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Growing Healthy podcast


Oct 27, 2017

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?  

http://aishamd.com/?p=974

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 in. 

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 it worsens. 

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 getting eczema. 

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 cases. 

Alicia, Now that we know a bit more about eczema - how can we manage it. 

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 good moisturizer!

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, overdressing.  

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 preventative strategies!  
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 assesed. 

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 this. 

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 this? 

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!

Cleansers:
Cera Ve Cleanser
Aveeno Soothing