Winter is here. Snow-capped mountains, glistening white trees and children with rosy cheeks, kissed by the cold, brighten our days. We put on our snow tires, start making crockpots, break out the fleece sweaters and put up our holiday decorations. For most us winter is time to savor, however, some of us groan as our children battle with the pediatric illnesses and chronic diseases that tend to flare during this cold and dry season.
One such chronic disease is eczema. Eczema, otherwise known as atopic dermatitis is a chronic skin condition commonly described as the “itch that rashes”. Your child may have eczema if he or she has itchy red patches of skin that have a fine scale covering. In infancy, the patches are usually located on cheeks, scalp, face, or extensor surfaces (backs or arms or front of legs). For older children, the rash may be located on the inside of elbows or backs of knees. Watching your child scratch, sometimes until they bleed is a painful experience for any parent, and worse yet is the possibility of a serious bacterial skin infection. So how can you protect your children?
- Schedule an appointment with your Pediatrician: Atopic dermatitis can mimic many other diseases so it is very important to receive a formal diagnosis for your child. Sometimes eczema is a sign of a more serious disease, so tell your doctor if you child isn’t gaining weight, has had severe recurrent bacterial infections, or if any genetic diseases run in your family.
- Moisturize, Moisturize, Moisturize: See the scaling and flaking on your child’s skin? That’s a sign that there are microscopic breaks in your child’s skin, and that means water can evaporate from your child’s skin very quickly. What to do? Pick up a great FRAGRANCE-FREE moisturizer from your local pharmacy. I love Cetaphil Cream (in the tub, not the pump), but Eucerin, Aquaphor, Vaseline, petrolatum all work great! Smear it on your child liberally head to toe (care to avoid eyes, mouth, anus) as often as you think about it, but at least twice per day.
- Reduce bath times and use a Non-Soap Cleanser: Remember bathing is very drying to the skin so shorten bath time to about 10-15 minutes. If your child isn’t dirty its okay to bathe every other day rather than daily! Use a fragrance-free, non-soap cleanser if possible (I love Cetaphil face wash for dry skin – in the face wash cleanser aisle) Is there a right way to dry your child? Yes! Try not to rub the skin put instead pat dry after a bath (to avoid irritating the skin more), and don’t forget to apply a MOISTURIZER after bath time!
- Avoid Known Irritants: Usual culprits? Fragrances, fragrances, fragrances found in soaps and detergents. Buy detergents that are labeled “free and clear” or for “sensitive skin.” Smoke, extreme hot or cold, sweat, wool clothing or synthetic fabrics are also known irritants. Go for breathable cotton clothes whenever you have a choice.
- Stop the Scratching: Cut fingernails short to minimize how much your child can claw at their skin. Try covering an affected area while it’s healing so your child can’t scratch. If all else fails, an oral antihistamine can be effective in reducing the itch. Try a non-sedating variety like cetirizine marketed as Zyrtec or loratadine marketed as Claritin for daytime, and sedating antihistamines such as diphenhydramine marketed as Benadryl at night. Call you doctor for correct dosing information.
- To test or not to test for allergies: The younger your child is, the more likely allergies are a contributing factor. The food most likely to trigger eczema is eggs, but other foods may also contribute. Food allergy is NOT a common trigger in older patients but environmental allergies like those to pet dander, pollen or dust mites may be a factor. While knowing if your child has an allergy that is affecting their eczema might help you eliminate this trigger, it won’t “cure” them.
- When to call the Pediatrician again? You’ve been diagnosed, you’ve tried everything listed here and your child’s skin is still as red as Santa’s suit.
- Your pediatrician may prescribe a topical steroid cream. These creams should be used only for short periods of time under the care of a doctor. While “short burst” use of the cream is safe and effective, long-term use can cause thinning of the skin, striae (stretch marks), growth suppression, or hormonal imbalances that should be monitored closely with the help of your doctor. Let your doctor know if your child is experiencing any side effects of treatment. Furthermore, never use these creams on your child’s face, armpits, or genitals! Those areas are just too sensitive.
- For children 2 years and older your doctor my prescribe medications such as tacrolimus (Protopic) or pimecrolimus (Elidel). These medications work in a different way than from steroid creams and can be used on all body locations without the skin atrophy that steroid creams may cause. However, these agents can cause sensitivity to the sun so sun protection is a must!
- If skin has become infected you doctor may prescribe a topical or oral antibiotic. So make sure if you see any signs of infection on your child’s skin to make an appointment right away. We don’t want an infection on the skin to move into the child’s blood stream!
Remember, there is no “cure” for eczema, but with the previously described steps you can help “control” your child’s disease. Don’t forget, that two out of three of all children who have eczema do improve over time and at least twenty percent go into complete “remission” as adults. So grab your bottle of moisturizer cream and enjoy winter! Call us if you have any questions.
Dr. Elenor MacGregor, D.O.