This month’s blog is on winter and its effect on skin. Winter is a difficult time for skin. The cold, dry air outside and the warmer dry air inside can cause significant skin irritation. Children with eczema can have frequent skin “flare ups” in the winter.
Let’s start with some information about eczema. Eczema is a chronic itchy skin condition. Eczema usually starts in the first few years of life, often before a child’s first birthday. Eczema symptoms seem to wax and wane. Some children have mild eczema while others have severe symptoms. Infants usually have eczema rashes on their cheeks, foreheads and scalp. It may affect most of the body but usually spares the diaper area since this area is moist. Once an infant begins crawling the rash might mostly affect the knees and elbows. Toddlers usually have eczema rashes in the knee and elbow creases as well as wrists, ankles and hands.It may also affect the skin around the mouth and eyelids. Older children might only have isolated eczema patches.
.What triggers a flare of eczema? Eczema often flares when the skin is very dry, when it comes into contact with irritating substances or allergic triggers, or when the skin is infected. In infants, saliva from drooling can cause worsening symptoms, especially on cheeks, chin and neck. Triggers can vary from child to child and can include pets, carpets, dust mites and certain fabrics and possibly some foods.
There is no cure for eczema but in most cases eczema becomes less severe with time. Eczema can usually be controlled with appropriate therapy.
So what “therapy” is used to treat eczema? Most dermatologists recommend that children with eczema should bathe daily. Baths are preferred over showers. Baths should be warm, not hot and limited to 10 minutes. Soap use should be limited to “dirty areas” such as the diaper area or areas that appear dirty. Soaps for sensitive skin should be used.
The skin should not be scrubbed but cleansed gently with a soft washcloth. Once out of the tub the skin should be patted dry, not rubbed. A moisturizer should be applied immediately after bathing.
Don't give bubble bath, as it will irritate skin!
Frequent application of moisturizers is the main therapy for eczema. Moisturizers should be applied at least twice a day in a thick layer over the skin. Creams and ointments are much better than lotions. Lotions are mostly water and are not very effective. If a child complains of burning with application of a cream switching to an ointment might help.
What if you are using moisturizers regularly and your child has an eczema flare? First, it’s important to be sure that the flare is not due to infection. Skin is our largest organ and protects our body from infection. If the skin is cracked or irritated (as it often can be with eczema), the protective skin layer is compromised and might allow bacteria to invade. Think infection if the affected skin is red, raw, weeping or crusted. In this case your child should be seen by a pediatrician to determine if oral or topical antibiotics are required. If the skin is mostly dry with “rough” areas but no redness or crusting then using a steroid cream or ointment might be advised. It’s best to discuss this with your child’s physician to determine if an over-the-counter steroid (1% Hydrocortisone cream/ointment) should be tried or if a prescription strength topical steroid is necessary. Topical steroids should only be used on affected skin and use should be limited to 1-2 weeks unless advised otherwise by a physician.
Does diet affect eczema? Significant eczema symptoms in an infant or toddler might be related to food allergies although this is not common. If treatment with appropriate bathing, frequent application of moisturizers and occasional use of topical steroids helps control eczema symptoms then a food allergy is unlikely. If eczema does not improve with appropriate therapy then it might be advisable to have an allergy evaluation.
So, in conclusion, there is no way to prevent eczema but good skin care and frequent use of moisturizers can strengthen the skin against all kinds of irritants. Avoidance of known eczema triggers is important. If flare-ups occur it is important to step up therapy right away before symptoms become severe.
Article written by Sue Gaston, M.D.