Eczema and Dermatitis – A parent’s complete guide.
What is it and who does it affect?
These two terms are both used to describe the same skin condition which can cause dry, itchy and irritated skin. It is the most common inflammatory disease of the skin. Approximately one in five children under six years of age suffer from eczema. Children often grow out of it and as a result only one in twelve adults have eczema. It can occur in very young babies and often begins with a small patchy rash on the cheeks or scalp. It can be differentiated from cradle cap by examining its colour. Cradle cap tends to be yellow in colour whereas eczema will cause more of a red rash. The rash can affect anywhere on the baby or child’s body – see ‘signs and symptoms’ for more information. It is more common in those with a family history of eczema, allergies or asthma. Eczema causes the natural skin barrier to be compromised as the outer layer of skin is dry and not as effective at protecting against irritants and infection. It’s a bit of a vicious cycle as this decrease in functionality of the skin barrier means that the skin is more sensitive to irritants known as triggers. Triggers include irritants (such as chemicals, hot or cold weather, smoke, detergent, cosmetics, fragrances and soap), allergens (dust, grass, foods, and pets), foods, stress, illness, and infection (Staph Aureus bacteria). Teething can also cause eczema flare ups – worth mentioning considering my audience 🙂 Eczema cannot be cured but it can be managed. It’s easier to prevent flare ups than treat them so keeping on top of good skin care practice is essential when caring for a baby or child with eczema.
What are the signs and symptoms?
Eczema can be mild and so just in a few small areas on the body or it can be very severe causing all over skin inflammation and irritation.
- Most common areas affected are at the backs of knees and elbows, the neck, cheeks, wrists, arms and hands.
- Dry flaky Skin
- Scaly patches of thick red skin
- Skin can lighten or darken in affected areas.
- The itching often results in scratched skin which can have tiny areas of broken skin which can be open to infection. This is known as secondary skin infections as a result of eczema.
- The itch actually gets worse after being scratched – try explaining that to a baby! This frustrating phenomenon is known as the ‘itch scratch cycle’
- Babies and children can become irritable and cranky if suffering from eczema as their sleep is often affected.
- The skin can be shiny, moist and blistery in areas during a flare up.
How do I treat it?
- Use a cold compress to relieve skin from the itchy feeling.
- Distract babies and children as much as you can to prevent scratching itchy skin.
- Skin care routine including the use of a bath product such as Oilatim Flare Up (from six months), Lipikar Syndet (my personal favourite), infacare (from one month) see here to read more or purchase: http://www.milltownpharmacy.ie/p/la_rocheposay_lipikar_syndet_400ml , http://www.milltownpharmacy.ie/p/oilatum_junior_flare_up_bath_additive http://www.milltownpharmacy.ie/p/infacare_baby_bath_400ml
- I would actually use nothing in a baby’s bath other than water until they are about three months of age. If you need to use something you could just use silcocks base (this is best softened in some hot water first in a small cup or jug and then added to the bath as it dissolves much better this way!)
- Use an emollient cream. An emollient soothes the skin and relieves itch. They act as the skins natural barrier and trap water in and prevent irritants from accessing the skin. Creams are more moisturising than lotions. I would recommend applying these directly after patting the skin dry after a bath or shower and also on a daily basis. There are several good emollient creams on the market – I will name a few of my favourites but its trial and error when finding the one that works best for your child: Aveeno Dermexa cream, Diprobase cream, Epaderm cream, La Roche Posay Lipikar AP Balm, MooGoo Full Cream Moisturiser, and Avene Trixera. The one I use myself (I am a life- long eczema sufferer as are my daughters although they have gotten off much lighter than I did as a child!) is the La Roche Posay Lipikar Balm and the reason is that I feel it lasts much longer on the skin – it absorbs well and only requires once daily application. I’m a big fan, but as I said its trial and error and all of the products I have mentioned are great and others in addition I’m sure. See here for more information or to purchase the Lipikar AP Balm : http://www.milltownpharmacy.ie/p/la_rocheposay_lipikar_baume_ap_400ml One thing to note – don’t use aqueous cream as a moisturiser as it can worsen eczema – its ok as a soap substitute in the bath though. Apply an emollient in the direction of hair growth, and ideally use one with a pump rather than a tub so that you don’t have to repeatedly stick your hand into the tub introducing dirt or infection. If you are using a tub then use a spatula to get the emollient out.
- Steroids – Steroid creams can be used in children over ten years of age without prescription. If your child is under ten years of age and is suffering from regular flare ups of eczema please talk to your GP about whether a steroid cream may be appropriate for them and if so which one. There are several different types of steroid creams available on prescription varying from mild to very potent and whilst they should always be used with caution and in line with the prescriber’s recommendations they can be hugely effective and can change the quality of life of a mother and baby or young child. These creams are just used in the short term to treat a bad flare up. Once the flare up is under control the use of a quality skincare regimen is often enough to prevent another flare up from coming.
- Antihistamines – These may help children over two years of age if they are extremely itchy during a flare up of eczema. There are two options available for children over two years without the need for a prescription – these are Zirtek solution and Phenergan solution. Zirtek is a non-drowsy medication whereas Phenergan can cause drowsiness. Phenergan can be useful if your child is itching a lot at night and having difficulty sleeping as a result. Please read dosage instructions and information on packets to find the suitable dose for your child. Children under two years can also get antihistamine medication but it must be prescribed by their GP.
- Wet wraps – This is when dressings are used over a lot of cream to hold the cream in place and to prevent itching. In children vests or leggings can be used just monitor temperature carefully. These should only be used for short periods in children.
- There are other options available if these steps do not work but they must be investigated by your child’s GP or dermatologist.
How to I prevent it?
- Scratch mittens
- Keep your child’s fingernails short so that if they do scratch they do not break the skin.
- Dress your baby or child in loose fitting cool clothing.
- Regimental use of specialised bath products and emollients.
- Keep a food diary – record everything that your baby or child eats or drinks and then note at the end of each day how their skin was – I find it easiest to use a scale of 1-10 with 1 being perfect and 10 being inflamed red widespread itchy rash. After about a month you can look back through the diary and you might find that every time the rash was at its worst a certain food was consumed within the two days beforehand. This helps to identify trigger foods which can then be avoided for a few weeks or months and then re-introduced slowly to see if the intolerance has been grown out of. I would not recommend removing entire food groups without discussing it with your GP first, such as dairy. But if you identify something such as strawberries is causing the problem then you can offer different fruits so that your baby is getting the nutrition they need to grow and develop.
- Be conscious that triggers for eczema or dermatitis can be external – such as washing detergents, chemicals on new clothes etc. For example one of my daughters reacted to Fairy Non-Bio detergent whilst the other one was fine with that but reacted to Persil Non-Bio – as you can imagine laundry became a fun filled challenge in our house for a year or so! Luckily they have both grown out of this particular sensitivity but the point I’m making is that there is no one ‘good’ detergent – everything has the potential to cause a reaction in your child, it’s about being aware and identifying their unique triggers and avoiding them. I would however recommend using the non-biological versions of the various products rather than the biological one which are known to cause irritation of sensitive skin.
- It’s also worth knowing that when you buy new clothes or receive gifts of them they have been treated in the factories by certain chemicals which can cause irritation and so I recommend always washing new clothes for young babies before using them – it’s a pain but could save your little one a lot of discomfort. I’d also avoid fabric conditioner.
- Watch out for common triggers such as wool, fragrances and astringents.
- Emotional stress can also cause flare ups – not that this can often be prevented, but at least you can identify if it is what is causing the problem.
- Sweating can irritate the skin so try to keep your baby or child cool in warmer weather.
- Over-washing your baby can also cause further drying of the skin so I would recommend bathing them just every few days. However I would recommend applying an emollient moisturiser every day.
- Pat the skin dry after washing rather than rubbing.
Contact your GP if:
- You cannot get your child’s eczema or dermatitis under control using a simple skincare regimen.
- If your baby or child shows signs of infection such as pus filled lumps or scratches, red scaly patches, fever or inflammation of the skin.
- If your baby is under two years and is very itchy.
- If your child is under ten years and is suffering from regular flare ups.
I hope you have found this article helpful and as always if you have any questions at all please don’t hesitate to contact me (Sheena) through the WonderBaba facebook page (www.facebook.com/wonderbabacare) or at Milltown totalhealth Pharmacy on 012600262.
See www.milltownpharmacy.ie to learn more about or purchase the products mentioned in this article.