This week our Paeds Nurse is bringing you the low down on Eczema; what it is, what triggers it, and what you can do as a parent to treat it. By the time this blog is done, we're hoping you'll feel more equipped to tackle the challenge of this tricky skin condition and, in turn, soothe your little one.
The not so funny thing about eczema is that nobody knows the exact cause of it. What we do see however is that kiddies with a family history of eczema, asthma or hay fever are more likely to develop it. Little boys and little girls are equally affected. We also know that eczema is linked to our immune system, in particular when it overreacts to irritants or allergens. Eczema affects almost a third [30%] of kids in Australia - but half of them grow out of it by the time they turn two. Further to this, research shows that 85% of little ones who suffer eczema will have grown out of it by their 5th birthday. Around 15% will be stuck having to manage it for life.
So, what is it?
Eczema is sometimes called atopic dermatitis and it's a condition that makes the skin dry, red, itchy and bumpy. Thinking back to school days I remember the kids with eczema, itching dry elbows or knees, their poor skin looking scaly and red. Thankfully we know a little more about how to treat it than back then and kids can live a very normal life with a little extra TLC for their body's largest organ.
A little fun fact about eczema is that the word itself originates from the Greek word, "ekzein" which means to 'break out.' Essentially when a child suffers what we call an 'exacerbation of eczema' their skin has indeed broken out, losing its' usual barrier function and making it more prone to dryness and infection.
One thing to remember about eczema is that it's not contagious and your main goal is all about making your little one more comfortable living with it. I know this process can be exhausting for parents though.
Eczema will show up on a bub's skin, potentially anywhere on their little bod. For adults and teens, eczema is most commonly seen on hands, neck, inner elbows, ankles, knees and feet. The first sign of eczema is red, itchy skin that may look particularly dry in appearance. It helps to understand that when someone is suffering from eczema their skin is hanging onto excess heat. The aim, therefore, is to cool the skin, allow it to breathe and help return moisture to it after the heat causes it to dry. We'll dive into treatment more a little later.
As we said earlier, eczema is more likely in a child who has a family history of it and this explains the role that genetics play. Scientists have found some people who suffer from eczema have a variation from normal within the proteins that help their body maintain normal skin. Work is being done to investigate these proteins and how we can maintain normal levels and therefore improve the skin of someone with eczema.
Eczema looks like this:
- Dry skin.
- Itchy skin.
- Red rashes.
- Bumpy skin.
- Scaly, leathery patches.
What makes eczema worse? What are the triggers?
The environment plays a huge role in eczema and how badly the skin is aggravated. Just like with asthma and hayfever many substances within our environments may make it worse. These are called allergens and sometimes the trickiest part for parents is figuring what allergens are affecting their unique child. Allergens may include things like pollen, pet hair or certain foods, such as egg, milk or peanuts.
The other thing about the environment is the weather. Low levels of humidity in the air mean it's naturally dryer and this can cause drying for our skin. This is the very reason why eczema is commonly worse for sufferers in the winter months because our heaters contribute to dry air. Couple this with parents piling on many layers of clothing on a child, their delicate skin may have trouble breathing. While summer, therefore, sounds the easier season, the flipside is that heat and high humidity will cause sweating, and unfortunately, this too can make eczema worse. You see the balance in temperature and humidity can be hard to find!
Exposure to other factors is another major contributor. Certain fabrics such as wool can be irritating to the skin. As too can soaps and some skin products. Parents of kiddies with eczema will soon realise their child is going to be more sensitive to anything you put on it, however thankfully these days there are many gentle, eczema-friendly products on the market. Another thing to consider is air pollutants. A child who is present in the company of a smoker is likely to experience worsening of their symptoms as tobacco smoke is never a good thing. Be mindful of other air pollutants without your home, work or play environments.
Stress is another thing I want to touch on as we know that our immune systems may suffer when the body is in fight or flight mode. Even mild stress levels for a child can worsen their eczema so it's highly encouraged to always keep a check on their emotional state. Signs your little one may be experiencing stress include irritability, difficulty concentrating, worrying or seeming anxious, regressions in their sleep or behaviour and changes in their bowel habits.
The Basics to managing Eczema: Think Hot Dry Prickles
Previously, we've summarised eczema's triggers in this easy to remember mnemonic: HOT DRY PRICKLES!
So, when it comes to treating it we can focus on these triggers and how to minimise their effect on our little ones.
HOT - As we mentioned above, eczema is more common in winter when we're pumping the heater and piling the layers on our kids. We suggest keeping your house below 20°C during the day and below 15°C overnight. Pop bubs in just one or two thin layers and let school or childcare know how to dress your little one appropriately.
If you are travelling remember that car seats can be quite warm for kids so dress them in light cotton layers and invest in a good sunshade for the window. Keep car heaters to minimal.
Little ones will generally itch more overnight as they are not distracted by other things and warm blankets can also make them hot. This can make sleeping difficult and can contribute to frequent waking or bleeding to the skin. We will talk about how to combat this with wet dressings below.
DRY - Try to avoid substances that dry the skin like detergents, soaps and bubble baths. It can help to use SLS-free toothpaste too.
When you're buying detergent think about non-perfumed options or pure, natural soap. Adding a low-allergenic fabric softener to your wash can help ease the stiffness of dry clothes. Likewise, clothes dried in a dryer as opposed to on the line, tend to come out softer.
Swimming in chlorinated water can help the exacerbation of eczema as the chlorine will minimise infection of the affected skin. This is the reason bleach baths are used as an effective treatment, and although it sounds dramatic, remember that bleach is the same chemical as pool chlorine and in the case of a bleach bath is used in far more dilute quantities. Only do bleach baths after discussion with your doctor, and always follow the concentration directions to a tee. Keep in mind that dummies may aggravate eczema around the mouth, chin and chest because saliva collects around these areas more with dummy use. For this reason, parents often find their little one's eczema to become a lot worse during teething times. Gently wipe away saliva and if the skin appears dry you can apply a moisturiser around the mouth area, which will help act as a barrier.
PRICKLES - the aim is to reduce the itch to bub's skin, so ditch the woollen and acrylic clothes, bedding and car seat covers and replace them with pure cotton. When you think about clothing for a bub with eczema it's wise to consider things like stitching, tags, frills, zips or lace edging. These components of clothing can make a child feel itchier.
Cotton and silk fabrics are best for clothing and bed linen. You can turn undergarments like singlets inside out and remove the tags to avoid the prickle feeling. Keep in mind that if a fabric feels even slightly rough to you it will be super irritating for someone with eczema.
Sometimes parents ask if kiddies with eczema should be immunised. What we want you to know is that unless advised by your doc there is no reason a child with eczema should not be immunised. Kiddies with allergies to eggs may require closer monitoring following vaccinations but this can all be discussed with your GP.
Treatments for Eczema
Kiddies with eczema will have very dry skin and for this reason, they will need a moisturiser. Moisturiser is used to prevent the skin from drying and are a very important part of treatment for your little one. Your GP or maternal child health nurse can advise you on which brands to go for, but typically you are looking for non-fragranced and not-too-greasy, Pharmacists can be super helpful peeps to chat to about which products will keep your little one.
Bath time is a very important part of a child with eczema's day. We don't want their skin to overheat more so keeping the bath on the cooler side is advised. Tepid water, around 30 degrees, is ideal. To prevent dryness add bath oil to the water. Your little one can play as normal in the bath and enjoy the fun factor that bathtime brings! Once they're ready to get out, simply pat their skin dry with a soft cotton towel and moisturise skin within the first few minutes after. This is a tricky way to trap some of the water in bub's skin and lock in the moisture which helps that skin stay hydrated.
Bleach baths can be incredibly helpful. Check out the Royal Children's Hospital guidelines on beach baths at this link here.
In between bath times, it's can be very soothing for your little one to have a cool compress. You can do this with wet washers, soaked in tepid water and some bath oil. Keep the towel quite wet once you remove it from the water and hold it against bub's red or itchy skin for 5-10 minutes. You can do this as often as required throughout the day. Always make sure you wash face washers after use or use disposable towels.
If your little love's eczema is persistent you must have your GP or dermatology nurse on board with a plan, as they play a valuable role in supporting you through the challenge of living with eczema. Part of this support includes demonstrating how to apply wet dressings and helping you source the equipment required. Wet dressings help eczema because they help reduce the itch, they help clean the skin's surface, they keep bub's skin hydrated and they protect the skin from further irritation. We know it can seem so counter-intuitive wrapping your bub in wet dressings and popping on a wet singlet before putting them in bed, but trust us on this that it works a treat. Wet dressings are considered essential to improving your bub's eczema and helping your little one get more sleep. The Royal Children's Hospital advises how to complete wet dressings here.
Sometimes eczema requires a little help from modern medicine to nip it in the bud. This comes in the form of cortisone steroid creams or ointments that a GP prescribes. These creams help calm inflammation in the skin and ease the redness that eczema causes, in turn making bub more comfortable. These creams are usually applied once or twice a day in conjunction with a bub's eczema routine including wet dressings. They come in different strengths. When applying these creams they go straight on the skin and then moisturiser over the top.
Is my little one's eczema infected?
When a bub is scratching their skin a lot it may become prone to infection. This occurs when bacteria enter the skin through broken areas. Kiddies with eczema sometimes suffer secondary infections if their eczema is not under control.
Signs of infection include:
- Skin that is more painful than usual
- Skin that is itchier than your child's norm
- If bub is finding it hard to extend their elbows or knees
- Bleeding eczema
- Weeping eczema
- yellow or crusty scabs
- If bub has a fever
If you think your little one's eczema has become infected you need to get them seen by your GP. When applying any creams it's important to gently remove the crusty areas by wet compresses. This way the medication can get through to where it needs to be.
So, there you have it: a breakdown of what to do when your little one's skin is having a breakdown! Share this with your parent tribe to get the knowledge about eczema out there. You never know who you'll be helping!