Eczema (in Greek, means to “boil over”) is a condition of the skin thought to affect 10% of the general population. It stems from a defect in the skin cells tight junctions (think of them as grout on a tile floor) – they are lacking, and as a result skin cells essentially can’t join forces to retain moisture, and many portals of entry exist for irritants to worsen the condition. Secondly, the immune system in children with eczema tends to overreact, with a more brisk response to inflammation and itch than normal.
There are many theories as to why eczema exists – genetics likely influence a good percentage of children – if one parent has allergies/eczema/asthma, there is about a 1:4 chance a child will develop one of these conditions, and if both parents have an allergic history, the chances are greater than 50%. Those children with lifelong/severe eczema have “atopic dermatitis”.
Babies with early onset eczema (i.e. before 4 months of age) statistically are at more risk for food allergies and asthma later in life. One theory is that their broken skin allows the entry of allergens into the body, triggering an early immune response that results in an “allergic march”, that if left untreated/unchecked, may progress to food allergies, allergic rhinitis (hay fever) and ultimately asthma.
Irritants, allergens, and even emotion and climate can trigger eczema as well. Irritants (solvents, detergents, perfumes, etc) should be avoided as a preventive strategy. Allergens (ranging from dust mites, to foods, to other environmental factors) may be more difficult to identify, and often challenging to avoid. Emotion and climate are factors even more difficult to control (especially with children).
So what’s a parent to do? Keeping baby’s skin as intact as possibly and reducing the inflammation may be key in not only preventing current discomfort and itch, but may impact future allergic manifestations, as well.
-Avoiding known irritants is important – and if allergens have been identified, avoiding them as well.
-Keeping the top layer of skin from becoming brittle, cracked, and itchy is the mainstay of eczema therapy. Emollients (creams and ointments) are more effective than lotions (which contain alcohol and water, and evaporate leading to dryness). FREQUENT application of emollients, especially within a minute or two after bathing, help seal in skin’s natural moisture, soften skin to reduce itch – thus maintaining its integrity.
-Bathing is important to reduce bacterial load on the skin, plump up the skin in preparation for emollient use, and to ease some itch. The key is short, warm (not hot) baths, use of cleanser (not soaps, that can strip even more natural oils from skin), and gentle toweling off (not brisk rubbing, that can provoke itch).
-Recognizing secondary infections early – if eczema is weeping, crusting, accompanied by fever or rapidly worsening itch, a trip to the doctor is essential to calm the storm in the skin.
-For severe cases, steroids or non-steroidal immune modulators are used to calm inflammation and return skin to a decent enough baseline that emollients can then take over the job. Over the counter products, if used frequently and routinely, can be the mainstay of therapy in most cases. Look for creams, emollients, and balms and avoid lotions. Look for products that contain ingredients like shea butter, avocado, grapeseed oil, antioxidants, ceramides – all these help mimic that “grout” that is missing in eczemaprone skin. Avoid soaps, sulfates, and products with nut oils (as their introduction through the broken barriers may provoke nut allergies later).
Also, dressing a child with eczema in loose, breathable cotton clothing is preferable. Angora, wool, cashmere and other wooly textures may start an itch/scratch cycle. Certainly in the winter, the layers in contact with skin should be breathable, and then followed by warm layers.
Communication with your doctor and/or pediatric allergist or dermatologist is key in helping identify triggers, keeping you updated on preventive strategies, and helping your little ones weather this sometimes difficult condition. Those partnerships are key, and as a parent, being a label-reader and being vigilantly diligent in your skin-care regime equally as important.
About JJ Levenstein, MD, FAAP
Dr. JJ Levenstein is a board-certified pediatrician, fellow of the American Academy of Pediatrics, and founder of a thriving private pediatric practice in Encino, California. Recently retired, she continues to serve on the clinical staff of Children’s Hospital Los Angeles, and has been consistently voted one of the Best Doctors in America® from 2003 through 2012. Drawing from her experience as a pediatrician and a mom, Dr. Levenstein serves as president and co-founder of MD Moms, makers of Baby Silk, the first personal care line for babies developed by pediatrician moms.