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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:
- Wet disposable towels in a bowl of tepid water and add one capful of bath oil.
- Apply cortisone or tar creams, if they are due to be applied.
- Apply moisturiser to the body and face.
- Wrap the wet towels around the affected areas gently,using a few layers.
- 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.
- 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 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.
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.