With spring just around the corner.. Here’s Pharmamum’s Ultimate Guide to Hay fever for immediate relief

Disclaimer –  The material on this blog is only to be used for informational purposes only. As each individual situation is unique, you should use proper discretion, in consultation with a health care practitioner, before applying the methods, medicines, techniques or otherwise described herein. The author and publisher expressly disclaim responsibility for any adverse effects that may result from the use or application of the information contained herein.

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From wet dressings to natural skincare we’ve got you covered!

Disclaimer –  The material on this blog is only to be used for informational purposes only. As each individual situation is unique, you should use proper discretion, in consultation with a health care practitioner, before applying the methods, medicines, techniques or otherwise described herein. The author and publisher expressly disclaim responsibility for any adverse effects that may result from the use or application of the information contained herein.

Pharmamum’s Ultimate Guide: Eczema (Part 2 of 2)

Wet dressings for Eczema

It is often thought, wet dressings are used for severe and infected eczema! Wrong! Wet dressings should almost be first line treatment. Wet dressings are essential when your child is itchy and hot. Wet dressings keep the skin cool and reduce the itch. They help hydrate the skin, keep the skin protected from trauma, and they are extremely helpful if your child scratches during the night, to the point blood is drawn. Wet dressings can be applied as often as needed and should be taken off before they are dry or first thing in the morning when your child wakes up. Wet dressings also help keep the skin clean when the skin is infected. Applying wet dressings as soon as the skin flares up, reduces the amount of cortisone creams required to control the eczema.

According to Melbourne’s  Royal Children’s hospital the recommended method to apply wet dressings is:

  1. Wet disposable towels in a bowl of tepid water and add one capful of bath oil.
  2. Apply cortisone or tar creams, if they are due to be applied.
  3. Apply moisturiser to the body and face.
  4. Wrap the wet towels around the affected areas gently,using a few layers.
  5. Wrap crepe bandages around the wet towels, firmly but not tightly. Avoid direct contact with the skin.

Wet dressings can also be applied to the neck, as a scarf or around the scalp and forehead, as a bandana. Children should not sleep with the scarf or bandana on, and should  be supervised whilst wearing them.

Signs of infection:

Bacterial and viral skin infections are more common in eczema sufferers. This is due to breaks in the skin from dry, itchy skin. Signs of infection are:

  • the skin has blisters, pustules or dry crusts
  • skin weeping a clear or yellow fluid
  • there is reddening, itching, soreness and sudden worsening of the eczema
  • yellow pus spots appear
  • generally feel unwell

If you think the eczema is infected, you should go to your family doctor and your doctor will either swab the infected area and/or start your child on a course of antibiotics. If there are areas of crusts, it is very important to remove them to treat the infection properly. To remove the crusts it must be done gently. Soak a face cloth in warm water and apply it to the crusted area for 5-10 minutes. The crusts once softened should be gently wiped away. If the crust does not gently come away, the area needs to be soaked for a longer period of time. Ego QV produce a bath oil called QV flare up bath oil that can be used when the skin is infected or at risk of infection. It contains an antibacterial to reduce the level of bacteria on the skin, and an oil which provides a thin film to maintain the hydration in the skin.

Remember:

  • Treat a flare up as soon as possible with wet dressings, cortisone creams and moisturisers
  • Maintain healed skin with moisturisers and bath oils.
  • Do not use skincare  products that contain sodium lauryl sulfate as they can damage the skin barrier and cause irritation
  • Keep your child cool, dress them in loose cotton clothing
  • Try and control scratching by using methods of distraction. Keep fingernails very short and consider using cotton gloves or mittens on the hands oven night.
  • If your baby sucks a dummy and the saliva irritates the skin, apply a moisturising ointment eg. Dermeze  around the mouth and down the neck where the dribble runs. If you apply the ointment just before a sleep, this will provide a barrier between the irritating saliva and the skin.
  • If swimming causes a flare up, moisturise the whole body in Dermeze, it repels the water and feels pleasant on the skin. Have a shower after to rinse off the pool water.
  • Wash clothes in sensitive washing powder/liquids eg. Purity washing liquid.

Diet and food Sensitivities

To date the evidence available states:

  • Exclusive breastfeeding for at least 4 months compared with  cow’s milk protein formula may decrease the cumulative incidence of  eczema and cow’s milk allergy in the first 2 years of life.
  • For formula fed infants at high risk of developing eczema, there is evidence that use of an extensively hydrolysed (only on prescription) or partially hydrolysed formula ( ie the HA formulas)  may reduce the risk of eczema.
  • There is insufficient evidence to support avoiding certain foods in pregnancy or breast feeding in order to prevent a child’s allergies.
  • It is thought that in about  30% of children with eczema, food may be one of the causes of a ‘flare up’ but in about 10% of those children,  food will be the main or only trigger. This means that only a small amount of children’s eczema improves when they make dietary changes.  If you remove the food the child is allergic to, the eczema will not be cured, but it will result in better eczema control. An elimination diet with food challenges may be trialled under medical supervision to avoid causing any nutritional deficiencies. If it looks like a food or an environmental factor like pollen, or animal fur is causing an eczema flare-up, a paediatrician or allergy specialist may organise a skin prick test, to find out exactly what your child is allergic to, and hence will give you a better picture of what to avoid.

Breast fed babies with eczema may have ‘flare ups’ due to the maternal diet as allergens do pass through the breast milk. Some mother’s may need to keep a food diary, to help them work out what food is potentially triggering a ‘flare up’ in their baby’s eczema . If a breastfeeding mother is eliminating certain foods it may reduce the severity of the eczema in the baby. The aid of a dietitian will be helpful to advise foods that can be substituted in order to avoid any nutritional deficiencies in both,  the mother and baby. Elimination diets are tried only if the eczema is severe enough to be affecting the quality of life of the child. If the eczema is well controlled with topical steroids and emollients, then dietary changes may not be necessary.

What else can I do?

Probiotics

Probiotics have shown promising potential in reducing the risk of eczema in infants. There  was a trial of 241 mother-infant pairs who were randomly assigned to receive one of two different probiotics or a  placebo, beginning 2 months before delivery and during the first 2 months of breast-feeding. The infants were followed until the age of 24 months and the results concluded that the risk of developing eczema during the first 24 months of life was significantly reduced in infants of mothers receiving the probiotic combination.

Ethical nutrients has a product available from most pharmacies called Eczema relief. One capsule can be opened and  dissolved in  either  water or milk for young infants/children. It has been shown to reduce itching associated with eczema, reduce sleeplessness associated with eczema and reduce the symptoms of eczema.

Vitamin D has not been proven to cure eczema but has shown to help eczema. There was a small clinical trial of 74 children who was grouped into mild, moderate and severe eczema and the study did show that the lower the vitamin D level, the worse the eczema.  While observational studies have suggested that vitamin D may be of benefit to children with eczema, future clinical trials are necessary to clarify whether or not vitamin D is useful in this skin disorder. However vitamin D is safe and inexpensive, so it seems a reasonable consideration.

Fish oil

Oral fish oil is often used to help skin with eczema, but not recommended if you have a seafood allergy.  Omega-3 fatty acids found in fish and fish oil help fight inflammation. They impact both elasticity and formation of the skin,helps moisturise and lubricate the skin internally.  Foods rich in essential fatty acids e.g oily fish, olive oil, flax seed oil, avocado, nuts all support many body systems and is important for  healthy immune function. There are many fish oil products available for children, but one I often recommend is Ethical nutrients Hi strength fish oil liquid for kids. It has a pleasant orange flavour and can be given from one year of age.

Newer prescription creams:

There is another class of eczema medication called topical calcineuron inhibitors eg. Elidel cream. Like topical steroids, they reduce the inflammation, however they are not the first line of treatment as they do not work as quickly as topical steroids and the long term safety has not yet been established.

Natural skin care ranges:

There are skin care ranges (eg.MooGoo, Weleda and Gaia) who pride themselves on using natural ingredients and avoid adding cheap harmful chemicals to their skin care products eg Sodium Lauryl Sulphate, Parabens, Petroleum etc. These companies dedicate their careers to research and development to wellness and optimal health. They have discovered how to add natural healing ingredients whilst still keeping their products preservative free with using natural agents that have antibacterial or antifungal properties. Whether its extracts from flowers, herbs, natural oils, vitamins etc they all have roles in maintaining optimal skin health. One particular range called MooGoo was developed in our very own country Australia. Their products are exceptional. However some people have allergies to natural products eg nuts and even though they can be healthy for you, if you are sensitive to a particular natural products your skin will react. It is important if you are trying a new cream on your child a skin patch test is important. Apply a small amount of the product on the inside of your child’s arm and monitor and observe for any skin reactions. Moogoo has a large range of products ie

  • Eczema and psoriasis cream- containing: Aloe Vera, Chamomile and  Sage oil
  • Soothing MSM cream- containing: Sweet almond oil, olive oil, coconut oil, organic sulfur, Aloe Vera, Vitamin E and Allantoin
  • Soothing Cream nut oil free- containing: olive oil, organic sulfur, evening primrose oil, honey, hops, allantoin and aloe vera.

These are just three products from their large range.

The role of these ingredients is to provide healing, enrich the moisture in the skin, calm the skin, nourish with vitamins, decrease inflammation and keeping the skin clean having antibacterial and antifungal properties.

Eczema sufferers have very delicate and sensitive skin and from what I hear as feedback from parents, some will say their child’s eczema was completely controlled by these products and others will say it either didn’t do much or infact their child’s skin was sensitive to the product. Always do a skin test before applying a large portion of the product to the body.

Eczema takes a lot of time and attention to keep it under control, however it is easier to keep it under control than to manage it when it is infected or severe.

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.

3 Practical Steps to Treating Eczema

Disclaimer –  The material on this blog is only to be used for informational purposes only. As each individual situation is unique, you should use proper discretion, in consultation with a health care practitioner, before applying the methods, medicines, techniques or otherwise described herein. The author and publisher expressly disclaim responsibility for any adverse effects that may result from the use or application of the information contained herein.

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.

The facts:

  • 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.

Treatment

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
  • Teething
  • Hot baths
  • Stress
  • swimming eg chlorinating chemicals
  • Soaps and detergents
  • Different fabrics- ie wool, nylon,acrylic fabrics
  • Food allergy and sensitivities
  • Viruses/infections
  • 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.

Bathing tips:

  • 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

Moisturising tips:

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

Alpha Keri

Mustela Stelatopia

Hamilton

Dermaveen

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.