Kids Health Watch is brought to you by our friends and Magnolia Springs Pediatrics
This winter in Baldwin County has brought us lots of fun experiences–Flu, Strep, GI bugs, colds and more weather changes than you can imagine. Added to them is a resurgence of eczema. While it can happen in any age person, over 85% of all eczema occurs in persons less than five years old. The good news is that eczema completely resolves in half of all infants affected by the disorder by age three. Let’s discuss the physiology behind eczema, some potential causes, and what you can do to help minimize the rash that itches!
Eczema is a term given when the skin turns red, dry, scaly and itchy. Oftentimes, there will be a family history of allergies, asthma, or other skin conditions that can help predict if a child will have eczema. While the exact cause of eczema is unknown, it’s often thought to be linked to an overactive response by the body’s immune system to triggers such as soaps, cosmetics, jewelry, detergents, and certain types of clothing. In addition, environmental allergens and foods can trigger “flare-ups,” as well as stress, illnesses and changes in temperature and humidity.
In infants, the itchy rash can produce an oozing, crusting condition that occurs mainly on the face and scalp, but it may appear anywhere. In older kids, the skin problem occurs most often between the ages of four and ten years old, and is characterized by round, slightly raised, itchy, and scaly eruptions on the face or trunk. These are less oozy and more scaly than in young infants, and the skin tends to appear somewhat thickened. The most frequent locations for this rash are in the bends of the elbows, behind the knees, on the backs of the wrists and ankles, and on the fingers. All types are very itchy, and the skin generally tends to be very dry. Sometimes, the eczema can occur into adulthood and tends to have localized flares of dry, itchy skin.
So, what do you do? Well, the first goal is try and identify possible triggers and eliminate them. In infants, be sure to use unscented and dye-free lotions, soaps, and detergents. And be sure to check that all caregivers are doing the same. I had one infant who was really breaking out, but the parents were using all the right products. Sure enough, when the child would go to grandma’s house a few times a week, the clothes were washed in her detergent and the child was reacting. Occasionally, I have seen children who manifested a food allergy by having really bad eczema. The most common culprits are milk, wheat, and eggs, but other environmental allergens can be responsible as well.
In terms of some treatment options, the basics include frequent use of scent free, dye-free moisturizers regularly and frequently to minimize itchiness and dryness, especially after bathing. Some children do better with frequent baths and some do better with bathing every other day. In addition, there are other creams that can be used, but these should only be used as directed by a physician. There are certain steroid creams that can cause serious damage to the skin on the face and body if used incorrectly. Also, some children require wet and dry body wraps and I have even had parents smear Vaseline inside a kid’s socks at night to keep the feet moist! It is critical to have a very specific plan with your physician that must be followed by all caregivers to help prevent and treat eczema.
One of the most important aspects of eczema to understand is that sometimes it just happens. And, as soon as you get the eczema under control, it comes back. So, don’t give up! Stay positive! And as always, consult aap.org and your physician with questions.
Robert L. Rux, M.D. is a Board Certified Pediatrician at Magnolia Springs Pediatrics. Originally from Mobile, he attended medical school at The University of Alabama School of Medicine (UAB) and completed residency at The Children’s Hospital of Alabama (UAB).