How to handle your child’s eczema

Eczema is a common, chronic ‘ inflammation of the skin’ (dermatitis) that makes it dry, scaly, raised, sometimes red and occasionally quite itchy. It affects 15 to 20 percent of children. Eczema can occur on many different parts of the body, but it usually occurs on the face/cheeks, torso, behind the knees and around elbows. It affects boys and girls equally and is common in families with a history of asthma, hay fever and allergies. It is often called ‘atopic dermatitis’ (AD) because of this association. Eczema is often hereditary, with some possible immune system dysfunction. It is felt to be a hypersensitivity reaction. It is brought on by various environmental triggers, classified into three categories:

• irritant (soaps, detergents, fabric softeners, bleach, bubble baths, fabrics such as wool, saliva, humid or dry air)
• allergenic (dust mites, pets, molds, pollen)
• food (dairy, eggs, seeds, nuts, soya, gluten).

Infections and stress can exacerbate eczema.With winter approaching, we see more eczema flare-ups in the clinic caused by dry indoor heat and cold outdoor air which dries the skin. Being prepared and keeping your child’s skin moistened and protected from the elements can reduce the risk.

Eczema Complications

One of the biggest complications from excessive scratching and dryness is infection. The skin loses its protective properties, more water is lost and irritants and infections (bacteria/viruses/fungi) can get into the skin. Oral over-the-counter antihistamines can help reduce the urge to scratch. Use non-sedating medications during the day and sedating medications during the night (such as Benadryl) to help combat itch and promote a restful night. Sleep disruption should be avoided as it can lead to behaviour problems during the day due to fatigue.

If infection occurs, a topical antibiotic may help, but sometimes oral antibiotics need to be prescribed by your doctor. It is believed that people with atopic dermatitis are more likely to have more of a certain skin bacteria that leads to infection.

Lactose Intolerance and Eczema

Dairy intolerance is an intolerance to the sugar (lactose) found in cow’s milk. The body is unable to digest or break down lactose properly and can cause bloating, gas, nausea, vomiting and diarrhea. It is one of the most common food-related triggers for eczema and can cause flare-ups. Dairy intolerance should not be confused with dairy allergy, which is a reaction to the protein found in milk. Unlike lactose intolerance, a dairy allergy does involve the immune system and can lead to life threatening symptoms of anaphylaxis (hives, facial swelling, difficulty breathing, collapse).

Staying Ahead of Eczema

Eczema tends to be chronic so staying healthy is important. A balanced diet rich in vitamin D and B and omega-6 and omega-3 fatty acids can help to keep the skin healthy. Probiotics have also been shown to help. Avoiding viruses and keeping immunizations up-to-date is important.

Eczema is a common skin condition in young children. The good news is that many kids will outgrow it. Caring for a child with eczema requires patience and time. Talk to your doctor to review and modify your treatment plan along the way.

Tips For Treating Eczema

Eczema can be difficult to manage, but there are effective measures to reduce symptoms:

• Identify triggers and avoid them if possible.
• Help your child adopt a daily moisturizing routine to nourish the skin. Daily lukewarm baths with a small capful of oil help to hydrate the skin. After bathing, pat the skin dry (don’t rub) and apply unscented hypoallergenic creams to slightly wet skin to lock in moisture. Creams offer more barrier protection because they are thicker than lotions and evaporate more slowly.
• Avoid creams with parabens, phthalates and lauryl-sulfates that can irritate the skin and disrupt the endocrine system.
• Dress your child in loose cotton clothing that breathes by drawing heat away from the skin and keeping the body cool.
• Dietary changes help if food allergy is expected, but less so if it’s not.
• Add a humidifier to your child’s room to prevent dryness, which can exacerbate itch.
• If needed, try a mild, over-the-counter cortisone cream. If it doesn’t relieve symptoms, ask your doctor about stronger steroids in a prescription medication.

Janine Flanagan is a pediatrician at St. Joseph’s Health Centre and The Hospital for Sick Children in Toronto.

Originally published in ParentsCanada magazine, Nov/Dec 2016.