Get Out of the Eczema Hot Zone
Are you -- and your kids -- living in an eczema “hot zone”? A recent study says that 1 in 10 kids nationwide have the uncomfortable -- and often embarrassing -- bumpy, itchy, rashy skin that’s a signature of this condition. Pennsylvania’s rates are a little below the national average, but in New Jersey 13 percent of kids have eczema, as do 11 percent in Delaware.
No matter which state you call home, your own home can feel like an eczema hot zone if you’ve ever been told by a doctor that one or more of your kids has it. Fitting the extra skin care into your daily routine, and keeping track of over-the-counter and prescription treatments can be challenging -- so much so that just one in three families managed to keep up with great eczema care for their children in one Harvard Medical School study.
What can you do? Ask your doctor for a written-down Eczema Action Plan to help you stay on track. You can download one here. It spells out when to use preventive washing and moisturizing steps, when to use extra-mild treatments if skin becomes irritated and when to turn to higher-strength medications prescribed by the doctor for more serious flare-ups.
For more insights into great eczema care for kids, Healthy Kids expert panelist Christopher Chang, M.D., Ph.D., a pediatric allergist/immunologist at Nemours/Alfred I. duPont Hospital for Children, has this advice.
Eczema causes bumpy, dry, itchy, scaly skin, often appearing in patches. It is a very common condition, part of a group of “atopic” diseases. Atopy means predisposed to allergy, so there is a hereditary factor to eczema. As such, there is no way to prevent it. Eczema is a part of what allergists call the “atopic march” or the progression of allergic diseases throughout life. It is usually seen in infancy, as bumps and dry, scaly patches on the skin. It can and often does last for years with periods of relief and flare-ups and is often accompanied or followed by allergies and asthma. One-third of patients with eczema will test positive for one or more food allergies and for some of them, the food will make the eczema worse. Fortunately, eczema subsides for many children and, for 50% of those affected, is gone by the age of 5. However,for others it may persist even into adulthood.
Eczema can be very difficult to treat. Children tend to scratch it and by doing so they break the skin barrier, causing further moisture loss. Dry skin is the enemy so the purpose of treatment is to keep moisture in the skin. We treat eczema with many over-the-counter lotions and creams, applied at least twice a day. Non-greasy lotions are easy to tolerate but the effects are short-lived because they tend to evaporate. Creams and ointments are more emollient but less well tolerated because they’re messy, especially for young children. The sticky substance gets on their hands and then on everything else. Eucerin cream, sold over the counter, is an effective middle-of-the-road treatment for many – not too heavy and sticky but with good emollient and staying power.We advise parents to avoid scented products especially those containing alcohol.
Beyond over-the-counter treatments are topical corticosteroids that come in different strengths. A 1% hydrocortisone cream, sold over the counter, is good for mild eczema.For more difficult cases, stronger corticosteroids can be prescribed by the allergist.For example, depending on the child’s condition and history, we may recommend a high potency topical steroid for 7-10 days and then lower the dosage. However, we don’t use strong ointments on sensitive, thin-skinned areas such as the face and genitalia. For these spots, immunomodulatory agents such as Elidel and Protopic are recommended. For some kids, scratching is a real problem, so we may prescribe Atarax, which combines antihistamine and ant-anxiety agents, to help them get some rest.
Wet wraps – essentially wrapping the child’s affected body parts with wet gauze – can provide relief by keeping the skin moist, but we recommend parents do this only with our recommendation.It doesn’t work for everyone. In the past, bathing was thought to dry out the skin, further exacerbating the eczema. But now we advise bathing once a day using unscented soaps or body wash (Dove is good); applying moisturizer right after bathing;using a topical corticosteroid as instructed; and eliminating allergens in the home, including foods, dust, pollen, and pet dander.
Christopher C. Chang, M.D., Ph.D., is division chief of the division of pediatric allergy/immunology at Nemours/Alfred I. duPont Hospital for Children, and clinical professor of pediatrics at Jefferson Medical College