Eczema is one of the most common chronic skin conditions affecting infants and children. It results in dry, itchy skin and red, irritated patches. Common areas of involvement in children include their cheeks, arms, legs and inside their elbows and knees. Eczema can range from mild to severe and can be very debilitating for some children, causing scarring, poor sleep and strain on family dynamics.
There are many misconceptions surrounding eczema, which causes a lot of frustration for parents. Many parents are told that if they can find the ‘cause’ of their child’s eczema and eliminate exposure, then their skin will improve. Unfortunately, this is not the case because the cause of eczema is a disrupted skin barrier, which leads to excessive water loss, dryness and itching.
Parents with a history of allergies or eczema often have babies with eczema. About 40% of children with eczema have a mutation in a protein called filaggrin, which is important in reducing the gap between skin cells. If the skin barrier is disrupted, as in eczema, then irritants and allergens are more likely to pass through and cause irritation, itching, and rash, but this is not the ‘cause’.
Children with eczema, especially those with persistent, severe cases affecting most of their body, are at higher risk to develop allergies and asthma as they get older.
Food Allergies and Eczema
Overuse of food allergy tests in children with eczema is a common problem. Children with eczema often have false positive results and parents are told to avoid introducing foods or even remove from their diet.
In rare instances, specific foods may be a major contributor to a child’s eczema, but this is the exception and typically affects infants less than one year of age with truly unmanageable, severe eczema, despite good daily skin care.
Breastfeeding mothers everywhere are incorrectly told to stop eating dairy or other foods to ‘treat’ their baby’s eczema. Not only is this unnecessary for most mothers but can lead to significant problems associated with a restricted diet…and not actually treat the eczema.
It is important for parents to understand the relapsing nature of eczema. It will worsen at times, often during the colder winter months when both indoor heat and outdoor air are very dry. It is common for parents to assume this is due to various changes to diet or other factors with the natural ups and downs of eczema. Incorrect assumptions can lead to unnecessary restrictions. Thankfully, most infants with eczema improve by age two and, for many, their eczema completely goes away.
Eczema treatment focuses on daily skin care and prevention of flare ups. Kids should bathe daily for 10-15 minutes in lukewarm water (hot water dries out the skin). Greasy, unscented balms such as petroleum jelly should be applied at least once a day, even when the skin looks okay, to help moisturize. Lotions do not absorb as well.
The ideal time for application is right after bathing, to help lock moisture in place. Any fragranced product, even if all natural or nice smelling, can irritate eczema. This includes soaps, detergents, and lotions. Some foods are notorious for irritating the skin and can cause redness on areas of contact. Strawberries, tomatoes, fruit juices, and ranch dressing are common examples. This is often mistaken for food allergy, but these are unlikely allergens.
When eczema flares, there are a variety of anti-inflammatory topical ointments that can be used. This includes topical corticosteroids of varying strength and non-steroid prescriptions. Viral illnesses, exposure to known irritants or environmental allergens such as cat/dog dander, and stress can all cause acute eczema flares. The number one reason why eczema is not well controlled is lack of consistent daily skin care and avoidance of triggers. When the skin is broken or bleeding, this can indicate bacterial infection and may require antibiotics to improve.
None of us want to watch our children itch and scratch all day. If they are bothered by eczema and especially if not sleeping well at night, allergists and dermatologists are well trained in helping families find relief. It is important to avoid dietary restrictions or unnecessary food allergy testing, which can cause long lasting consequences after eczema naturally improves over time.
David Stukus, MD, is an associate professor of pediatrics in the Section of Allergy and Immunology at Nationwide Children’s Hospital. Dr. Dave, as his patients call him, is passionate about increasing awareness for allergies and asthma.
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