Help!! my son has horrible eczema. he is 5 years old and
if flares for no obvious reason. we use the steroid cream
prescribed, which helps...but then it comes back when we
stop. What can we do to treat it? is there something
that might be triggering it? The poor guy is so itchy when it
happens....is there something we can do to help that?
AP: Maria, what is eczema and what causes it?
MK: well Alicia, Eczema, or dermatitis is a problem with the skin
as a barrier to keep moisture in and bacteria and irritatants
out. Lets first talk about what normal skin does.
Healthy skin cells form a barrier to the outside world, they are
plumped up by water and have fats and oils surrounding them to
create a protective barrier against the outside world.
In eczema the structure of skin is a bit different, you may not
have as much fat and oil between those skin cells and as a result
your skin cells are not as able to keep as much water inside
them. They get dry and gaps in the skin form which allow more
moisture to leak out and irritants and bacteria to get
Some people are more prone to having eczema through genetics (ie
family members have it or other conditions that are commonly linked
such as allergies or asthma) or their profession, or daily
activities increase the risk of eczema. Common things that
might increase the risk of eczema are washing hands frequently, or
repeated exposure to substances that pull away those healthy oils
and fats. As a result your skin barrier breaks down and becomes
dry, irritated, cracked and inflamed. This damaged skin is
then even more susceptible to any substances that irritate it and
The skin changes also are associated with significant itch, which
can then lead to further skin damage when people scratch this
itch! What a vicious circle!
Eczema can be quite mild - day a bit of redness and itchiness
behind the knees or in the elbow creases, to quite severe with red,
itchy, weepy skin with crusts. It can also come and go, or be
present for long periods of time and require ongoing treatment to
keep it at bay!
Alicia, who gets eczema?
AP: Good question Maria! We know that 1 in 10 people will be
affected by eczema. Most of these will have it before the age
of 5. We also know that it can be associated with seasonal
allergies and asthma. If one parent has one of these then
kids are about twice as likely to get eczema, if both parents have
these symptoms then it is 3-5 times more likely that the child will
get it. In terms of decreasing risk, we know that early
exposure to certain bacteria through day care, farm animals and
having a dog at home can be protective, and decrease the risk of
Most cases of eczema in children will get better by the time they
get through their teenage years.
Maria we know that in people who have eczema there are certain
things that can make it worse or cause a flare...could you chat
with us a bit about that?
MK: Sure. So anything that disrupts that skin barrier can
bring on a flare or make eczema worse, and this is important to
recognize for prevention and the ongoing management of
eczema. Common things that can disrupt that skin barrier are
soaps, bubble baths or anything else that strips those precious
natural oils from our skin. Also trauma to the skin itself
can increase flares of eczema - this can come from someone
scratching their itchy skin, or wearing "scratchy" clothing such as
wool next to skin. Also anything that increases the pull of
moisture out of your skin can be a problem, these are things like
low humidity and heat. Because eczema and seasonal allergies
can be associated, there is always a question as to whether certain
substances can cause flares of eczema. There is not great evidence
that certain foods can trigger or worsen eczema, and it is
important to see a doctor who specializes in allergies if you think
this might be the case in your child or yourself before you
eliminate it from their diet. The risk of foods triggering
eczema in adults is very rare. There is some evidence that
contact with dust mite and cat dander can worsen eczema in the
areas that were exposed, but again, not in the majority of
Alicia, Now that we know a bit more about eczema - how can we
AP: So there are a few things we can do on a daily basis as
prevention for eczema in those people who have it. Some of
these things we have already eluded to. Avoiding harsh soaps,
fragrances and other substances that can strip our skins naturally
occuring oils is a great first step. If you are having a
bath, do not add bubble bath, and only use soap on your dirty bits
in the last few minutes. Good options for cleansing include
Cetaphil, Cera Ve and Aveeno skin cleansers. Also good if you
have to wash your hands often, is to have some of these at all the
sinks you use to wash your hands at, and right next to it...some
AP - One of the most important things is to hydrate our skin, and
in this case the goopier the hydrating cream the better!
These create a better barrier to keep moisture in our skin.
The commonly recommended products are thick creams such as Cera Ve
and Glaxyl Base and ointment type products such as Vaseline,
Aquaphor or Prevex. We should be applying these 2-3 times
daily and after our skin has been wet (after a bath, washing hands
etc). It is really important that we apply to wet skin, do
not thouroughly dry it, and apply quickly after bath, shower or
hand washing. Some people find the ointment products very
greasy, so perhaps using the cream's during the day and ointment
before bed may be more acceptable. Different creams and emollients
work differently for people, so there is a bit of trial and error,
and this may change based on the time of year as well.
Instead of using a typical soap to wash - emmolient soap
substitutes such as the Cera Ve or non scented bath oil is
fine. Also making sure water in our baths or showers are not
too hot, as this pulls moisture out of the skin.
MK - I will add in that for babies and toddlers with very dry skin
prone to eczema, I often recommend not using any soap at all.
People are often taken aback by this but remember that all soaps
will strip the natural moisture barrier. You still need to
add in a good THICK moisturizer.
AP - Avoiding scratchy materials, such as wool, synthetics, tags
and zippers that irritate the area. Avoiding excessive heat,
MK - What about your favorite activity, Alicia? Laundry?
AP - I love laundry. For eczema and sensitive skin, remove
all harsh and perfumed detergents. And try not to use dryer
sheets. Anything that smells, really.
Maria, if doing these things regularly does not keep eczema at bay,
what would the next steps be for managing a flare.
MK: So there are a variety of different techniques we can use to
manage flares. First of all....keep up with all the
In terms of managing the skin symptoms the mainstay is topical
steroids. These are applied to the affected areas of the skin
and help to decrease the inflammation and allow the skin to
heal. Some milder options you can buy at a pharmacy are 1%
hydrocortisone ointment, which you can apply twice daily to the
flared area until it goes away, this may be all some people
need. Remember there is a difference between cream and
ointment. Ointment is thicker and will stay on longer.
But it's greasy and can stain clothes. Others may have more
significant flares and need a prescription based steroid for their
skin. We generally recommend applying for 48 hours after a
flare seems to have gone.
Occasionally eczema can get infected, and this often appears like a
yellowy orange crust to the eczema, we can often manage this with a
topical antibiotic, but if you think the eczema is infected, you
should certainly see your health care provider to have it
For people who are getting infected eczema we also recommend 1-2
bleach baths a week, as long as there are no open areas on the
skin, as a preventative measure. This is 1/4 cup of bleach in
a half full (80 litres) of warm water and soak for about 10
minutes. Do not put your head under water and rinse off with warm
water after, and then immediately apply your moisturizing cream or
emollient to it.
Occasionally we also recommend Wet Wraps for those people with more
severe eczema, these are applied over the emollient and/or steroid
cream to help cool, improve moisturization and help with the
itch. There is more information about this in the show notes,
but certainly talk to your health care provider about
There are stronger topical medications then can also be applied if
what we have reviewed is not effective, but most mild to moderate
eczema can be managed with diligent prevention and quick treatment
of the flares.
The other component to eczema is the itch...and this can be severe!
Alicia, what do you generally recommend to your patients for
AP: In milder cases, the steroid cream itself and good moisturizing
can certainly help with the itch. But some people need a bit
more help, and it is really important to try to help control this
itch, as we scratch itches...and this causes more damage to our
skin, which will then worsen the eczema! So antihistamines
such as benadryl, reactine etc can be used, and we dose these based
on weight in kids, and please ensure if you are using any
medication regularly in children that you use a proper measuring
device, and not a kitchen spoon! There are also stronger
medications that can be prescribed for the itch, so talk to your
health care provider if you are still struggling.
MK: So I think that is the basics for Eczema, and of course there
are some people out there struggling with severe eczema, for which
they are needing oral medications to help control, but for those of
you with mild to moderate eczema, we hope this helps to keep it at
bay...and dont forget that eczema is a long term disease of the
skin, and so it will flare if you dont use the daily preventative
measures that we spoke about.
Keep on Growing Healthy!
Cera Ve Cleanser