“It hurts Mummy”
No mother wants to hear their child utter these words. And to hear these words time and time again is heartbreaking. It is also frustrating when all attempts to help your child prove ineffective. It happens all too often for the parent of the child with eczema.
So what is eczema and why does your child have it?
Eczema is a chronic, recurring, non-infectious, inflammatory condition of the upper layers of the skin. It is rapidly becoming one of the most common medical problems in the world.
Although both adults and children can develop eczema it is predominantly considered a childhood condition. The fact is there are many different forms of eczema and it is the atopic form of eczema that most commonly affects children. One Scottish study revealed that children are five times more prone to develop atopic eczema than adults.
An inherited tendency
The term atopic refers to a person who is prone to allergy. Most children who develop atopic eczema inherit it from their parents. It is however not eczema itself that they inherit but rather the tendency for their body to overreact to certain substances in their environment. These substances most commonly include house dust mite, pollens, proteins on cat and dog fur and some foods.
Although children with atopic eczema have a hypersensitivity of their immune system and produce too much of the allergy antibody (IgE) they have no other problem with their immune system.
The exact underlying mechanism as to why this hypersensitivity develops is not known. However research shows that children born to parents where one parent has an atopic condition (eczema, asthma or hayfever) the chances of their child developing eczema are considerably increased. The chances are even further increased if both parents suffer from an atopic condition.
That is the age that eczema frequently first appears.
It is rare for a child to develop atopic eczema before the age of two months. The reason for this is unclear however one theory is that the baby’s nervous system is too immature prior to this age to enable the baby the ability to scratch.
Eczema is a very individual condition and each child will suffer differently. Similarly the severity of the eczema will vary from child to child. Despite this the clinical features and the pattern of involvement make atopic eczema usually quite easy to recognise.
Dry, red, scaly and itchy skin
Atopic eczema may appear in small patches or cover the whole body. Typically the affected skin is dry, red, scaly and very itchy. Eczema is characteristically quite severe in the early months often becoming less severe by the age of two years.
Skin oozes and crusts
For a baby who develops childhood atopic eczema between the ages of 2 –4 months the initial symptoms include inflammation of the skin with oozing and crusting. The cheeks and scalp are often the first areas affected.
Facial eczema usually subsides and the rash becomes more prominent on the limbs especially the wrists and hands and behind the knees and elbows.
Dry scaly eczema
Childhood atopic eczema may continue on past the age of two years but for some the first signs do not appear until this age. When eczema develops around the age of two years the oozing and crusting is less common as the rash is usually drier and scaly.
Atopic eczema clears spontaneously in the majority of children between the ages of 2 – 5 years. If it does persist there is usually a marked improvement by the time they start school. However those with severe eczema when young may carry their eczema into their teenage years or even into adulthood.
Due to the nature of the condition a flare up is not uncommon and can occur at any time even on skin that has been eczema free for years. This is especially so for those people who choose occupations in adulthood where their hands and face are exposed to irritant chemicals or detergents. For those who have had eczema they will be more prone to have sensitive skin for the rest of their life.
It is all trial and error
Finding an effective treatment for your child can be a long drawn out process involving much trial and error. Due to the individual nature of the condition treatment is also individual and what works for one child may not always work for the next. This means there is no single treatment for eczema.
There are however some characteristics of eczema that are present in all but the rarest of cases. Hence the principles of treatment remain consistent even when the specifics of the treatment vary.
Moisturise, moisturise, moisturise
Eczema and dry skin go hand in hand, meaning moisturising the skin is of vital importance for anyone with eczema. Eczema skin lacks the natural oily layer that acts as a protective barrier. This needs to be replaced regularly with the use of emollients or moisturisers.
Moisture decreases itching
Regularly moisturising the skin will help to reduce the itching and inflammation associated with your child’s eczema. This in turn will help to minimise the severity of the condition and make it easier to live with.
Moisture increases flexibility
The skin remains more flexible when moisturised regularly. Well-moisturised skin is less likely to become cracked. Cracked skin is not only painful but also prone to infection. Once an infection develops on the already tender skin the pain and discomfort will increase and the skin will become more difficult to care for.
The secret is to find a good emollient and use it regularly. Make it a habit to moisturise after bathing or showering and after any prolonged exposure to water. Carry an emollient with you so you can remoisturise your child’s skin as needed. Be aware that not all creams used to treat your child’s eczema will be a moisturiser. It may be necessary to use a separate moisturiser as well as your treatment creams.
Emollients equal moisture
Emollients are oil-based or fat-based moisturising and softening agents. You will need to use them regularly on your child to keep the skin soft and supple. There is a huge range of emollients available including bath oils, creams, lotions, ointments, shower gels and the list goes on.
Emollients have two basic functions. Firstly they work to form a protective water proof layer over the skin. This helps to keep moisture in and prevents it from being lost from the skin. The second function of an emollient is to make the skin feel smoother and more comfortable by helping to stick the skin layers together much the same as how the skin’s natural oils do.
Avoid perfumes, colourings and preservatives
Choosing the right emollient for your child can be a very difficult process and it may simply be a matter of trial and error until you find one that suits your child’s skin. As a general guideline it is best to select products that are marked ‘hypoallergenic”. Additives such as perfumes, colourings and preservatives are all prone to cause an allergic reaction in a child prone to atopic eczema.
Products containing lanolin should also be avoided. Lanolin is an animal fat derived from sheep’s wool and often causes a reaction in those with sensitive skin.
It is also recommended that any topical application being used for the first time should be patch tested before applying it to the affected areas. Simply apply a small amount to an unaffected area. The inside of the forearm is often ideal or for younger children who you don’t want to touch the area the back of the shoulder works well. Leave the cream for 24 hours and observe it for redness or irritation.
Bathing is good – despite what you have been told
Most babies and small children love their bath. The freedom of no nappy, being able to splash freely in the water. It is usually a time of fun filled pleasure for both parent and child.
Unfortunately many parents avoid bathing their child if they have eczema or at least minimise the number of baths and the amount of time spent in the bath.
And why shouldn’t they?
Water is drying to the skin. It will strip the skin of its natural oils and make the baby’s eczema worse. Whilst it is true – water is drying to the skin – there is a way around it. Bathing your child can be beneficial for their sensitive eczema skin.
The secret is to always add a bath oil.
Bath oil will soften the water and moisturise the skin whilst your baby baths. Ensure the water is only ever luke warm as overheating the skin will dilate the blood vessels increasing redness and irritation.
A 10 – 15 minute bath in luke warm water with bath oil added each evening is ideal. Follow this by the application of the treating cream. It is after the soaking that your baby’s skin will be at its softest and moistest making it most receptive to the cream you use. This means the cream will have its greatest effect when applied straight after the bath.
Doing this of an evening, just before bed means your baby is relaxed, soothed and settled. Hopefully a better sleep is in store – less irritation and less itching.
Remember that bath oil makes your child’s skin slippery. Extra care is always needed to ensure they do not slip whilst in the bath. For areas of skin which are extra dry or for areas that are difficult to soak (ie face, behind ears) the bath oil can be applied directly to their skin. Simply put a little on your own fingers and gently rub it onto your child’s skin. This will give a greater concentration of moisture to a localised area.
Itching and scratching – a never ending battle
The other major factor to be overcome with childhood eczema is the itching. Atopic eczema is characteristically very itchy. This will make a child restless and irritable, not to mention the damage that is done to the skin by continual scratching.
If it were as simple as a good scratch and the itch were gone it would be fine but this is simply not the case. The more a child scratches the itchier they become and so they keep scratching. This is known as the scratch itch cycle.
A child who has chronic eczema and is continuously itching and scratching will develop a habit of scratching and even when the eczema is gone and the itch is resolved they will continue to scratch out of habit.
The end result of continued scratching is scratch marks and thickened skin that is red, sore and broken, leaving it open to infection.
The habit needs to be broken to overcome the problem. In very severe cases an oral antihistamine may be required to ease the cycle. However, often just a conscious effort not to scratch and the application of emollients will ease the itch and sooth the skin sufficiently to allow it to heal.
Try not to overheat the skin, or let it become excessively dry, and if possible avoid any irritants that you know will irritate your child’s skin.
In an attempt to minimise damage done by the itching keep your child’s fingernails short. Cotton gloves or mittens especially at night are also a good idea. This will not stop them from trying to scratch, but it will reduce the damage they are doing to their skin.
Similarly keeping as much of their skin as possible covered will prevent damage from scratching. Long pants and sleeves are ideal. The worst time for scratching is usually at night when the child is asleep. If possible dress your child in all-in-one pajamas that have feet and hand covers included.
During the day distraction is the best remedy. If you can keep your child’s mind and hands busy they are less likely to scratch. Of course this depends on the age of the child. The best you can do with young babies is to keep their hands covered in little cotton mitts.
As a child gets older it is possible to talk to them and explain why they should not scratch. This will not stop the scratching but at least with gentle reminders they may try not to. If they simply must scratch try applying a cold compress to the area to ease the urge.
Try also to identify any triggers that aggravate your child’s rash or if there is a pattern of itching. There may be a time of day when the itching is worse. There may also be certain products that make your child’s itching worse. For example synthetic bedding or clothing often aggravates eczema and increases the itching as does an over heated dry atmosphere.
As your child gets older explaining their condition to them and gaining their co-operation is important.
Eczema cannot be cured but it can be managed
Although it often feels like you are the only ones in this situation – you are not alone. Childhood eczema is a very common condition. Arm yourself with as much information as you can and talk to people in a similar situation. Build up a support network around you.
And most of all don’t give up – keep at it until you find the right solution to control your child’s eczema.