For the past 3 weeks, we have covered Dr Lynn Chiam’s talk ‘All about Children’s Skin’ at the Rise and Shine Expo, Singapore. Today, we are asking follow-up questions from her talk, specifically to help parents with eczema children.
Dr Lynn Chiam of Children & Adult Skin Hair Laser Clinic is a consultant dermatologist who subspecializes in paediatric skin conditions at Mount Elizabeth Novena Specialist Medical Centre, Singapore. She was formerly the head of paediatric dermatology at National Skin Centre, Singapore before leaving for private practice. She has vast experience in childhood atopic dermatitis and childhood birthmarks. She has previously shared her expertise in this blog on Teen Eczema and Facial Eczema.
MarcieMom: Thanks Dr Lynn for spending some time here, and helping to address follow-up questions to your talk. You mentioned that the skin function includes protection against sun, and that baby’s skin offers less protection. How about skin of an eczema infant? And the skin of an eczema adult? Do they offer even less protection against the sun as the skin barrier of eczema patients are already defective?
Dr Lynn: Protection against the sun depends on the integrity of the skin as well as the amount of pigment cells in the skin. In general, a baby’s skin is less mature and contains less pigment cells compared to an adult and thus is more susceptible to the adverse effects of the sun. Darker- skinned individual tend to get less sun burn as compared to fair-skinned individuals.
In infants and adults with eczema, their skin barrier functions is defective and they can get broken skin as a result of scratching. This can make them more susceptible to sunlight and exposure to excessive amount of sunlight is known to trigger or aggravate the eczema.
MarcieMom: You also mentioned that the skin forms part of our body’s immune system. Is this due to the skin flora? Does the ‘porous’ eczema skin means that babies with eczema have a lower immunity and does this lower immunity translate to falling sick often? What is the implication for parents in caring for the general health of an eczema baby?
Dr Lynn: The skin contains cells which are involved in the reaction that our body mounts in response to an infection and inflammation. They are known as “B” cells and “T” cells. They can be thought of as “soldier cells” that defend our body when it is “attacked”. The skin flora on the other hand describes the bacteria, fungi and viruses that reside on our skin without causing any harm to our body. They are not part of the immune system.
The “porous” eczema skin allows bacteria and viruses to penetrate more easily and thus eczema patients are at a higher risk of getting skin infections. The skin of patients with eczema do have lower immunity to prevent skin infections but in general this not lead to overall decrease in their body’s immunity. Children with eczema do not fall sick more often as compared to their peers.
It is important for parents and health care providers to recognise eczema superimposed with skin infection as the skin infection has to be cleared for the eczema to heal well.
MarcieMom: Is wet wrap/dressing recommended for infants below 6 month old? Does the thinner skin of babies affect whether they ought to be wet wrapped?
Dr Lynn: As the skin of an infant below 6 months has a larger surface area: volume and is thinner as compared to adults, they tend to absorb a larger percentage of creams that is applied. Thus it may lead to side effects as a consequence of more creams that is absorbed via the skin into their system. Thus I will generally not advise wet wraps for infants unless the eczema is very severe and the creams used are very gentle.
MarcieMom: Similarly for steroid potency, is there a certain age by which the skin is thick enough to consider stronger potency steroid cream?
Dr Lynn: There are no guidelines for the potencies of steroids to be used according to age. In general, I will not use anything stronger than a mid-potency steroid in children less than 8 years old. The potency of the steroid used also depends on the thickness of the skin and the severity of the eczema. The neck, inner aspects of elbows, back of knees and wrist are generally considered to have thin skin and only low to mid-potency steroids should be used. Contrary to this, more potent steroids have to be used on the palms, soles and areas where the skin is thick as a result of the eczema.
For more severe eczema, a more potent steroid should be used to control the inflammation before tailing to a less potent one.
Thank you Dr Lynn for sharing your thoughts on the above questions, and thank you for the wealth of information you’ve provided in this blog.
For the 3 previous posts of this series, see