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.