At my clinic in Bangsar KL (Bright Star Baby & Child Clinic), we encounter numerous cases of eczema in children, and often parents ask us, “Doctor, can you cure my child’s eczema?”
Let’s first take a look at: What is eczema?
Eczema is the name for a group of conditions that cause the skin to become red, itchy and inflamed. It sometimes causes the skin to have small, fluid-filled bumps that become moist and ooze. The most common cause of eczema is atopic dermatitis (sometimes called infantile eczema), which affects older kids as well as infants.
Is eczema CONTAGIOUS?
Remember, eczema is NOT CONTAGIOUS. You can’t “catch it” from someone else.
There are several types of eczema apart from Atopic dermatitis. Contact dermatitis, dyshidrotic eczema and seborrheic dermatitis, also known as “cradle cap” in infants, are some of the common types that affect children. Eczema, especially atopic dermatitis, often appears in the first six months to 5 years of a child’s life.
Doctor, why did my child get eczema? What causes it?
The exact cause of eczema is unknown. Researchers do know that children who develop eczema do so because of a combination of genes and environmental triggers. When children come into contact with an allergen they are sensitive to, it “turns on” the immune system and causes flare ups in the skin.
We also know that children who come from families with a history of atopic dermatitis, asthma, or allergic rhinitis (known as the atopic triad) are more likely to develop atopic dermatitis. But there are also cases of spontaneous eczema, ie. no family history of atopic conditions exists.
The word "atopic" describes conditions that happen when someone is overly sensitive (allergic) to allergens in the environment. "Dermatitis" means that the skin is inflamed, red or sore.
What are some of the triggers of eczema?
**Firstly, triggers DO NOT cause eczema. Triggers may worsen eczema or make it appear, but don’t cause it in the first place.
· Many things can trigger eczema
· A trigger that causes one child’s eczema to flare may not cause another child’s eczema to flare.
· As a child grows older, eczema triggers can change.
· Some of the most common eczema triggers include:
o Dry skin
o Heat and sweating
o Infection
o Allergens such as pet dander, pollen or dust
o Mold
o Certain harsh soaps and detergents
o Certain fabrics (such as wool or coarsely woven materials)
o Certain skin care products, perfumes, and colognes (particularly those that contain alcohol)
o Tobacco smoke
o Some foods (common ones are dairy products and eggs, wheat, soy, nuts, shellfish)
o Emotional stress
Saliva from drooling can also cause irritation on your baby’s cheeks, chin and neck. Even your baby’s favourite stuffed toy may be a trigger.
How does eczema look like?
Eczema, especially atopic dermatitis (AD), may look and act very differently as your child gets older. The appearance and location of the eczema changes as kids age. It’s important to understand which type of eczema they may have and also their symptoms and triggers so that you can better treat and manage it as they grow and change.
It is best to seek help from your child’s doctor to properly diagnose and manage eczema.
How to manage eczema?
For most types of eczema, managing flares comes down to these basics:
· Know your child’s particular triggers to avoid exposure
· Implement a daily bathing and moisturizing routine to protect skin and lock in moisture
· Use OTC and prescription medication consistently and as prescribed by the doctor to curb symptoms
How can I help my child?
Avoid triggers as much as you can.
Remember these steps:
1. Clean
2. Treat
3. Moisturize
1. Clean: Give your child at least one bath a day, using lukewarm or cool water (not hot not cold water), and do not overdo it as overcleaning strips off natural moisture of the skin. A bath before bedtime is best. Use a gentle cleanser with low PH (<5.5), or bath oils are good. Avoid fragrances.
2. Treat: After bathing, pat the skin dry lightly so that it is still slightly damp. Then apply the topical medication (usually topical steroid creams and other prescription creams) that your doctor prescribed. Follow the instructions to apply on specific areas of the body.
3. Moisturize: Apply moisturizers liberally to all areas of skin, not just the eczema areas. Do it many times a day, not just after bathing. Ointments and creams work better than lotions.
During severe flareups, wet wrap therapy helps calm down the skin, on top of the above strategies. A bleach bath may also help. （Please ask your Pediatrician）
Also, curbing the tendency to scratch the rash can prevent the condition from worsening and progressing to cause more severe skin damage or a secondary infection.
But doctor, I heard steroids are bad for you?
A common myth that is propagated in the media is that steroids are bad for your skin. When used appropriately and for the right amount of time, steroid creams help treat moderate to severe eczema effectively, when used in combination with a good daily cleansing and hydrating routine.
But doctor, I thought that just moisturizer alone is good enough to treat eczema, especially if I buy a very good organic xx brand? What about those steroid side effects?
Moisturizers alone will only treat the very mildest form of eczema. Simply using moisturizers alone to treat moderate eczema is not effective at all, and may prolong the suffering of your child's condition, leading to more itching and scratching, which may increase the risk of infection. There are some transient side effects of long term steroid usage, such as discoloration of skin and extra hair growth, but those will stop once you stop the creams. More likely, those negative changes in the skin are a result of the eczema and scratching itself, not from the steroids. In any case, once the eczema improves and you stop putting on the steroid creams, all these conditions will also improve.
Regarding children having stunted growth from taking steroids, those effects are usually seen from long term ORAL steroid use, not from creams that you apply on the skin.
Don't worry, as long as you are using the steroid creams as directed by the doctor with the appropriate amount of time, it is very safe.
**Watch Out Signs**
Parents must watch for signs of infection: pus-filled bumps, pain, oozing sores, redness, heat — on the skin. If you see these signs, bring your child to the doctor right away.
So doctor, is there a cure for eczema?
There is no cure for eczema but there are treatments and more are coming.
Some children outgrow their eczema. Others continue to have eczema flares and remissions for life.
Eczema can be treated. Mild eczema can often be treated with corticosteroids that you apply to the child’s skin.
When eczema becomes more severe, a dermatologist can consider other treatment options. Using bursts of stronger corticosteroids that you apply to the skin can be helpful as can light treatments and stronger medicine that works throughout the body. Some other therapies for treatment of eczema include: prescription topical medications, phototherapy, and immunosuppressants.
Take Home Message:
The important thing to remember about eczema is that for many children, eczema is a chronic (lifelong) problem. There is no easy fix.
It is NOT contagious.
Always try to avoid triggers, treat flare-ups immediately (follow your doctor’s instructions), and moisturize vigorously. Watch out for infections too.
Steroids are safe when used appropriately following doctor's instructions.
Working together with your doctor is the way to go. Your doctor can help you really understand when to use what medication in treating the eczema and other ways to best help your child.