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Pharmamum’s Ultimate Guide: Eczema (Part 1 of 2)
Red, itchy, dry, scaly skin, comes to mind when I think about eczema. As a pharmacist, I see eczema in babies and children all the time, and no wonder, Atopic or ‘Allergic’ eczema occurs in 10-20% of children in Australia. In this blog I aim to discuss eczema, give the facts and recommend some great tips to manage eczema and advise how to prevent and avoid ‘flare ups’.
What is eczema?
The skin is our largest organ and possesses a rich blood supply which is involved in thermoregulation, wound healing, immune reaction and control of blood pressure. Healthy cells are plump with water. The skin cells produce an oil, which allows the skin to retain moisture and allows the skin to act as a protective barrier and prevent harmful substances or bacteria from entering our bodies. In eczema, the skin barrier does not work very well. A person with eczema has less water retaining properties and moisture is easily lost from the skin. Less oil is produced on the skin’s surface to retain the moisture inside the cells. Hence, there is increased risk of bacteria and irritants passing through, causing skin irritations and even infections. In eczema, there is an overproduction of immune cells called T cells, which start to work overtime when triggered, causing the skin to become red, inflamed and itchy. When you scratch, chemicals are released making the skin more itchy. This causes an ‘itch scratch cycle.’
What causes Eczema?
The cause of eczema is unknown however it is almost like an interaction between genetic factors and environmental factors. There is no cure for Eczema, nor is it contagious. Eczema can be aggravated by many factors, sometimes eczema can flare for an unknown reason.
- Eczema affects 10-20% of children
- If one parent has eczema, there will be a 60% chance of their children developing eczema
- If both parents have eczema, there is an 80% chance of their children developing eczema
- 50% of children will no longer be affected by Eczema by the age of 2
- 85% of children will no longer be affected by Eczema by the age of 5
- About 40% of babies with eczema develop asthma and/or hay fever when they get older.
Education plays a huge role in managing eczema. A person will have a number of ‘flare ups’ in their life and they need to learn:
a) What triggers a ‘flare up’
b) What is the best way to treat a ‘flare up
c) How can I prevent another ‘flare up’ in the not too distant future.
For mothers with babies who have eczema, this will be a huge learning curve especially if you did not suffer with eczema growing up. In babies, eczema often presents itself in the first 6 months of life usually first on the face. You may notice that dummies, dribble, teething and food around the mouth can all irritate the skin and cause eczema ‘flare ups.’ Eczema can also occur on the scalp, behind the ears, on the body, arms and legs (especially in the elbow and knee creases). The rash is red, dry and itchy. The skin can crack, weep and bleed and this can lead to infection.
3 step treatment guide
1) Avoid the triggers
Over time, learn what triggers your child’s eczema eg:
- Dry skin
- Soap, perfume, baby wipes, washing powder
- Allergens eg dust mites, pet fur, pollens
- Hot baths
- swimming eg chlorinating chemicals
- Soaps and detergents
- Different fabrics- ie wool, nylon,acrylic fabrics
- Food allergy and sensitivities
- Heat ie overheating in the cold dryer months
2) Protect the skin by bathing and moisturising
Understanding how skin cells are affected in eczema, illustrates how bathing and moisturising the skin has a huge role in preventing eczema ‘flare ups’ and improving the barrier function of the skin. Bathing allows moisture into the skin and moisturising straight after a bath ‘locks’ that moisture in. Short baths are recommended, a bath less than 10 minutes re-hydrates the skin where as a long bath dehydrates the skin. The bathing routine should be followed diligently during a ‘flare up’ and after as a preventative.
- The water should be lukewarm. During a ‘flare up’ the bath temperature should not be more than 29 degrees celsius.
- Apply a capful of bath oil into the bath and use this as a soap substitute. eg QV bath oil, Hamilton’s bath oil, Dermaveen bath oil etc.
- Use a soap free gentle cleanser on the parts of the body that requires additional cleaning. eg QV gentle wash, Hamilton wash, Dermaveen extra gentle baby soap free wash etc
- If eczema is on the face, soak a face cloth in the water and bath oil and gently apply to face.
- Take care with babies and toddlers as their skin can be slippery in the bath.
- Pat dry with a soft natural fibre towel
- Moisturiser should then be applied to the damp skin
As a parent, you walk into a pharmacy, head towards the skin care area, and become overwhelmed with the amount of choice there is for moisturisers. Moisturisers are classified based on their oil and water content. Ointments have the greatest oil content, followed by creams and then lotions. Which one do you choose? What you choose, should depend on a number of factors eg:
- What season we are currently in
- Where the Eczema is on the body
- What ingredients are in the preparation
- Severity of the eczema.
Winter can be a challenging time for eczema sufferers, their skin often gets dry and very itchy. When the heaters are on and the air is dry, thick moisturisers will be of benefit ie Dermeze ointment. In the summer more humid months, eczema should improve, and thick moisturisers may feel very uncomfortable on the skin and a lighter cream/lotion may be more appropriate eg QV cream or lotion.
Moisturisers are used to prevent the skin from drying. They should be used frequently, and are very important in the management of eczema. Moisturisers can be used alone or they can also be applied over a cortisone cream and under wet dressings.(Which will be discussed in Eczema part 2). Moisturisers can be applied as often as required and they should be applied all over the face and body and not just to the areas of eczema. Apply moisturisers during ‘flare ups’ as well as whilst in remission to prevent ‘flare ups’. I always recommend a simple moisturiser, one which is fragrant free and purely formulated for sensitive skin. Go by how your child reacts, if they are too young to express themselves and they cry hysterically when you apply a certain cream/lotion, that could be an indication the cream is stinging them and worth changing to a different cream. Creams and lotions often have added preservatives that may sting when applied. Ointments usually don’t sting and generally preferred over creams for this reason. However If your child gets pimples under their skin, that is a sign of blocked pores and would be an indication that the ointment is too heavy for the skin, and changing to a thinner moisturiser would be recommended.
Make bath time and moisturising fun, have bath toys and massage the creams into your child’s skin in a relaxing and fun way. I used to sing songs whilst moisturising my children or play peek-a-boo in the bath with face washes etc.
The following skin care ranges all produce a bath oil, a soap free body wash and moisturising creams and lotions and all suitable for eczema prone skin:
Ego QV skin care
Moisturisers are first line treatment and if used on their own, will only treat mild eczema. In most people, they will treat the dryness, improve the skin barrier function and help prevent eczema ‘flare ups.’ Moderate to severe eczema cannot be treated simply by moisturisers, no matter how expensive or fancy the moisturiser is. Once the skin becomes red and inflamed, it requires a topical steroid to bring the eczema under control.
3) Treat ‘flare ups’
When the skin becomes red, inflamed and even broken, a topical steroid is required to bring the redness and inflammation down and break the ‘itch scratch cycle’. Topical steroids come in creams, lotions, ointments and scalp lotions.There are a lot of ‘myths and misconceptions’ about topical steroids that have developed over the years and have made parents understandably concerned about using them. Parents can be so fearful to use them on their children, that their eczema becomes ‘‘under treated.’ The eczema sufferer will scratch the skin to the point that the skin opens and bleeds. This often leads to infection. Continual itching, rubbing and scratching over time causes the skin to eventually thicken when eczema is under-treated. Cortisone is a natural hormone produced in the body with one of its roles being controlling inflammation. Cortisone creams, if used as recommended by your doctor are completely safe. In sensitive areas (eg face) mild cortisone creams are recommended eg hydrocortisone (brands include:Sigmacort and Dermaid). The following statements will dispel myths associated with the use of topical steroids:
a) Topical steroids (cortisone) will affect growth and development
Untreated severe eczema can impact on physical, psychological and social development, and this can affect children’s growth and development. When steroid creams are applied correctly, often a child’s growth recovers as the eczema improves. Steroid creams and ointments almost never get absorbed into the bloodstream, and so will not affect growth and development, or the body’s ability to fight infections.The exception is in babies and very young children when topical steroids are applied in large quantities all over the body (especially if used under occlusive bandages) absorption into the bloodstream is possible. For this reason, strong (potent) topical steroids should not be used in children under 12 months of age except under the supervision of a dermatologist, who would ensure that there was no long-term risk to the child.
b)Topical steroids will cause my child’s skin to thin
It is true that potent and very potent topical steroids can cause thinning of the skin if used for too long and without a break. Dermatologists hardly ever see patients with skin thinning because they recommend using the cream in intermittent bursts and by using the appropriate strength and quantity. Many eczema sufferers can control their skin with weak topical steroids ie hydrocortisone (Sigmacort1%/Derm-Aid1%). With these preparations, skin damage is very uncommon even when they are used on and off for years.
c)Topical steroids should not be used on broken skin
If you have bad eczema and the skin is broken and cracked, then using a topical steroid on broken skin is perfectly safe if used according to your doctors instructions and often will help the skin heal faster.
d)Topical steroids should only be used in very small amounts
Whilst your doctor and pharmacist will advise to use the cream/ointment sparingly and only use a thin layer, often people will not use enough. A good rule of thumb to go by, is to squeeze a length of steroid cream/ointment onto the tip of an adult index finger, from the tip of the finger to the first finger crease you come to (approx. 2 cm). This amount of steroid should be enough to cover an area of skin the size of two flat adult palms of the hand (including fingers).
Stay tuned for part 2 eczema blog, which will contain information about the following:
1) Wet dressings for eczema
2) Infection in Eczema
3) Diet and food sensitivities
4) Supplements to help treat eczema
Please feel free to leave comments on this blog and if there are any questions I am more than happy to answer them. Also if you tried a remedy that worked well for your children that was or wasn’t mentioned above, let me know. I hope this information does help.