Eczema (2)

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     Eczema (atopic dermatitis to doctors) has always been related to allergic diseases such as asthma, seasonal allergies and food allergies. When many people in a family have allergies, a child in that family has a greater risk of having eczema.

     Recent research has found that the gene responsible for eczema causes a lack of a certain fatty substance on the skin surface that holds moisture in the skin. Without that substance, the skin loses moisture, dries out and cracks. Normal, moist skin is a perfect protective barrier against substances on the skin surface that could cause irritation. When skin is dry and cracked, those irritants can get into the skin and cause the body’s immune system to react with redness and itching. This reaction can occur even if the child is not actually allergic to the irritant, which explains why some children with eczema may have negative allergy testing.

     Eczema causes patches of scaling, red, itchy, skin. Areas of skin that repeatedly go from wet to dry are especially susceptible. In infants and young children, areas that get drooled on - the cheeks, neck and area behind the ears along with the scalp, arms and legs are often involved. In older children, areas that collect sweat such as the creases in front of the elbow or behind the knees are often worse. A child who frequently washes and dries his hands may have “glove-like” eczema. Athletes may develop eczema patches from sweating under their protective pads.

      When the skin’s normal protective barrier is broken, it can also allow infectious agents – bacteria, viruses and fungus – to invade the skin. Sometimes, when an eczema outbreak is especially resistant to treatment, it is because the area has a secondary infection that needs to be treated along with the eczema. Some bacterial and viral infections can become severe – even life-threatening.

     Children with eczema not only suffer pain and itching, they can also have anxiety, embarrassment and emotional distress. They can have sleep disturbances that can lead to poor school performance and even resemble attention deficit disorder. People often react negatively when they see a child with the rash or worry that their children could “catch it”.

     To successfully deal with their child’s eczema, parents need to think in terms of long-term prevention rather than treatment. If the child does have allergies that bring on the eczema, those allergic agents must be avoided. Repeated moisturizing, especially after the skin has been wet, is important. Too often, parents let up on skin care when the child is dong well and only react to outbreaks of eczema, Moisturizing should be kept up even when a child doesn’t have a rash. For a basic moisturizer, try different over-the-counter creams, lotions or oils until you find which one that works best for your child with the least irritation.

     Bathing can be done from once a day to three times a day during outbreaks. Use a mild, additive-free soap. Some doctors now recommend putting some bleach in the water once a week to decrease the bacteria count on the child's skin. After the bath, lightly pat the skin dry and then apply the moisturizer while the skin is still slightly wet. Apply moisturizer to both the affected areas and the clear areas of skin. Areas that are repeatedly exposed to moisture may need repeated application through the day. An over-the-counter oral antihistamine can be given at night to help the child sleep or given during the day to decrease itching. It is often said to treat eczema like "an itch that rashes rather than a rash that itches". In addition to moisturizers, low-dose corticosteroid creams are available without a prescription and can be used to both prevent and treat outbreaks. Stronger steroid creams need a prescription and should be used sparingly under a physician’s guidance because they can cause permanent scars. Finally, there are other medications called calcineurin inhibitors that are used for eczema but they also need a prescription. If an area of eczema doesn’t respond to treatment, check with your child’s caregiver to be sure that the area doesn’t have a secondary infection.

Safety Tips About Fever Medications

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     Fever is one of the most common concerns that parents have, so it follows that fever medications are some of the most common medications parents give to their children.

     In February of 2012, I wrote an article on acetaminophen that discussed the use of acetaminophen and warned about over-dosing because so many cough, cold and fever medications contain acetaminophen. I recommended using ibuprofen instead.  This article is to give you a warning about ibuprofen (No one said that being a parent was easy!).

     Ibuprofen is a medication called a non-steroidal anti-inflammatory.  Steroids help everything from knee pain to asthma because they decrease inflammation – the swelling, pain and fever that is the body’s normal response to irritation, allergy or infection. Ibuprofen decreases inflammation, but it is “non-steroidal”- it isn’t a steroid but many of its actions are similar to steroids. One of those actions is to decrease substances called prostaglandins that cause inflammation. However, one certain prostaglandin also helps to control how much urine the kidney makes and, when it is suppressed by ibuprofen, it results in lower urine production. Most of the time, this slight decrease in urine production doesn’t cause a problem, especially in adults. But if someone is dehydrated, this added decrease in urine can put enough strain on the kidney to cause it to shut down completely. Children become dehydrated more rapidly than adults and young children can become dehydrated very rapidly, so, this is a problem parents need to be aware of.

     I have said in many articles that fever is a normal part of infection. There is no such thing as a “dangerous” fever with infection and it doesn’t cause brain damage or any other harm to the child. However, it does cause a lot of fear in parents and that fear can often lead to giving medications to “try to get the fever down”. That fear can cause parents to give too much acetaminophen, especially when given with other cold medications, and it can also lead to giving too much (or too often) ibuprofen. If a child has an intestinal flu virus with vomiting, diarrhea and fever, that child can easily become dehydrated and then the ibuprofen can cause kidney shut-down.

     The message, of course, is to give only enough fever medication to make the child comfortable. If you choose to give acetaminophen, check the bottles to be sure of the dose and to know if it is in any other medications you are giving. Don’t give ibuprofen for fever if your child has vomiting, diarrhea or decreased intake of liquids.

Warning About Pet Amphibians And Reptiles

  Children, especially boys, have a fascination with snakes, frogs, iguanas and turtles. In 2011, the Centers for Disease Control and Prevention (CDC), a national agency that monitors risks to the public’s health, issued a warning about amphibians and reptiles as pets. This warning specifically mentioned African dwarf frogs that have become popular in home aquariums.

   The warning concerns the spread of an infection with Salmonella, a form of bacteria that can cause fever, diarrhea and abdominal cramping which can lead to dehydration and even require hospitalization. Children can easily become contaminated with Salmonella from contact with amphibians and reptiles, their habitats or the water from the aquariums. Young children are especially susceptible to getting infected because they don’t wash their hands well and always put their hands in their mouths. The CDC warned against having these kinds of pets in homes, daycares or preschools where there are children under five years old. Children should not have these pets in their bedroom.  Anyone who has contact with amphibian or reptile pets or their habitats should carefully wash their hands immediately after contact. If fever or diarrhea develops in a child who has contact with one of these pets, the parents should speak with the child’s caregiver.

About Doctors

Like many top professions, medicine attracts people who have certain personality traits. In medicine, these include attention to detail that boarders on compulsion, self-confidence that boarders on arrogance and willingness to make hard decisions that boarders on being judgmental. It takes all of these to be able to pick up a sharp knife, cut deeply into a living human being and trust that everything will be all right.

     As a retired, neighborhood doctor, I hear lots of doctor stories. I heard about an elderly lady who had a pacemaker placed in her chest and afterwards began to suffer strange fevers and side effects. Even though the family pleaded with the doctor that all the trouble seemed to start with the placement of the pacemaker, the doctor refused to believe anything was wrong with the device and refused to investigate. Only when the woman was near death was it learned that the pacemaker was contaminated with bacteria and the problems were due to an infection spreading through her bloodstream. I heard about the healthy man who had a routine colonoscopy and the doctor, even though he suspected that he punctured the bowel wall when he removed a polyp, said nothing. As the patient got more ill over the next few days, the doctor gave the family a jumble of mixed diagnosis and explanations as to what was happening. When they asked if the surgery could have caused a problem, the doctor got defensive. At autopsy, it was clear that the hole in the bowel wall had caused a fatal infection.

     Patients come into the medical care system trusting, frightened and needy. But they should never lose their confidence in their ability to judge what is happening in an interaction with a doctor or any other medical caregiver. If you feel you are being judged, you are. If you feel you haven’t been listened to, you haven’t been. If you feel that there is something wrong and the medical person is ignoring it, that’s what is happening. There is nothing about medicine that cannot be easily explained in non-medical terms. If you find yourself confused, insecure or disrespected, it is not your fault, it is the fault of the person you are dealing with.

     Medical education is trying hard to change young doctors’ attitudes towards patients, but the personality type that gets into medicine won’t change. Patients rightfully approach an interaction with a physician with respect for his/her intelligence, training and dedication, but they also need to keep in mind that the doctor is a human being and can make mistakes.  Always ask questions and only accept clear, understandable answers.