Atopic dermatitis, also known as eczema, is a common childhood problem. It is characterized by irritated, reddened, dry, itchy skin. Eczema can be mild, where there are only a few patches of dry, rough skin. Or it can be severe, where there are many zones of redness and irritation throughout the torso, arms and legs, and the child can be seen scratching the skin throughout the day. Children with eczema often have other family members with the same condition, or with other tendencies toward allergy–such as hay fever or asthma.
The underlying problem of eczema is skin irritation. It can arise where there’s friction with fabrics, watch bands, rings, clothes tags. Certain detergents or soaps can cause flares. Other people can develop eczema as a result of airborne irritants, such as cat hair or molds, even renovation dust. You’ll also hear of people having eczema while they live in one city, and it will become quiescent in another–even though their diet, or exposure to cats and dogs remains the same. It can be very difficult to sort out what the exact instigator might be–given the multitude of particles present in smog or household dust.
Moisturizing the skin is the mainstay of therapy. Emollients add a microscopic layer that protects the skin against irritants and allergens.
Distinctive features of the eczema according to the age of the child
Infancy (infantile eczema)
The baby might first develop rashes and dry, irritated skin at about about two or three months of age. In some children, the onset is later. The skin is reddened, with a moist, weepy texture. Little scratch marks appear from the baby itching and rubbing the area against the crib sheets.
When the conditions starts in early infancy, the cheeks are usually the first area of the body to become involved. This makes sense as the cheeks are constantly coming in contact with different fabrics, such as sheets, blankets and the clothes of the people holding the baby. After the cheeks, the rest of the face, neck, trunk, wrists, and extensor (outer, not inner) surfaces of the arms/legs might become involved.
As mentioned before, the extent and severity of the rashes can vary a great deal, with some babies having frequent eruptions, and others only occasional flare-ups.
Around age two or three, the child’s skin usually starts improving–with the child having a “remission” that lasts about two years.
The child still, however, has very dry skin that is more sensitive than other children’s. Also, the flare-ups typical of atopic dermatitis can still occur, but they’ll probably be less frequent.
School Age (Age 5 to adolescent)
As the child gets older, the skin continues being dry and sensitive to irritants. Itchy rashes can occur as they did earlier in childhood, but the pattern of distribution is different in the older child. The trunk and the flexor (inner crease) areas of the arms and legs–such as behind the knees, the inner elbow, and the underarm–are more likely to become irritated. This is unlike the infant and toddler where the kneecaps, elbows, and outer surfaces of the arms and legs were more often the sites where rashes would erupt.
Atopic dermatitis is not a condition that can be cured once and for all
Instead, it is a problem that one has to “live with” but which you can make an effort at and often succeed in controlling. A person with sensitive skin usually has sensitive skin throughout their life. The important thing is trying to keep the skin moisturized and identifying and avoiding irritants. What irritates one child might not bother another. Some children will go through a period when their skin has frequent flare-ups, and then they’ll go through a long period of almost complete remission.
Ways to treat Eczema
Treatment can be divided into two phases: maintenance therapy (use of daily moisturizers and avoidance of irritants) and flare-up therapy (spare use of special steroid creams for areas of exacerbation).
- There are many good moisturizers on the market, including alpha Keri lotion, Vanicream, Vaseline Intensive Care, Lubriderm, Aquaphor, Eucerin, and Complex 15. People with eczema usually find that some feel better on their skin than others. This is probably due to different skin textures.
- Avoid frequent baths. Every other day baths should be enough, with the exception of the diaper area and spot washing of the hands and face.
- Taking baths is preferable to taking showers, as the water stream over the body is more likely to wash away the body’s natural oils.
- When bathing, avoid overly warm or cold water, and use a gentle soap.
- When drying off, don’t rub the skin but rather pat it lightly and then apply the moisturizer
- There is an over-the-counter product called Aveeno Bath which can be added to the bath water and which is very soothing for dry, irritated skin. Avoid bubble baths and bath oils with fragrances and colorings that could aggravate the skin.
- Choose fabrics carefully. Avoid placing rough-textured clothing and wool directly against the skin.
- You might consider placing a cotton sheet over your couch or on your rug for toddlers and youngsters who are playing, crawling, or sitting on rough fabrics with exposed arms/legs.
- Keep the child’s fingernails as clean and short as possible to avoid introducing infection when they itch.
Steroid creams are used to calm the immune reactions that cause the irritated skin. They don’t have overnight results; they take several days to exert their effect. Often parents feel “the stuff isn’t working” and stop using it before it is able to act.
Steroid creams and ointments come in various strengths. Steroid cream can have side effects if they are used improperly. Overuse of strong steroid cream on a regular basis could affect a child’s immune system or growth rate or lead to permanent skin changes. That is why they are only used on small areas for a limited number of days. They have to be used sparingly, with only a tiny amount gently rubbed in. When a child has a flare-up, a stronger steroid cream might be used in one small area, with the other areas of eczema being treated with just moisturizers or a lower potency cream.
Sometimes parents can feel frustrated because the eczema doesn’t “just go away.” By paying careful attention to diet and moisturizing the child’s skin regularly, even the toughest cases can show great improvement.
The role of food allergy in eczema
Food allergens play a role in about half of the cases of eczema. The most common culprits are cow’s milk proteins, (such as the lactoglobulins in whey, casein ) egg white (albumin) and peanut butter. Wheat, soy, apple juice, and corn are some of the other common foods that aggravate some people. A special note–cow’s milk, eggs and peanut butter lead the list of allergens found in school-aged children. In young infants, green peas and apple juice are sometimes found to cause eczema.
The exact mechanisms by which foods influence eczema are not fully understood. The skin is a very active immune organ and is in constant communication with the rest of the body through the blood stream. Children often have a post viral rash after several days of fever. This is due to more T cell traffic under the skin after the illness. A similar phenomena occurs with food allergens. It is thought that the presence of the offending food causes more immune cells under the skin, and this can cause a low grade release of histamine from specialized skin cells. In young babies, eczema can take several months to present itself. In fact, babies who are sensitive to cow’s milk proteins often come down with the characteristic patches at about 3-4 months of age, even though they’ve been on the same formula since birth.
Parents of children with eczema have to play detective to try to distinguish what food might be irritating…cow’s milk formula? Cheese? Apple juice? Peanut butter? It’s a good idea to take away one food group at a time, for about a month to see if any improvement occurs. More importantly, it’s good to avoid lots of artificial flavors and colors, such as those found in fruit “drinks” and 10% juice “juice boxes.” Kids with eczema are better off drinking whole fruit juices, diluted with water. Juices are a very concentrated form of fruit and if one is mildly allergic to something like cranberries, cranberry juice is taking a lot of cranberries in one gulp.