Eczema is one of the most common ailments that we see in our practice. Eczema is more than just dry skin. Children with eczema have skin that is deficient in crucial lipids and proteins. At a minimum, they suffer from intermittent dry, itchy skin. In more severe cases, patients experience constant pruritus, skin thickening, and skin discoloration. Approximately, 10-15 percent of children have some degree of eczema. Most children outgrow eczema, but about 3 percent of adults are affected.
Itchy skin or pruritus is the most common symptom. Infants typically develop dry patches on the face and the backs of the knees and elbows. During childhood, the distribution often changes to involve the flexor surfaces of the elbows and knees.
Eczema is a chronic condition and therefore requires maintenance care. The first step is to eliminate potential triggers. Environmental triggers include dry air and heat. Indoor and outdoor allergens include dust mites, animal dander, mold and pollen. Currently, there is conflicting data about whether certain foods can trigger eczema. Anecdotally, I have had a number of patients with moderate to severe eczema who have improved with an elimination diet. If you intend to try an elimination diet, please talk to your pediatrician and make sure you maximize your baby’s nutrition.
The second step is to keep your child’s skin well hydrated. This is accomplished through the liberal and frequent application of thick creams or ointments. I generally suggest that you apply an ointment twice during the day and after a bath. Your pediatrician might also add a mild steroid cream to your maintenance regimen.
The third step is to control pruritus (itching). This is important because scratching can compromise the integrity of the skin and make eczema worse. Usually, moisturizers and steroids are sufficient to control the rash but sometimes pediatricians will add a sedating antihistamine, like Benadryl, to control the pruritus overnight. I should note that in this setting, the primary effect of the antihistamine is to improve sleep rather than decrease pruritus.
When your child’s eczema is not controlled with the above therapies, your pediatrician may prescribe prescription strength topical steroids. When used appropriately, topical steroids are exceedingly safe. I always tell parents to call if they are applying the medicine for longer than five days in a row at a frequency greater than twice a month. This might mean you need to try a more aggressive strategy.
I would like to take a moment to focus on a very important part of the day for patients with eczema - the bath. I recommend using a “wet strategy.” This strategy includes a short bath every night. After the bath, cover the affected areas with a wet washcloth for five minutes. Then, apply a thick ointment to “lock-in” the moisture and use a cool mist humidifier in your child’s room while your child is sleeping. Always use hypoallergenic bath products. For more severe eczema, we sometimes recommend a bleach bath as well. The bleach bath decreases the bacterial load on your child’s skin and, in turn, helps to decrease the amount of inflammation and itchiness your child experiences.
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