Advice Column, Health, Parenting

Uncomfortable in your own skin? How to manage eczema

What is eczema?

Atopic eczema is a common chronic skin condition that causes dry, red and itchy skin. It may affect up to 20% of infants, and 3% of adults. It is commonly associated with other allergic disease such as asthma and hay fever. Atopic eczema usually begins in infancy, at around 3 months, and it may persist into adulthood. Its’ course may vary over a period of time with bouts of red, angry flares interspersed with relatively normal-looking skin. The good news is that in most cases eczema improves by age 3 to 5 years, and has often completely resolved by teenage-hood.

What causes eczema?

Importantly, eczema is not a contagious disorder. It is due to the interplay of genetics, environmental factors, and a defective skin barrier in an individual. 

Due to this abnormal layer of skin, there may be water loss, and allergens and irritants may enter the skin resulting in itchiness and dryness. The skin may be vulnerable to bacterial infections during the flares.

What are the common sites of eczema?

In young children, eczema is usually seen on the face and outer legs and arms. It appears wet and oozing. As a child gets older, the rash usually changes to a dry scaly itchy rash, and the position moves to the inner creases of the elbows and knees.

Is eczema a serious condition?

Though not associated with serious illness, eczema has definitely been proven to affect one’s quality of life. This may be due to the intractable itch, often subconscious, leading to sleep problems for example. Lack of sleep may, in turn, result in both behavioural and learning problems during school. There is often an associated issue of low self-esteem as individuals feel embarrassed by their skin, and absenteeism is common.

What causes eczema to flare-up?

Heat, woollen or synthetic clothing, fragranced soaps, washing detergents, and bubble baths have all been associated with eczema flare-ups.

What are the steps to manage eczema?

Reduce trigger factors 

  • prevent over-heating
  • wear cottons rather than wool or synthetic clothing
  • keep nails short to reduce damage to the skin from scratching
  • emollients should replace soaps
  • fabric softeners should be avoided
  • avoid bubble baths
  • bath water should be lukewarm not hot, and once out pat yourself dry, don’t  rub the skin
  • wash hair in the basin to avoid shampoo making contact with the skin
  • before swimming, use a layer of emollient from top to toe
  • after swimming, have a shower to remove the chlorine, followed by using an emollient again

Moisturizing emollients

These are the cornerstone of eczema treatment. They create an oily layer on top of the skin, which stops water from leaving the skin and therefore becoming dry. They should be applied in large quantities and frequently, as much as 8 times a day. Aqueous cream should not be used as a moisturizer as if it is left on the skin it is likely to irritate it however it may be used as a substitute for soap.

Steroid creams

These are effective in stopping skin inflammation. They work rapidly to settle down eczema flare- ups, and should be used during flare-ups to prevent skin damage. Steroids come in different strengths, from very mild to very strong. Very strong steroid ointments should be used sparingly as they have side effects such as thinning of the skin. Mild steroids have far fewer side effects, and will not affect a child’s growth and development. In a flare-up, a potent steroid cream can be used, but once controlled a lower strength ointment should replace it. This should be slowly reduced until the steroid cream can be stopped completely, and then only the emollient continued. Emollients should be used during flares too, and applied directly onto the steroid ointment. Cortisone tablets, syrups or injections are not recommended. While they may provide short term improvement, they may also cause worsening of eczema and are associated negative side effects.

Antibiotics

Your doctor may prescribe antibiotics in severe cases where areas of infection are noted around the eczematous lesions.

Is eczema due to a food allergy?

There is a lot of concern that eczema is a result of a food allergy. In fact, a very small minority of children with atopic dermatitis will have food allergy. This is far more common in severe atopic dermatitis. It is more likely that eczema causes food allergies, than the other way around, as allergens may enter the skin through the defective skin barrier. Food should not be removed from diet for the treatment of atopic dermatitis without the guidance of an allergy doctor. A baby with widespread eczema not responding to the correct eczema treatment may need to be worked-up for a possible food allergy.

Can I prevent my baby from developing eczema?

Babies at high risk are those whose parents or siblings have any type of allergies. There is a lower risk of eczema if babies are not exposed to cigarette smoking. Breastfeeding is beneficial in the first 4 months, if possible. Probiotics during pregnancy may provide a beneficial role in eczema prevention. And lastly, regular use of emollients in high risk babies, even if no eczema is present, has been shown to be protective against developing eczema.

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