Common Infants Skin Conditions…Eczema
Eczema is one of the most prevalent skin conditions in infants and child, affecting about 20% of pre-school children in Ireland.
Eczema causes the skin to become red, itchy, dry and cracked. The most common type of eczema is 'atopic eczema', which mainly affects babies and children. Atopic eczema causes the skin to become itchy, dry, cracked and sore. Although atopic eczema can affect any part of the body, it most often affects the hands, insides of the elbows, backs of the knees and the face and scalp in children.
What causes Atopic Eczema?
To understand what eczema is and what causes it, it helps to know something about the differences between healthy skin and skin affected by eczema.
One way of picturing the way your skin works is by thinking of it as a brick wall. In health skin, the outer skin cells are the bricks, while fats and oils act as the mortar that keeps everything together and acts as a seal. The skin cells attract and keep water inside, and the fats and oils also help keep the water in.
If your child has eczema, their skin may not produce as much fats and oils as other people’s, and will be less able to retain water. The protective barrier is therefore not as good as it should be. Gaps open up between the skin cells because they are not sufficiently plumped up with water. Moisture is then lost from the deeper layers of the skin, allowing bacteria or irritants to pass through more easily. In addition, many children suffering from more extreme forms of eczema are missing a structural skin protein called filaggrin, which results in a defective skin barrier. While 6 out of 10 children can be expected to “grow out” out the condition, many will continue to suffer into adulthood.
What are the treatments for eczema?
Eczema is not a curable condition as such, although many children do grow out of it as they mature. There are, however, many tips and treatments that can help to soothe flare ups and keep eczema at bay:
- For most children, itchiness is the worst and most uncomfortable symptom of eczema and can often be the most difficult to treat. Itchiness may also lead to sleep problems for both the child with eczema and their family. Scratching can in turn contribute to infection and worsening of the condition. The Itch in eczema is not caused by histamine, like the itch suffered by an insect bite. Hence anti histamines do not tend to help much with the itch associated with atopic eczema. Sedating antihistamines such as chlorphenamine(Piriton) may be prescribed to help the child sleep but should be reserved for flare ups and as a short term measure only.
- Emollients are one of the most successful options for eczema and form the cornerstone of treatment. Emollients help to form an additional barrier over the surface of the skin, reducing moisture loss and helping prevent the ingress of irritants and pathogens into the skin layers. Emollients must be applied very frequently, at least 4 times a day to the child’s skin, to help maintain that barrier function. The best emollient is the emollient that the patient prefers, as they are most likely to apply more frequently. Aqueous cream and emulsifying ointment have fallen out of favour in recent years, due to the ingredient SLS(sodium lauryl sulfate) that these products contain, as this substance has been found to be irritating to the skin and can, in fact, worsen the condition. There are many more suitable preparations available in your local pharmacy.
- Never use soap or bubblebaths in your child’s bath if they suffer with eczema. Again emollients should be used as a soap substitute, and there are emollient products specially formulated as soap substitutes, a wide range is now available, many targeted for infants and children with eczema.
- Daily baths are encouraged for infants and children with eczema. The bath should be luke-warm, as heat can trigger a flare up and plain water or a simple soap substitute should be used. Pat the skin dry afterwards and apply emollient in a smoothing action, never rub it into the skin as this can irritate fragile skin.
- If bringing your child swimming, apply a thicker layer of emollient beforehand to act as a barrier to the irritant chemicals in the water and reapply after showering upon exiting.
- If possible use a pump dispenser for emollients, or use a metal spoon to decant the cream or ointment into your hand. Try to avoid putting your hand directly into the container as this can introduce contamination and increase infection risk
- Skin infections are common in children suffering with eczema. If you suspect infection(skin become sore, red inflamed, sometimes with blisters or pus) contact your GP, as your child may need antibiotics.
- Topical steroids are one of the most common treatments for eczema, mainly used initially to get a bout of eczema under control, where it then can be maintained with emollients. In more severe cases, oral corticosteroids may be used, or other treatments such as immunosuppressants or biologic therapies. It is important that the use of steroids in children are under the supervision of a healthcare professional, usually the child’s GP and are usually for short term use only.
Your local pharmacist is a good place to start if you suspect your infant or young child is suffering from eczema. They can be a great source of advice on the treatment of milder cases of eczema and can indicate cases which may warrant GP referral for prescribed therapies.
