Oh eczema. How I loathe thee.
My four year old has terrible eczema that we have struggled with since she was about 5 months old. Sometimes it is better, sometimes it is worse. Depends on the season, the humidity, what she has been doing (eg swimming in a heavily chlorinated pool) and whether mummy/daddy have been diligent and remembered to apply her creams as much as we should (which can I say is sometimes really HARD! And then, if I have been a little slack, I feel sooooo guilty).
So what is eczema anyway?
It is a common skin condition that makes the skin dry, red and itchy. It usually starts in kids before the age of 1 year. For most kids, it can be well controlled, but whilst some kids are lucky and “grow out of it,” for many children they will need to apply moisturisers (sometimes called “emollients”) and steroid creams for many years (for some even into adulthood). It can affect up to 20% of children under 2 years of age – that is one in every 5 children!
It occurs frequently in people (and in families) who suffer from other conditions like asthma, allergies and hayfever. These are called “atopic conditions.”
What does it look like?
- Redness, weepiness and crusting, leading to dry, thickened and scaling skin
- The skin can feel a little bit like sandpaper and appears rough as well as dry
- Intense itching
- Distribution varies with age of the child
- In babies – face, scalp, behind ears, body, arms and legs
- In toddlers and older children – in the skin creases behind the knees, in the crook of the elbows, around the ankles and wrists.
- In some kids, the rash can cover their entire body
When do I need to see a doctor about it?
If the rash begins to look infected (as suggested by a flare up of the eczema, crusts, weeping, redness, increased itch or pustules (pimples), erosions of the skin and/or vesicles (ie fluid filled blisters) ), OR if it is severe/widespread/distressing for your child – you should definitely be seeking medical advice!
Eczema CAN be well controlled, but the most frustrating thing I find about it is that the severity fluctuates – usually because I’ve gotten slack and not applied Gwennie’s moisturisers as frequently as I should, but sometimes totally unrelated to anything I can identify. It is really important to try to maintain and manage the eczema, even when the skin seems clear. Also – avoiding triggers is important.
What can trigger eczema?
Well, it is different for different people of course but here are some common ones:
- Being too hot (similarly hot showers and baths can make eczema worse)
- Dryness of the skin (often associated with winter and low humidity)
- Prickly/rough material (eg wool, sandpits, tags on clothes)
- Irritation from soaps, laundry detergents or other chemicals
- Intercurrent illnesses (eg if you have a cold virus)
- Allergies – eg to environmental triggers like pollen or dust mites, OR to certain foods
So how do we treat it?
Seriously the biggest pointers I can give you as both a mum of 2 kids with eczema (one of them with bad eczema) AND a paediatrician are:
- Apply moisturisers frequently and liberally (ie use a lot). I don’t really have an absolute favourite moisturiser to recommend (as we have pretty much used them all) but they MUST be fragrance-free, colour-free and soap free. **YOU NEED TO USE IT FREQUENTLY ENOUGH TO KEEP THE SKIN FEELING TACKY** This might mean 5 times a day or more for some kids. I leave tubes/pump packs of moisturiser all over the house (and soap free wash for hands at every sink in the house) and try to do it whenever I remember. Some of the ones I like and currently use are – in no particular order (I have no affiliation with any of these companies or products – I’ve just used them):
- QV cream (and the QV flare up cream during exacerbations)
- QV bath oil in the bath as well as the QV intensive wash (in the pump – easier in the bath)
- Dermeze – thick cream
- Aveeno baby eczema therapy cream (same as their Dermexa cream)
- Dermaveen eczema cream
- Don’t let your kids have long, hot baths/showers. It just flares the skin up. If your child has really bad eczema, you shouldn’t even bath them every day if you can help it. Just slather them up in moisturiser (eg a cheap simple one like sorbolene +/- glycerine (you can get a big pump pack for like $5-10) or aqueous cream) and then wipe them down with a face washer. On the other hand if you have a really stinky, sweaty kid and you HAVE to bath them (don’t worry, I get it) – then just make sure you moisturise heavily after their bath. Also, use a simple bath oil in the bath like QV bath oil (not the fragranced ones eg Johnson & Johnson – these are okay for kids without eczema, but not for those WITH eczema).
- Wet wraps are fiddly and annoying – but they work AMAZINGLY well overnight when eczema is bad. The hand out that I give to my patients is the one on the Royal Children’s Hospital (Melbourne) website: http://www.rch.org.au/uploadedFiles/Main/Content/derm/Wet_dressings_A3.pdf Sometimes when eczema is severe, these are re-applied in hospital up to 4 times a day.
- Topical corticosteroids – these act to reduce inflammation and use them on the advice of your doctor (you can get weak steroid creams over the counter at the pharmacy; the stronger steroid creams you need a prescription for)
- A cap of bleach to the bath (sodium hypochlorite 4%) WITH bath oil (eg QV bath oil)
- Avoidance of soaps/perfumed products (including bubble bath, body wash etc)
- When kids are distressed and SUPER itchy, a cold pack works wonders
- Use an antifungal/antibacterial cream if there are signs of infection – you will need to seek your doctor’s advice on this
- Sometimes kids do need oral antibiotics or antivirals if there are signs of the eczema becoming infected with a bacteria or virus. Again, seek the advice of your doctor.
Anyhow, I hope you have found this helpful. Eczema is so frustrating (for a mum or dad) and uncomfortable (for the child) and so very common.
See how you go with these tips and tricks and until next time, stop scratching! ?
xx Dr Megs
For more articles from Dr Megan Yap visit her blog – “Dr Megs – Paeds & Feeds” at http://www.kids-health.guru/