Friday Feature – Eczema Q&A with Dr. B

Q&A with Dr Christopher Bridgett

MarcieMom (@MarcieMom) met Dr Christopher Bridgett (@ckbridgett) through Twitter – and learnt that he had a special interest of using behavioural interventions to help people with atopic eczema. DrB trained in medicine at Corpus Christi College, Oxford and St Bartholomew’s Hospital, London, then as a psychiatrist in Oxford. He now works in private practice in London. He has co-authored several publications on The Combined Approach, that proposes using habit reversal to stop habitual scratching in atopic eczema. To find out more about behavioural dermatology, click to read DrB’s interview with Peter Norén MD, the Swedish dermatologist who created The Combined Approach.

MarcieMom: Welcome Dr B, this week’s all about newborn babies. Being a first time mom, I made the mistake of thinking my baby’s eczema rash was normal acne. So the question is: Rashes on newborn are often considered normal, and sometimes listed in the hospital guideline to new parents that they needn’t bring their newborn to see a doctor. How should a parent distinguish between the ‘normal’ rash and eczema rash?

Dr B: This is really outside my area of expertise and experience – I am only a psychiatrist, working with dermatologists, and their patients. I guess it’s safe for me to say any persistent rash should be seen by someone, and suspect eczema if atopy runs in the family.

MarcieMom: Some eczema babies also get cradle cap, and the cradle cap shampoo has to be used to massage the scalp and wash off the cradle cap. What’s the difference between cradle cap shampoo and normal baby shampoo?

Dr B: Aha! I think I can answer this… Yes, they are different. Cradle cap is seborrheic dermatitis of the new born and infants – it is usually harmless, and can clear on its own, without any special treatment. The regular baby shampoo will help reduce the rash, but specially formulated cradle cap shampoo is stronger – it may have salicylic acid in it for example. If the special shampoo is used, please make sure it is suitable for the age of the child!

Marcie Mom: I’ve also read that brushing a newborn hair helps to keep cradle cap away. Is that true? What does brushing hair do to the scalp?

Dr B: Yes, brushing the hair helps tidy things up, until the cradle cap clears. With cradle cap there is excess sebum being produced. Sebum is the natural oil of the skin. Sebum is good for the skin and hair, in moderation – for example, it gives insulation against water loss. When birds preen they are spreading oil over their feathers, and that is what brushing the hair does – see how it shines! – DrB.

What?! Eczema and ADHD in children

Not sitting still in restaurant!

Is your child just irritable with his/her skin condition or has ADHD (attention deficit hyperactivity disorder)? Just came across two studies in 2003 and 2009 that suggest an association between eczema and ADHD in children. 5.2% of 1,436 children with eczema also have ADHD versus 3.4% of children without eczema. Also the younger the child has eczema, the increased likelihood of ADHD. When I read this, I’m thinking “Oh no! Watching TV is already linked to ADHD (and we do let Marcie watch TV to distract her from scratching while we do some housework/eat a quick meal) and now eczema also?!”

The good news is that the studies do not suggest a causal relationship, not definitive and it could also be that eczema children see a doctor more often, thus more chances of detecting ADHD. It could also be that eczema children who suffer from lack of sleep get restless or cranky, and not that they have ADHD. The even better news I read online is that eczema children are “very bright” as the skin and the brain develop at the same time, so “very reactive skin and very reactive mind” according to Sophie Worobec MD at University of Illinois.

In case you are wondering if your eczema child has ADHD, as we sometimes wonder, below are some symptoms of ADHD:

– Can’t focus on the task, easily distracted

– Unable to pay attention

– Fidget when sitting/ climbing all the time

– Talk excessively, can’t play quietly

– Impulsive

The ADHD behavior has to continue for 6 months. ADHD, like eczema, is also linked to genetics and immune system. Having a daily schedule, immediate reward system for good behavior, eating high protein food (like meat, beans, eggs) and complex carbohydrates have been reported to help with ADHD (but again nothing conclusive). So.. while I can’t survive without letting Marcie watch TV and can’t do any better than what I’m already doing for her eczema, I will read more books and build more blocks with her.. hopefully, it helps.

How do you know if your baby has eczema

Rashes on 2 month old baby's face

Determining  if your baby has eczema may not be so straight forward. Being a first time mom, I remembered reading a checklist from the paediatrician on what is normal and not normal in a newborn. Rashes is one of the items listed as normal, no need to see a paediatrician.

My baby Marcie has eczema from 2 weeks old and I only realised that her rashes were not ‘normal’ on her 1st month checkup. The paediatrician diagnosed Marcie with eczema after looking at her rashes and linked it as an allergy to milk (which turned out to be not the cause).

If you are wondering if your baby has eczema, the signs and symptoms listed below can serve as a guideline:

1. Itch – Itch causes scratching (and keeping my baby from scratching really stresses me out!)

2. Inflammation – Damage to skin cells caused by scratching. The redness in skin is caused by increased blood flow and the skin feels warm to touch and swollen.

3. Scaly Skin – More than usual dead cells on skin; can come in various forms, including white/powdery, cracked, thin/transparent sheets that peel off or thick/yellow flakes/chips

4. Lichenification – Thicker, darker and rougher skin from scratching/rubbing

5. Brown skin color – Brown spot where eczema used to be, caused by cells in skin (‘melanocytes’) releasing extra pigments from scratching

6. Scratch marks

7. Crusts – Caused by leaking serum, the liquid part of blood that heals inflammation

8. Cracking

9. Small blisters

10. Nails – Thick & rough nails, pitted/ ridged

11. Dry skin

There are more signs and symptoms listed in the book “Eczema Free for Life” by Adnan Nasir, but listing all that here will be information overkill.

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