Having a child with eczema is almost like living in hell. Your child does not sleep, she scratches and scratches until she bleeds. She cries all night. Her skin looks like that of a crocodile. Sometimes it looks like she was boiled; her skin is so red and dry. Ina Opperman talks to Dr Richard Aron, a Cape Town dermatologist.
Eczema often makes parents feel discouraged and demotivated, but once you understand more about the disease, it gets easier to manage.
Impact on children and parents
Research by Kaarina Meintjes and Ann Nolte on parents’ experience of childhood atopic eczema in the public health sector of Gauteng, published in Curationis, showed that eczema has a profound physical, emotional and social impact on children and parents. Therefore effective management of eczema is important to control of the condition, reduce the number and severity of relapse episodes and to reduce the impact of eczema.
Having a child with eczema leads to feelings of frustration, stress, confusion, guilt, fear and low self-esteem. Meintjes and Nolte found parents also face eczema management challenges because drug treatments are insufficient or ineffective and the referral system is ineffective. However, parents’ physical, emotional and social wellbeing improve as their children get better.
What is eczema and why do babies get it?
Eczema is a chronic inflammatory skin disorder that develops mainly in early childhood. It is of genetic origin and possibly has an auto-immune connection. It may be associated with asthma and hay fever. Certain triggers make eczema appear or make existing eczema worse.
What can trigger eczema?
- Food additives such as preservatives: read the labels on all food that you buy for your child to ensure that it is free of additives. Fruit juice, for example, may contain sodium benzoate, a preservative that can trigger eczema. Jellies are full of artificial colourings and should be avoided completely.
- Dried fruit that contain sulphur dioxide.
- Allergies to food such as dairy, nuts and wheat: if one of these allergies has been established by testing, avoid these foods and also read food labels to ensure it does not contain one of these triggers. Never just avoid these foods if you are unsure that it causes eczema in your child.
- Allergies to substances such as grass pollen: this is a difficult one to avoid with children who want to play outside, but you have to find alternatives such as indoor play areas.
- Sand: although not an allergic trigger, sand may irritate sensitive skin and contact should be avoided in children with active eczema.
- Paint and glue: small children use paint and glue in nursery school and this often causes “hand eczema”.
- Chlorine and salt: this means that your child should not swim in a swimming pool treated with chemicals or the ocean unless their skin is healed completely.
- Teething and viral infections.
When the skin heals, triggers are less likely to cause eczema.
Eczema and vaccines
Vaccines can be a trigger for eczema, but Dr Aron emphasises that inoculation must never be skipped due to eczema. Rather delay the inoculation if your baby’s eczema is flaring until it is healed.
How can eczema be treated?
While many children with mild eczema are successfully treated in primary care situations, there are a significant percentage of children who could benefit from referral to a dermatologist.
Dermatologists usually treat eczema with steroid cream, moisturisers and antibiotic cream. Steroid creams lessen the inflammation, while moisturisers help with dry skin and antibiotic cream fights skin infection.
Dr Aron says he uses a compound of all three creams and believes this is why his treatments are so effective. The compound he prescribes is also milder and requires less application. “The compound must always contain steroid cream and an antibiotic cream, because 70-90% of children with eczema also have a bacterial infection.”
Most children will respond to topical therapy alone, but in more severe cases some form of oral therapy may be needed.
Bath-time treatments are expensive and not effective, Dr Aron points out.
Tip: Never use aqueous cream, because it contains sodium lauryl sulphate, an emulsifier that can irritate the skin and act as an irritant for active eczema according to the British Journal of Dermatology.
Keep eczema under control
Parents can keep eczema in small children under control by:
- Being aware of triggers
- Using the treatment as prescribed
- Asking if you do not know or understand
- Continuing treatment over the medium term.
Facts about eczema
- Children can outgrow eczema, but the condition cannot be cured
- Eczema can be healed and go into remission
- Eczema can recur when your child is exposed to triggers, or get stressed when she goes to a new school.
Remember: Knowledge is power. If you know the triggers for your child, you can steer clear of them as far as possible. If you know more about effective treatment, you can prevent or lessen flares.