Last Saturday’s Eczema Forum in Singapore presents a good overview on child eczema, explaining the various causes, factors and treatment options. It was well attended by over 100 people, and I’m amazed half of which looked like grandparents who were wanting to find out more information for their grandchildren (how proactive they are)! The other half were parents with eczema children and what I’m even more puzzled is how everyone except me and another family managed to find alternative childcare during the talk! Marcie was the only (sometimes noisy) toddler in the room!
So here are my notes for those who wanted to attend but missed it!
By Dr Mark Koh, Dermatologist at Changi General Hospital – Why Does my Child get eczema?
Emphasis was on eczema being a chronic condition, without a cure but possible to control.
Common skin condition – affecting 20% school-going kids with no gender bias
Common eczema areas – Flexural areas – behind knees, elbows and for the older patients, ankles (with lichenification), around the mouth for infants with saliva, face, hands
Appearance of eczema skin – pictures were shared, generally, red, patchy, inflamed (a point was mentioned about eczema skin being unable to tan, thus more likely to look whitish), read this post to learn more on eczema skin color.
Eczema Causes – Multi-factorial, genetic factors, environmental factors
1. Defective skin barrier that is more susceptible to water loss and unable to form an effective natural barrier and lacking in filaggrin, lipids and proteases (read post on cause-skin barrier) – point was made that no oral medication can improve skin barrier, but moisturizing remains as effective treatment. Best moisturizer? One that the child will use, can be used frequently and affordable, brands such as QV and Physiogel were mentioned. (Side note: Two parents feedback that Seba-med didn’t work for their child)
2. Inflammatory cells – Immune system incorrectly attacking the skin, triggered by allergens and leading to production of chemicals that trigger itch (read post on cause-auto-immunity). This can be treated by steroid cream in most cases. Relevant posts on steroid:
Is Steroid Cream Safe? (shows table with various steroid potency)
Are you Suffering from Steroid-Phobia? (a table was shared on what’s a safe amount to use, and on the face and neck, up to 10g is safe on a child in 10-day period, twice application. Striae (stretchmarks), skin thinning, elangiectasia, hair growth are some side-effects of steroid but generally reversible)
3. Hygiene Hypothesis – Body is prepared as a defense against bacteria but with increased use of soap, anti-bacterial wash, the body mistook skin to attack (read more in post on cause-auto-immunity).
4. Environmental Factors – Weather changes (individual will react differently in different weather), Sweat (irritant), strong soaps and chemicals (Dettol and Johnson & Johnson baby were mentioned), House Dust Mites (that can be trapped in carpets, pets, stuff toys), Insect bites
Read these relevant posts:
How to Shower your Child? (mentioned that can bathe twice a day in cool/lukewarm water, soak in bath oil for 15 minutes, can choose one with antiseptic if not open to bleach bath. Water loss after shower is high, so be sure to moisturize immediately after. Bath oil can help maintain moisture better than soap.)
Swimming recommendation – Not longer than an hour, not from 10am to 4pm, use SPF50 sunscreen, try not to go once the pool has been chlorinated nor before the pool is due to be clean (too strong chlorine or too much bacteria), always shower immediately and moisturize thereafter! Also good to find out cleaning schedule and % of bacteria, amount of chlorine used.
Other Triggers for Eczema – Eczema flares can also be caused by staph bacteria (read post on cause-staph bacteria), virus (including herpes simplex virus, read post on eczema herpeticum) and fungus. Stress (read interview with Dr Bridgett on stress, read post One more reason not to stress your child). Allergy (read post on cause-allergy where you’ll see the table of common allergens for infant, pre-schoolers and older children), food is mentioned as unlikely to play a major role in eczema and a skin prick test can be performed to check on common allergens.
Posts on Allergy tests:
To control eczema well, will allow the child to break the itch-scratch cycle; read this post on ‘Why Scratching Feels so Good but is so Bad for your child‘.
The second talk was by by Dr Ang Seng Bin, KKH ‘How do I manage my child’s eczema?’
The contents were somewhat similar to Dr Mark Koh’s talk, so I’d just focus on the more interesting points:
Eczema statistics: 25% get from 0-1 year old, 22.7% by 7 year old and 17.9% by 12 year old, thus there’s a likelihood of ‘outgrowing’ the eczema
Costs of Eczema: Financial costs – direct cost of consultation, treatment, moisturizers and indirect cost of taking leave; Stress – in family of severe eczema is higher than that with children of type1 Diabetes (read popular post – 10 reasons why parents with eczema child have a tougher time)
Characteristics of Eczema Skin – Some interesting points mentioned:
1. Unable to regulate temperature effectively, sometimes feeling too cold in air-con while feeling too hot in the sun.
2. Sensitive to Fever, eczema flares during fever with rashes resembling punched-out ulcers. See post on eczema herpeticum, generally if eczema get worse rapidly, with fever, lethargy and distress, should see doctor rather than continue to self-medicate/treatment. Antibiotics may be prescribed by doctor and can treat inflammation and thus, also reduces inflamed skin.
3. More susceptible to conditions such as viral wart and Molluscum
4. Some contact allergens include (from most common to least) nickel, thimersol, colophony and lanolin.
In all cases, moisturizing is a must. Mild cases require mild potency steroid, and increasing potency for more severe cases but always under doctor’s prescription. Wet wraps and calcineurin inhibitors (which are immune moderators) can be used for moderates cases. Read this interview ’Easy to Use Wet Wrapping to Keep Child’s Skin Hydrated‘ on using Tubifast Garments for wet wraps. Azathioprine, cyclosporine and UV light therapy (for adults) may be prescribed in more severe cases.
More on moisturizing:
1. Moisturizing can reduce amount of steroid used and reduce frequency of eczema flares.
2. It may have some preventive measure, as an unpublished study that tracked 75 newborn being moisturized from birth showed none of them had eczema.
3. Moisturizing is to be used both during eczema flares and when there aren’t any, for the maintenance of the skin barrier.
So What Moisturizer?
Let’s cover the NOs – Fragrance, color, soap, protein, Seba-med mentioned by parents to worsen the skin and a patient was sensitized to aloe vera and started being allergic to it, Aqueous cream contain sodium lauryl sulphate that is an allergen. Nothing that the child will complain painful, itchy or sticky after application. For more posts on moisturizers:
Managing the Scratching
Various tips – Delay the scratching, Distract the child, Drink cool water seems to help some kids (read this post – Giving my Eczema Baby Cold Water), De-Stress and Divine intervention (meaning using religion, Marcie and I do pray every night using the prayer hand from church where each finger represents a category of people. So we pray for eczema babies often!) Not to say (or shout) stop scratching! to your child, read my post here.
There were many questions and I do feel like declaring, ‘Read my ECZEMABLUES.COM for answers‘ as really all of the questions have been tackled in my blog. And if you haven’t realized, there’s a tag cloud on the bottom of right sidebar where you can choose the topics you want to find out more about.
Some Q&As below, others are collated with doctors’ talks summary above.
1. Can Moisturizer and steroid creams be kept in fridge? Yes, no issue with that if child likes it cooling. Also mentioned that steroid should be applied before moisturizer and if can be done at the same time. Moreover, inflammatory skin cells tend to be more widespread than the visible eczema patch, so not an issue to have steroid spread more than the original application area when moisturizing.
2. For scalp eczema, can try anti-inflammatory shampoo such as Coal Tar or SebiTar. Read this Dr Q&A with Dr Bridgett on cradle cap shampoo.
3. Is probiotics helpful? Answer was generally no effect, but can try if start taking pre-natal up to child is few months old. May delay eczema. Refer to posts:
4. Is omega 3/6 helpful? Answer was no conclusive research. Read my posts on Kids’ Nutrition which I’m working with Toby Amidor, a registered dietitian. You’ll find links on antioxidants, fish, fluids and inflammatory foods to avoid.
5. What to do when air-con dry skin? Read this post on Keeping Cool with Air-Con and Moist with Humidifier.