. “I see a lot of kids in the four-to-six-year age range who have had eczema since infancy. Now they’re starting school, and they’re labelled as having behavioural challenges. You treat them effectively and suddenly they sit still; they can focus. I see it very frequently,” Dr. Hanna says.

Parents who hear the word “eczema” and think topical steroid treatments is the answer will want to know that new non-steroidal options are now available. Dr. Hanna notes that treatments have come a long way, with clinical trials establishing the safety and efficacy of these options, and with ongoing studies specifically in paediatric and infant populations. “The amount of movement we’ve had in therapeutic options, including the most recent treatments, has really changed how we are able to treat eczema and the extent to which we can control and limit the disease,” says Dr. Hanna.

Although treatment options have evolved, steroids still play a role in his approach when appropriate.

Everleigh just recently began treatment with Dr. Hanna, and although the journey is still unfolding, Jennifer says understanding what’s going on and knowing her daughter is finally receiving the right care is transformative—for both of them. “She feels now that someone is hearing her. She feels like he gets it,” Jennifer says. “And Dr. Hanna does.”

Visit skinformation.healthing.ca to learn more about seborrheic dermatitis, and eczemahelp.ca for more information about atopic dermatitis.