What is it and who does it affect?
These two terms are both used to describe the same skin condition which can cause dry, itchy and irritated skin. It is the most common inflammatory disease of the skin.
 
Approximately one-in-five children under six years of age suffer from eczema. Children often grow out of it and, as a result, only one-in-12 adults have eczema. It can occur in very young babies and often begins with a small, patchy rash on the cheeks or scalp. It can be differentiated from cradle cap by examining its colour. Cradle cap tends to be yellow in colour, whereas eczema will cause more of a red rash.
 
The rash can affect anywhere on the baby or child’s body – see ‘signs and symptoms’ for more information. It is more common in those with a family history of eczema, allergies or asthma. Eczema causes the natural skin barrier to be compromised, as the outer layer of skin is dry and not as effective at protecting against irritants and infection.
 
It’s a bit of a vicious cycle, as this decrease in functionality of the skin barrier means that the skin is more sensitive to irritants known as triggers. Triggers include irritants (such as chemicals, hot or cold weather, smoke, detergent, cosmetics, fragrances and soap), allergens (dust, grass, foods, and pets), foods, stress, illness, and infection (Staph Aureus bacteria). Teething can also cause eczema flare ups – worth mentioning, considering my audience.
 
Eczema cannot be cured but it can be managed. It’s easier to prevent flare-ups than treat them, so keeping on top of good skincare practice is essential when caring for a baby or child with eczema.
 
 
What are the signs and symptoms?
Eczema can be mild and so can affect just a few small areas on the body; or it can be very severe, causing all over skin inflammation and irritation.
 
The most commonly affected areas are at the backs of knees and elbows, the neck, cheeks, wrists, arms and hands.
 
Common symptoms include:
  • Dry, flaky skin.
  • Scaly patches of thick red skin.
  • Skin can lighten or darken in affected areas.
  • The itching often results in scratched skin, which can leave tiny areas of broken skin that are open to infection. These are known as secondary skin infections, as a result of eczema.
  • The itch actually gets worse after being scratched – try explaining that to a baby! This frustrating phenomenon is known as the ‘itch scratch cycle’
  • Babies and children can become irritable and cranky if suffering from eczema, as their sleep is often affected.
  • The skin can be shiny, moist and blistery in areas during a flare-up.
How do I treat it?
Use a cold compress to relieve skin from the itchy feeling. Also, try to distract babies and children as much as you can to prevent them from scratching and worsening itchy skin.
 
It’s really important to have a good skincare routine including the use of a specific eczema bath/shower products, an emollient cream, steroid cream for flare-ups (for children under 10 years, these must be prescribed by a doctor), antihistamines (for children over two years, only without prescription), and wet wraps.
 
I would actually use nothing other than water in a baby’s bath until they are about three months of age. If you need to use something, you could just use Silcock's Base (this is best softened in some hot water first, in a small cup or jug, and then added to the bath as it dissolves much better this way!)
 
An emollient soothes the skin and relieves the itch. They act as the skin's natural barrier; trapping water in, and preventing irritants from accessing the skin. Creams are more moisturising than lotions. I would recommend applying these directly after patting the skin dry, after a bath or shower, and also on a daily basis. There are several good emollient creams on the market, and new ones always coming out; so as products are always changing, if you want a recommendation please contact me through the WonderBaba Facebook page. I have a lot of personal experience and can offer professional and personal recommendations!
 
One thing to note: don’t use Aqueous Cream as a moisturiser, as it can worsen eczema – its okay as a soap substitute in the bath, though. Apply an emollient in the direction of hair growth, and ideally use one with a pump rather than a tub so that you don’t have to repeatedly stick your hand into the tub, introducing dirt or infection. If you are using a tub, then use a spatula to get the emollient out.
 
 
Steroids
Steroid creams can be used in children over 10 years of age without prescription. If your child is under 10 years of age and is suffering from regular flare-ups of eczema, please talk to your GP about whether a steroid cream may be appropriate for them and, if so, which one. There are several different types of steroid creams available on prescription, varying from mild to very potent, and whilst they should always be used with caution and in line with the prescriber’s recommendations, they can be hugely effective and can change the quality of life of a mother and baby or young child. These creams are just used in the short term to treat a bad flare-up. Once the flare-up is under control, the use of a quality skincare regimen is often enough to prevent another flare-up from coming
 
Antihistamines
These may help children over two years of age if they are extremely itchy during a flare-up of eczema. There are two options available for children over two years without the need for a prescription – these are Zirtek solution and Phenergan solution. Zirtek is a non-drowsy medication, whereas Phenergan can cause drowsiness. Phenergan can be useful if your child is itching a lot at night and having difficulty sleeping as a result.
 
Please read dosage instructions and information on packets to find the suitable dose for your child. Children under two years can also get antihistamine medication, but it must be prescribed by their GP. If you would like advice or up-to-date information on these medicines, please do not hesitate to contact me by private message on the WonderBaba Facebook page.
 
Wet wraps
This is when dressings are used over a lot of cream to hold the cream in place and to prevent itching. In children, vests or leggings can be used - just monitor temperature carefully. These should only be used for short periods in children.
 
There are other options available if these steps do not work, but they must be investigated by your child’s GP or dermatologist.
 
 
How to I minimise it?
  • Scratch mittens.
  • Keep your child’s fingernails short so that if they do scratch, they do not break the skin.
  • Dress your baby or child in loose fitting cool clothing.
  • Regimental use of specialised bath products and emollients.
  • Keep a food diary to try to identify triggers or allergens.
  • Be conscious that triggers for eczema or dermatitis can be external – such as washing detergents, chemicals on new clothes, etc. There is no one ‘good’ detergent – everything has the potential to cause a reaction in your child; it’s about being aware and identifying their unique triggers, and avoiding them. I would, however, recommend using the non-biological versions of the various products rather than the biological ones, which are known to cause irritation of sensitive skin.
  • It’s also worth knowing that when you buy new clothes or receive gifts of them, they have been treated in the factories by certain chemicals which can cause irritation, and so I recommend always washing new clothes for young babies before using them – it’s a pain, but could save your little one a lot of discomfort. I’d also avoid fabric conditioner.
  • Watch out for common irritants such as wool, fragrances and astringents.
  • Emotional stress can also cause flare-ups – not that this can often be prevented, but at least you can identify if it is what is causing the problem.
  • Sweating can irritate the skin, so try to keep your baby or child cool in warmer weather.
  • Over-washing your baby can also cause further drying of the skin, so I would recommend bathing them just every few days. However, I would recommend applying an emollient moisturiser every day.
  • Pat the skin dry after washing, rather than rubbing.
Contact your GP if:
  • You cannot get your child’s eczema or dermatitis under control using a simple skincare regimen.
  • Your baby or child shows signs of infection such as pus-filled lumps or scratches, red scaly patches, fever, or inflammation of the skin.
  • If your baby is under two years and is very itchy.
  • If your child is under 10 years and is suffering from regular flare-ups.
I hope you have found this article helpful and, as always, if you have any questions at all or would like personal product recommendations - please don’t hesitate to contact me through the WonderBaba Facebook page or at Milltown Totalhealth Pharmacy on 012600262.
Pharmacist
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