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Eczema challenges for pediatric patients, there is hope!

By, Dr. Anca Tomsa, M.D. FAAP    

Eczema or Atopic dermatitis (AD) is a chronic inflammatory, relapsing condition, causing increased pruritus of the skin.

AD affects primarily children, with onset before 1 to 5 years of age in 65-85% of affected patients respectively with increasing prevalence.

AD is a result of a problem in the skin barrier, and its’ relapsing course and chronic nature causes frustration among parents, patients and their treating physicians.

AD affects the quality of life of both caregivers and patients, as parents of children with eczema can spend up to 3 hours per day taking care of their children’s skin. Both parents and children can struggle with lack of sleep, feelings of hopelessness and depression from eczema, and link of poorly controlled Eczema and ADHD, has been reported in recent studies.

Allergies and Atopic Dermatitis

Food induced allergic dermatitis is very rare, however, it’s proven that children with earlier onset and more severe atopic dermatitis have a food allergy prevalence ranging from 40 to 80%, with most common food allergies being to: milk, egg, peanut, wheat and soy. There is however no connection between food allergies and eczema.
Furthermore, children with associated allergic rhinitis, commonly known as seasonal allergies, will benefit from being placed on anti-histamines when changes in seasons occur and there is high pollen content in the air, as patients with atopic dermatitis are known to have higher risk of associated allergic rhinitis, asthma and vice-versa.

Weather and Atopic Dermatitis

It is known that some of the patients with AD will have flares in the summer time, some in the colder weather, and most struggle when the weather changes from hot to cold and vice-versa.
Regulating body temperature seems to be the key in controlling eczema as perspiration (sweating) is a natural defense of the body to help lower its’ temperature, hence sweating in the summer time. Due to high content of minerals in the sweat, eczema would exacerbate in the hot spots where moisture accumulates the most: neck area, inside of the elbows, back of the knees. Overheating can also cause an increase vasodilation and inflammation worsening in these areas. Short baths and change of clothes is recommended during summer time to prevent eczema exacerbations.
Living in Florida may have advantage for our children with eczema. This is, as some scientists believe, swimming in salt water along with exposure to the UVB light, which is used in phototherapy management of eczema, is a great benefit in helping patients with eczema. This is provided they rinse off the salt after bathing in the sun and moisturize their skin. This same advice is important to follow in the summer after swimming in pools with chlorinated water.

Keeping the skin barrier intact is key

• Daily short warm baths using mild soaps ( Cetaphil, Dove, CeraVe), followed by use of skin moisturizers such as: Aquaphor oint., Eucerin cream/lotion, CeraVe cream/lotion, Cetaphil cream/lotion, Vanicream, Aveeno cream/lotion.
• Topical anti-inflammatory medications as prescribed by your doctor (Twice a day for 1-2 weeks as needed for exacerbations and twice per week in common affected areas to prevent exacerbations).
• Itch control using an oral antihistaminic or topical cream or ointment, as indicated by your physician.
• Managing infectious triggers, recognizing and treating infection related flares. (bleach baths, over the counter cleansers such as CLn wash, or antibiotics as indicated by your physician).
All of the treatments listed above can be found at your local pharmacy.

10 ways to help tackle eczema in the summer from the National Eczema Association:

• Wear wide-brimmed hats and loose, breathable fabrics in light colors to reflect the sun.
• If you work up a sweat, rinse off with fresh water and change clothes so the skin stays clean, cool, and dry.
• Use antihistamines to combat seasonal and environmental allergies.
• Keep an air purifier in your home to stave off dust, dander, and other allergens.
• Consider using a humidifier if the air-conditioner dries out the air too much.
• Rinse off saltwater and chlorinated water, then reapply moisturizer and sunblock.
• Drink sufficient amounts of water. The secret to good health is staying hydrated from within.
• Invest in hypoallergenic sunblock. When you’re sunburned and the skin barrier is damaged and starts peeling, it could make your eczema worse down the road.
• Be picky about the ingredients found in your moisturizer, sunblock, and insect repellant. Some might contain harsh chemicals that could aggravate your skin.
• Since stress is a leading trigger of eczema, treat yourself and your family to a relaxing vacation.

Resources:
• National Eczema Association: www.nationaleczema.org
• www.aap.org: “Atopic Dermatitis: Skin Directed Management”, Megha M. Tollefson et al, Pediatrics, December , 2014

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