Eczema (an article dedicated to all the itchy babies out there)

For those of you fortunate enough to have eluded this prevalent disease, eczema is a skin condition commonly known as the “itch that rashes”. It’s itchy, it’s painful, it’s stubborn, and it’s ugly. Once your pediatrician or family doctor has diagnosed your child with eczema, it’s important to know what steps to take in order to alleviate your child’s suffering.

First
1) Use perfume-free, dye-free detergents and soaps on your child’s clothing, bedding, and skin.

2) Moisturize, moisturize, moisturize! I like to tell moms that the child should be slippery and glistening because there’s so much moisturizer on their skin. I know parents think it’s gross and unattractive for their child to be greasy, but if your first priority is the child’s comfort, make sure they’re moisturized well. Since lotions are frequently alcohol or water based they evaporate from the skin quickly; try to use creams or better yet, petroleum jelly products when possible. I know parents that have even used Crisco!

3) Bathe them. Some of you who might have been told to avoid daily baths in order to further prevent drying out the skin. The truth is that bathing in lukewarm water for a brief period (less than 5 minutes) helps remove offending agents and introduces moisture to aggravated skin. Applying moisturizers immediately after bathing while the child is still wet helps to seal in some of the moisture.

4) Avoid wool and synthetic materials. Cotton is best for these children.


Second
1) If basic measures such as avoiding offending agents and applying moisturizer do not work, then your physician will likely prescribe a steroid cream/lotion/or ointment. Know that not all steroids are the same- even the same name will have a different potency depending on whether or not it is a lotion (least potent), a cream (medium potency), or an ointment (highest potency). Do not exceed the recommended duration of application because steroids can thin and discolor the skin and can be absorbed in the bloodstream. Also, steroids should be used on the face sparingly.

2) Food allergies are becoming increasingly linked to eczema. Should you suspect that your child’s flare-ups are tied to introduction of certain foods, talk to your physician about allergy testing (if your child is old enough) or simply food avoidance.

3) Sometime eczema is resistant to the therapies listed above, because the skin is infected, usually with a common bacteria like Staphylococcus aureus. If the lesions appear “wet”, meaning weeping and oozing with excessive redness or pustules, the skin may be infected. In this case, either topical or oral antibiotics may be used to clear the infection. Unfortunately, it is the case that some children are colonized with these bacteria, making their skin even more prone to infection. In such cases, some physicians will recommend bleach baths. DO NOT DO THIS WITHOUT CLEAR INSTRUCTIONS FROM YOUR PHYSICIAN!

4) Immunomodulators are among the newest therapies for eczema. Known on the market as Elidel and Protopic, these drugs effectively treat eczema without the use of steroids. However, because they suppress certain parts of the immune system, the FDA is concerned about an increased risk to lymphoma and has therefore issued a “black-box warning”. As with all drugs, use these drugs judiciously and only when necessary.

5) UV light therapy is also recommended by a few dermatologists. It’s expensive and used only on older patients with more resistant forms of eczema.

If you find you’ve hit a roadblock with your pediatrician, consider consulting a pediatric dermatologist or allergist. Be persistent and patient and you will help your child.