Have a skin question? Want to vent on raising an eczema child? Or simply chat with a mom who doesn’t judge? Write in via comments and your question will get a reply (on or off the column). Or #SkinishMom on twitter!
To the #SkinishMom:
Help! My kid won’t stop scratching and it’s getting impossible to keep him from it. Any ideas?
One tired mom
I know! It does get impossible sometimes to stop scratching, many times I feel like I’ve run out of eyes to watch out for it, ears to listen for it and saliva to remind not to scratch. Here are the ‘crazy’, desperate distraction tips that I’ve come out with over the 5 years. Of course, the eczema ought to be controlled too, otherwise it’s kinda unfair to expect the kid not to scratch. So here goes my quirky anti-scratching tips!
Art – You can’t paint and scratch at the same time, that’s why my bag always has an activity book and my home is stock full of them.
Burst bubble – If you’re wary of the bubble (soap) on your kid, use a long straw to burst the bubble instead.
Cloud imagination – this works if you’re out in the park and your kid starts scratching, start spying shapes in the cloud.
Dance – It’s quite difficult to dance and scratch at the same time!
Eat – this is one fav technique of grandparents, not very ideal but to them, it’s better than scratching. I would choose physical activities to burn off the extra calories after.
Force it – If your child is still a baby, you may have to hold her hands whenever you’re able to limit the scratching. There are very few distraction techniques for baby since they can’t engage in as many activities (except scratching).
Go get it – Sometimes I get my kid to get something which works to stop the scratching for a while.
Hold on to it – Same thing – can’t scratch if you’re holding onto something.
Ice – Anything cold – ice cube (works to distract in a restaurant waiting for food) or ice pad work.
Ice can really entertain Marcie, especially when I run out of coloring paper at restaurant!
Jello – Making jello takes up time, likewise pizza. I like jello though – eating a chilled one distracts scratching too.
Kiss – Kissing is distracting too! Be careful of your saliva irritating her skin though.
Lie – this one is tricky! But sometimes I tell my kid to look at this or that when there’s nothing special, then think of something special about it.
Monopoly – A board game that requires to keep moving the token, getting title deeds, counting fake money and engages the brain.
Noodles with chopsticks – This one is challenging and maybe the fingers get too tired to scratch after!
On the light, Off the light – Worked for me for a while when my kid was a toddler and amused with the car light.
Play dough – This is fabulous, not too dirty but be sure the child understands not to eat it.
Quit saying stop scratching – At different age, you may want to actually stop saying that and watch if your kid still scratches when you’re not paying attention to it. Read about reinforcing positives, instead of focusing on what not to do here.
Relax – Stress can be ‘caught’ by your kid, so relax and see if it helps.
Sing – Sing a funny noise, skin-related or not. Make up songs of My Little Pony, Frozen or about anything!
Tickle – this one always works!
Unite – whatever distraction tips (somewhat equal parenting style cos there’s so much time devoted to distracting an eczema kid), you and your spouse must be united and agree.
Vacation – many people have improved skin during vacation, we don’t really know why. But hey, with more new things to do, a vacay may just work to snap out of the routine scratching.
Waste some toilet paper – Maybe get lower quality ones for tearing! (Potty training an eczema kid is a whole different ball game.)
Xtreme measures – my own extreme is having to secure, swaddle, tie (is there a more politically correct word?) my baby’s hands for a minute, while I make her milk. It was a very difficult period of time.
You – don’t forget TLC for yourself.
Deflated
Zzz – Only if prescribed by doctor, you can try antihistamines to help your kid sleep better (not knock him out!).
This is part of a quarterly round-up of some of the recent eczema-related studies, so that we can be aware of possible treatments and their efficacy (and I can also keep myself updated with the latest eczema research!)
Today’s topic is on Antihistamines, do they Work? I’ve read in forums that some patients swear it helps with the itch, while others swear at it for being totally useless. What’s the research in this area? I’ve found a few studies online, but before we go into them, let’s get some Antihistamines’ basics.
What are Antihistamines?
Antihistamines are medication that are taken orally to block the activity of histamine at skin H1 receptor sites, thus alleviating itch. The older generation of antihistamines is sedative, usually prescribed to relieve itch and scratching at night.
Backtrack a step for some of you to understand the rationale – One of the characteristic of eczema is itch, which triggers patients and children with eczema to scratch at the inflamed skin/ lesion. Scratching worsens the skin inflammation, exacerbating the itch-scratch cycle. Scratching also thickens the skin, further breaks down the skin barrier and risks infection. Thus antihistamines are prescribed to alleviate the itch, to reduce scratching. More on scratching here.
There are broadly two types of antihistamines,
1) the sedating types such as alimemazine, chlorphenamine, cyproheptadine, hydroxyzine and promethazine.
2) the non-sedating types such as cetirizine, levocetirizine, loratadine, desloratadine and fexofenadine. Supposedly, the non-sedating type can bind more selectively to the H1 receptors and last longer for 24 hours but many reported not effective.
How are Antihistamines supposed to help Eczema patients?
Oral H1 antihistamines have been prescribed for eczema patients, usually for their sedative effects. It appears that the sedating type is more commonly concurred to relieve itch better than the non-sedating. However, longer than 2 weeks’ use have been described to render sedating antihistamine ineffective to the patient.
Can Antihistamines be prescribed for Children with Eczema?
Yes, studies had been conducted for children from age 1, and different antihistamines have different age limits and the dosage depends on the weight of the child. Read that hydroxyzine is not recommended for below 6-month eczema baby and promethazine and alimemazine not for children under 2 years old.
Are there side-effects to Antihistamines?
Antihistamines may cause side effects such as drowsiness, headaches, constipation, dry mouth and blurred vision, and worsen condition such as glaucoma and retention of urine.
What’s the verdict on Antihistamine on Eczema?
After reviewing PubMed, it appears that it is difficult to isolate the effect of antihistamine as trials undertaken had used antihistamines as an add-on therapy (imagine which eczema patient would take part in a study that prohibit you from moisturizing and treating your eczema, insisting you consume only antihistamines!). Therefore, there is no conclusion as to whether antihistamines work. Based on a selection of antihistamines’ studies published on PubMed, cetirizine improved eczema (along with topical treatment) while chlorphenamine did not show difference in alleviating scratching at night. Hydroxyzine reported to work better than cyproheptadine in another study.
As you can see, there’s no clear conclusion on whether antihistamine is useful, neither is there clear study on whether the sedating type is more useful than the non-sedating. What is your experience? Do share in the comments, greatly appreciate!
3. Found women had more “localized itching occurring in attacks, with stinging, warmth and painful qualities”, more visible scratch lesions and greater impact on their quality of life
4. Study is useful in future sex-specific diagnostics or even therapeutics in pruritus.
For the past week, I took to Twitter to ask parenting experts their tips to distract eczema children from scratching. Why?
Because I realized that close to 2 years after this post – Saying (or Shouting) Stop Scratching to your Eczema Child, communicating effectively (other than shouting stop scratching) remains a difficult task for many families with eczema children, including myself!
So here are the responses, and many other friends around the world on Twitter also chipped in their tips! Add yours to the comment, and also let me know which one works best for you!
Tips from Parenting Experts & Expert Moms
Shara Lawrence-Weis, mother of 4 with background in education, early childhood & nanny work.
“Scratching might hurt your skin. Let’s think of other things you can do to help the itching.”
Dr Lynne Kenney, mom, mother of two, a practicing pediatric psychologist and author of The Family Coach Method.
“Did u know scratching is self-reinforcing cause it can release dopamine? Distraction from scratching is about finding other ways to use ones hands and still release dopamine (link)”
Erika Brodnock, mum of 5 & CEO of Karisma Kids that helps raise happy, confident & creative children.
“Gently patting the itchy areas while singing a song distracts in very itchy moments!!”
“Empathize: “Ooh, I know you’re itchy”. Action: “Let’s put some lotion on instead of scratching.”
Shadra Bruce, creator of MomsGetReal.com and also an author.
“Keep their hands and minds off the itch by keeping then focused on being creative! Arts, crafts, and hands-on helping moms.”
Mary Hartley, RD, Nutritionist, with her own practice
“Time to get moisturized!”
Shonette Bason, mom of 4 children and works full time as an outstanding primary teacher, author and consultant trainer for Early Years Education.
“Dough Disco (practising finger muscle control with dough and music!) is good for hands distraction!”
Ann Wu, MD, MPH, mom to eczema kids, Pediatrician and asthma researcher at Harvard medical school
“I usually say, “I know–it feels so good to itch! But I don’t want you to look like a red bean popsicle.”
Tips from Tweeps (friends who tweet):
I admit I do say Stop Scratching! followed by Put on some lotion! – Maria Wen Adcock, BiculturalMama
Today I fashioned some footed pajamas…using Egyptian magic cream and seeing what happens and it worked great. For the first time in almost a year, he slept without one scratch…I stayed up all night watching tho – Veena Goel Crownholm, Tiarastobabies
Sitting in a bath with some baking soda – MVOrganics
Depends on itch. if unthinking idle itch can simply put something in child’s hands, or distract non verbally. also need to accept that true burn of ezcema canNOT be ignored. so it depends on the habits and state of eczema flare – SarahJChapman
Depending on age, u could discuss beforehand and have a keyword that u both decide on that you say to remind them to stop. – Michelle Winters, Pediatric Sleep Consultant VASleepCoach
Make it a game: ‘I bet you can’t leave your arm alone’ – Ali_Nguyen
If you reduce the itch then hopefully they will stop scratching! – Dermasilk
Jennifer shares on managing a second child when the first has eczema
This is a new series focused on personal journey with eczema while managing a certain aspect of life. Today, we have Jennifer Roberge, whose eldest son Tristan has had eczema from three-month old and shares how she manages taking care of him while having another child. Jennifer is a blogger at It’s an Itchy Little World and a mompreneur who started her own company and online storeThe Eczema Company – she’s a return guest on my blog and you can read her first interview on her mompreneur journey here. Marcie Mom: Hi Jennifer, thanks for taking part in my 2013 blog series ‘Someone has Eczema’! Share with us a little on the severity of Tristan’s eczema when you were pregnant with your second child; was it tiring even before the second one was born?
Jennifer: During my pregnancy, Tristan (just shy of two years) had severe eczema behind his knees, around his midsection, around his ankles, wrists, and hands. It was dry, flaky, inflamed, and extremely itchy. My husband and I would lie awake with him at night trying to help him settle back down to sleep and try to forget the incredible, over powering urge to itch. So, we weren’t sleeping well to begin with – add to that the end of my pregnancy where sleep tends to evade mothers to be. They weren’t the easiest of times, that’s for sure. The eczema worsened after the baby was born, and continued to cover his body. Around three he was 90% covered, head-to-toe in eczema and resembled a burn victim. It was a difficult balancing act, trying to prevent my son from tearing up his fragile skin and managing an infant.
Marcie Mom: I know that Tristan has allergies too. Did you manage to figure out what’s triggering the majority of his eczema flares and his allergies before the birth of your second child? And did being able to manage somewhat his eczema helped in your decision to have a second child?
Jennifer: To be completely honest, when we decided to have a second child, Tristan’s skin was much less severe, so his condition didn’t really play much of a part in our decision. When things started to worsen during the pregnancy, my goal was to determine all of Tristan’s triggers and to get control over his eczema before the baby was born, but it didn’t happen that way. We hit rock bottom after the baby was born and when Tristan head-to-toe, severe eczema. No one in the house was sleeping, so we went for extreme methods and did a full elimination diet and saw results within days. It was nothing short of a miracle for our family.
Marcie Mom: Do share with us how you manage the breast-feeding, taking care of a new born, when Tristan I suppose do still need attention to his eczema and allergies? What was the toughest part?
Jennifer: Tristan needed constant supervision back then, not because he was only two, but because he’d scratch his skin raw if we left him alone for a minute. So, breast-feeding was extremely difficult. Tristan was very jealous and wasn’t a fan of my alone time with the baby during nursing, so when I was alone with the children, I’d cover Tristan’s hands with ScratchMeNot mittens and distract him with a book during nursing. Yes, I managed to learn how to read to him breast feeding! I also remember I relied on an infant wrap a lot during the first few months. I’d have my baby safely attached to me and I’d have free hands to help Tristan when he needed me. The wrap was essential back then. What was the hardest part of it all? When no one was sleeping – not the baby, not Tristan, not my husband or I. It’s one thing getting up to nurse throughout the night, but add to that frequent wakings and hours spent with an uncomfortable toddler that will do anything in his power to scratch until he draws blood.
Marcie Mom: One final question – what word of encouragement would you give to someone who just found out she is pregnant with a second child while the eldest has eczema?
Jennifer: Buy a good infant wrap or sling. Try to work on determining your child’s eczema triggers before the baby arrives – we waited too late. If your child wakes a lot during the night, try rotating nights with your partner. One night you take all the shifts with your restless child, the next time it’s your partner. And nap as often as you can to catch up on lack of sleep.
Marcie Mom: Thanks Jennifer for sharing your personal journey, it definitely strikes a chord with many moms out there!
This is a eries focused on personal journey with eczema while managing a certain aspect of life. Today, we have Vida Lok, whose 4 year-old son has had eczema since he was a few months old and shares how she manages bedtime for her son. Vida blogs at MommyLok on her three children and book reviews written by her daughter.
Marcie Mom: Hi Vida, thanks for taking part in my new blog series ‘Someone has Eczema’! Can you share with us the severity of your son’s eczema and which are the triggers you’ve figured out?
Vida: Hi Marcie Mom! My pleasure and thank you so much for blogging specifically about eczema. I know this issue causes heartaches for many parents, including myself. The worst of my son’s eczema is primarily focused on the hands, feet and neck area (up to the ears). His skin can get so irritated that it causes bloody cracks all over his fingers and also at the bottom of his earlobe. Many times, I wake up to find blood spots all over the pillow and bed sheets. As for triggers, I haven’t determined what they are specifically though I would say it’s primarily weather-related.
Marcie Mom: Bedtime is the most difficult time to manage eczema for our children; the scratching intensifies when we just want to shut our eyes! Is your son sleeping well through the night, and what preparations do you take before, during sleep to minimize the scratching damage?
Vida: At 4 years old, I was hoping that he would be sleeping on his own by now. However, he still wakes up (I’d say at least 6 nights out of the week) screaming in the middle of the night because he is so agitated. It’s been a frustrating (and tiring) 4 years of this nightly routine. Children just do not deserve this sort of torment! Every day after his shower, we moisturize (mineral oil, creams and Vaseline) and then once again right before he sleeps. However, like my daughter who has suffered through the same thing, all the moisturizers just seem to dry up upon contact to his skin. It just does not seem to provide much relief. We also use the humidifier since winter is so dry, but it hasn’t had much of an effect on his relief either. The most effective preparation we have is to make sure that his fingernails are filed down every couple days to minimize the intensity of his scratching.
Marcie Mom: Many parents would love to figure out a way to get their children to sleep throughout, and for us, parents with eczema children – sleeping without scratching is already a dream come true! Is there a ‘magic’ trick that you’ve figured out, or anytime when your child slept without the scratching?
Vida: I really wish I could be that miracle mom and share the secrets of “curing” eczema for all the children who suffer from it. However, sadly, I just have to wait for those occasional lucky nights where my son’s eczema is slightly better than the previous nights and he can sleep a bit more comfortably.
Marcie Mom: One final question – is it difficult to manage bedtime for your toddler, when you’ve another two children to take care of? How did you get them all to bed?
Vida: You can say it’s a bit difficult! My two sons share a room so that causes a problem right there (they’re too tempted to play and talk all night!) Though sometimes it helps because if my toddler sees my older son going to bed, it’s easier to convince him that he should be in bed, as well. My daughter is 8 years old now so she’s a little easier to manage (and also because bribery is more effective on her!) As with most kids, I’m sure, some nights are easier than others. I try to spend as much time with them at nighttime (since I work during the day, bedtime is where I get to spend quality time with my children) so some nights they actually look forward to bedtime. Those other nights? If I’m repeating myself over and over again to them (“It’s bedtime, go to sleep!”), they’ll eventually settle down because they’re tired of hearing me be so annoying!
Marcie Mom: Thanks Vida for taking time to share your bedtime journey, I’m sure many many parents out there can identify with your sharing! and yes, bed time is quality time for me too!
Vida: Thank YOU for allowing me to share! And best of luck to all the parents out there.
Dr. Christopher Bridgett is Hon. Clinical Senior Lecturer Imperial College at Chelsea & Westminster Hospital London. He is a psychiatrist with a special interest of using behavioural interventions to help people with atopic eczema, co-author of The Combined Approach at AtopicSkinDisease.com
In the manual ‘Atopic Skin Disease’, three levels of treatment are stated, namely:
1. Emollient Therapy
2. Steroid
3. Habit reversal
It is advised in your manual that steroid should not be used without follow-up moisturizer but moisturizer can be without steroid application. In the course of recovery, level 3 can be stopped first, followed by 2 and 1. We’ve covered the basics of all three levels in previous posts. There are some further dimensions in the management of eczema as follow:
Stress for Eczema Child
1. Stress – Stress is one of the possible triggers for eczema.
Can you help a parent to identify when a child is stressed and how to see if the child is stressed because of the eczema or because of something else?
Stress can cause emotional upset – unhappiness and apprehensiveness for example – in anyone, young or old. In a child this may include tearfulness, and avoidance behaviour, just as in an adult. Certainly having eczema itself is stressful, for both the child and the parents. Careful observation may clarify if something else is the source of stress: stress comes from common causes, even for the youngest child, and family upsets may be especially important to think about. If there are no other causes and the eczema is troublesome, then adequate treatment of the eczema will be stress relieving – for everyone.
How can a parent help a child to relax?
Helping a child to relax usually involves simple acts – giving attention, and comfort, with suitable play, and amusing distraction. Reading a favourite story is a tried and tested bedtime means of inducing relaxation and sleep. But when a child is stressed, enabling relaxation is more difficult, especially if the causes of stress are not identified and dealt with.
Positive Attitude
2. Attitudes – Positive attitudes are suggested in your manual, such as ‘Manage, Don’t be Managed’ and to be careful so the doctor/nurse does not to ‘spread’ helplessness during a consultation.
Should a patient comes across a doctor who is passive about managing the eczema, what can he/she do to change the doctor’s attitude?
(Obviously, the other choice is simply switch doctor! But as a service to other patients, someone ought to say something!)
I find myself saying something about this all the time! Of course the responsibility for a successful visit to a doctor rests with all those involved. Each person should consider first what they themselves can do, rather than seeing any problem as caused by someone else. Some really useful ideas about this were covered when Jennifer talked to me: see http://atopicskindisease.com/articles/20111216 This might make a good topic for people reading this post to comment on here: I suggest your readers share their thoughts and experiences with you.
At some health centres and doctors surgeries there are patient discussion groups to allow people to share ideas on how things can be improved. Has anyone had experience of such a group? Does your doctor ever conduct a patient satisfaction survey?
Each person should consider first what they themselves can do, rather than seeing any problem as caused by someone else.
Review of Habit Reversal
In The Combined Approach, follow-up visits include asking the patient or parent their (i) scratching frequency (ii) when there’s most scratching (iii) % of scratching from itch (iv) severity of eczema (v) % new eczema vs old and (vi) where most eczema.
If a parent cannot find a doctor or convince their current doctor to implement the Combined Approach, can the parents implement this on their own without a doctor doing the follow-up (i.e. monitoring scratching on their own)?
The questions that you detail are in the first stages of The Combined Approach, during the first 4 to 6 weeks when habit reversal is important. The later part of the programme we call follow-up, and then vigilance for acute flare-up is the important emphasis, with early and energetic treatment with topical treatment being the order of the day. Habit reversal is not important long term. It is optimal topical treatment that is essential to maintain the progress that The Combined Approach achieves.
How to use The Combined Approach depends on the resources available. The clinic-based format is very effective, but if it is not feasible a self-help format is a good alternative, as discussed at http://atopicskindisease.com
Hopefully blogs like this, and websites like www.AtopicSkinDisease.com will now gradually help everyone everywhere to discover how to treat atopic eczema successfully. There is no need now for anyone to necessarily Live With Eczema: there is now a possibility to learn how to Live Without Eczema.
Dr. Christopher Bridgett is Hon. Clinical Senior Lecturer Imperial College at Chelsea & Westminster Hospital London. He is a psychiatrist with a special interest of using behavioural interventions to help people with atopic eczema, co-author of The Combined Approach at AtopicSkinDisease.com
I read in your manual ‘Atopic Skin Disease’ of how a nervous habit develops, namely:
1. Normal initial specific response to an injury (or itch)
2. Increased frequency by positive reinforcement that leads to
3. Behavior (or scratching) becomes automatic
4. The habit generalizes to cause more situations precipitating the behavior
5. Decreased personal and social awareness
Introduction of Replacement Habit
Also illustrated in your manual, another habit is introduced to reverse the scratching:
1. New habit is opposite to the old habit
2. Can be maintained for several minutes
3. Socially acceptable and compatible with normal activities
4. Strengthen muscles antagonistic to those of old habit
The techniques used in Noren and Melin, 1989 study mentioned in Atopic Skin Disease are:
1. Clenching fists and counting to 30 as an alternative to habit of scratching
2. Pinching the skin where it was itching as an alternative to itch-provoked scratching
Can you explain to our parents how to tell their child to clench fist and pinch skin? Is this something that can be understood by young children? And will pinching skin lead to the child using painful techniques to get rid of scratching? (I read in your manual not to say ‘Stop Scratching’, just as I’ve posted!)
The method of clenching a fist, then pinching the skin, is only suitable for older children, who are able to understand the instruction, and can accept responsibility for following the recommendations. The younger child requires a different approach which sees the parents as responsible for the treatment, with an adapted programme in between: see http://www.atopicskindisease.com/articles/20120115
So, no pinching small children please!
And yes – it is important to avoid saying “Stop Scratching” – you are quite right, of course!
Parents noting child is scratching (picture credit atopicskindisease.com)
Register Scratching Frequency
In The Combined Approach, the first homework assignment to patients is to register the scratch frequency. This aids in the analysis of the scratching habit, following an ABC format of understanding the antecedents, behavior and consequences. Do you normally explain the ABC to patients before requesting them to register their scratching frequency? How can a parent help explain this to a young child? How can a parent help a child to count the scratching?
Dr Bridgett: The explanation of the ABC normally comes after registration, as part of the instruction of how habit reversal works. See the patient handbook for Older Children: http://atopicskindisease.com/categories/20110503_1
The younger child has a different treatment programme, without any counting of scratching: for the younger child it is the parents who are responsible. They can achieve awareness of the childs behaviour without using a counter.
MarcieMom: Thank you Dr Christopher Bridgett for explaining habit reversal that is part of The Combined Approach. In our next post, we will understand the three levels of treatment and conclude the series.
Dr. Christopher Bridgett is Hon. Clinical Senior Lecturer Imperial College at Chelsea & Westminster Hospital London. He is a psychiatrist with a special interest of using behavioural interventions to help people with atopic eczema, co-author of The Combined Approach at AtopicSkinDisease.com
The Combined Approach includes topical treatment using emollient and steroid. Moisturizing is a HUGE part of topical treatment, as emollients both lubricate and moisturize. Dr Bridgett’s advice on moisturizing is Thinly, Gently, Quickly and Often. There are a few other points mentioned in the ‘Atopic Skin Disease’:
Thinnest possible application without ‘rubbing it in’
More on exposed areas such as the head, neck and hands
Pump dispensers preferable to open tubs due to bacteria infection
Applying topical steroid first, then emollient over both the skin and the steroid
Cream preferred over lotion
Can you explain why thinnest possible application is preferable for emollient?
(I’d usually slather on my child as I find applying a thin layer leads to more rubbing to spread the emollient)
Also, can you explain why topical steroid first?
(I’d written on this here and it does generate some discussion!)
Can you explain why cream is preferable over lotion?
Dr Bridgett: Your three questions answered:
Thin applications of moisturizer allows heat to escape, but insulates against water loss.
If moisturizer is applied often enough, when the steroid is applied directly onto the eczema, it is applied to skin that has been recently moisturized. We get then the best results by putting moisturizer on over topical steroid, and moisturizing all the skin, not just that which has the eczema.
The thicker the moisturizer, the better the moisturizing effect. Also, often there are less additives in thicker moisturizers, as thicker moisturizers “keep” longer. There is less chance that a sensitivity reaction will occur with an ointment, compared with a cream. See http://atopicskindisease.com/articles/20110801
Explaining Topical Treatment – Steroid
It is stated in ‘Atopic Skin Disease’ manual that steroid cream work by inhibiting protein synthesis, secretion of products, cell division and migration of cells. The epidermis can benefit from reduced cell division, and the dermis from reduced cellular and lymphokine activity. Can you explain what this means, and
why it is important to continue steroid treatment after epidermis healing (‘2-stage in steroid effect’)?
Dr Bridgett: It seems the steroid anti-inflammatory effect is partly achieved by reducing over-activity in the skin, allowing natural healing then to lay down healthy skin again. By the time the seems good to look at, the healing is not complete through and through – there is more that is needed under the surface, so we recommend continuing with the topical steroid, beyond The Look Good Point: do not stop too soon. See http://atopicskindisease.com/articles/TT7
Many parents are very concerned with the skin-thinning side effects of steroid and also the ‘withdrawal’ symptoms once steroid treatment is discontinued. I read in your manual that side-effects are associated with inappropriate use of topical steroid and the risk is usually inadequate treatment (i.e. stopping steroid cream too early or using one of too low strength).
How do you normally convince parents that steroid cream is safe? And what guidelines would you give them to gauge if the steroid cream of correct potency, frequency and amount is used?
Dr Bridgett: Steroid side-effects come especially from using topical steroids long-term and in an unsupervised way. The method we use in The Combined Approach includes more supervision than is usually given, with a programme of several clinic visits, involving careful discussion of all anxieties and concerns. Using The Combined Approach, including therefore habit reversal, which allows natural healing alongside the good steroid effect. Then less topical steroid is used overall, for good effects, not side effects!
We offer information about the potency groups of the topical steroids, and how they are usually used. The thicker the skin, the stronger the topical steroid to be used. See http://atopicskindisease.com/categories/20110423_11
Each application of any cream needs to be sparingly applied – whether it is an emollient or a topical steroid: only a shine is required.
MarcieMom: Thank you Dr Christopher Bridgett for explaining the topical treatment that is part of The Combined Approach. In our next post, we will understand more on habit reversal techniques.
Dr. Christopher Bridgett is Hon. Clinical Senior Lecturer Imperial College at Chelsea & Westminster Hospital London. He is a psychiatrist with a special interest of using behavioural interventions to help people with atopic eczema, co-author of The Combined Approach at AtopicSkinDisease.com
4 post series, starting with this post on Combined Approach
The Combined Approach is about using conventional topical treatment (steroids and moisturizers) together with the elimination of self-damaging behavior using habit reversal techniques. ‘Atopic Skin Disease’ was published in 1996 as there was much success using The Combined Approach, which was reported at the European Congresses on Dermatology and Psychiatry in 1991 and 1995.
Patient Improvised Distraction vs Combined Approach
MarcieMom: Dr Bridgett, can you briefly explain the difference between The Combined Approach versus an eczema patient using his/her own ways to divert attention from scratching?
Dr Bridgett: The Combined Approach is an exercise in behavioral medicine, and has two elements combined:
1. Optimized conventional treatment (emollients and topical steroids usually) : this is an important part of the approach, and cannot be overlooked!
2. Habit reversal: a formal behaviour modification technique: it requires, when offered to Adults and Older Children, first a period of registration using a hand tally counter – this is continued, as habit reversal is introduced. The inventiveness of the eczema patient is very useful in introducing new successful habit reversal behaviours, but some structure, discipline and supervision is linked to the success reported by many patients, and this requires reference to written material, and is often usefully supported by contact with others.
Also, if an eczema patient or parent of eczema child comes to know of your approach, can he/she simply pass your manual to a dermatologist that he/she is seeing?
The manual is available for anyone to consult and follow if they wish, and both nurse practitioners and medical practitioners are successfully using The Combined Approach. An important alternative is to use the self help format set out in the book The Eczema Solution by Sue Armstrong-Brown.
When is Habit Reversal Most Effective?
The main idea is that scratching can often become a habit – that is, the adult or child with eczema then scratches not only because of itch. It is mentioned that adults with severe eczema can benefit most from The Combined Approach. Why is this so?
Can you share with us pictures of before and after eczema and what was the habit that was eliminated that led to an improvement?
Dr Bridgett: Habit reversal is most effective
in combination with optimized conventional treatment, and
when there is evidence of chronic eczema – in adults or children – that is to say, the thickened skin called lichenification, which is due to regular rubbing and scratching that has become a habit, complicating atopic eczema. Any rubbing and scratching of the skin can become a habit, but each person can have their own particular problem.
Habitual Picking during TV
In the first pictures below the patient was habitually picking the skin of her forehead when watching TV, resulting in chronic eczema. When habit reversal was added to optimized topical treatment the skin healed very quickly.
Before & After Pics of Forehead, contributed by Dr B
In the next pictures, the patient had developed a habit of using the rivets on her jeans to scratch against:
Before The Combined Approach
Before The Combined Approach
After The Combined Approach
Combined Habit Reversal with Topical Treatment
I note that The Combined Approach does start with understanding and explaining the importance of topical treatment, as eliminating scratching is not a stand-alone treatment. Would explaining the structure of the skin and how a weak skin barrier is prone to water loss be important in the first visit? If yes, could you do a quick introduction for our parents to understand?
Dr Bridgett: Yes, The Combined Approach always covers the importance of skin as a barrier, and the importance of optimal topical treatment.
The skin has two layers, epidermis and dermis. The outer epidermis, which carefully replaces itself every four weeks, is important in preventing water getting out from inside, and irritation and infection getting in from outside.
Acute eczema involves inflammation of the epidermis. It’s structure then becomes weakened, allowing excessive water to escape. Extra moisturizers are then needed to stop excessive water loss, and anti-inflammatory topical steroids are also needed. And that’s not the whole story: the inflammation releases itchy substances that cause scratching – and this scratching stimulates over-activity of the epidermal cells. If the emollients and topical steroids are used correctly the situation quickly returns to normal. If not, the scratching continues, becomes a habit and the damaged and sensitive skin of chronic eczema is the result.
MarcieMom: Thank you Dr Christopher Bridgett for giving us an understanding of the Combined Approach and showed us some of the successful cases. In our next post, we will understand more on the use of moisturizers and steroids as explained in the manual ‘Atopic Skin Disease’.
Sue Atkins is The Parenting Expert , author of the best-selling book ‘Parenting Made Easy – How to Raise Happy Children’ and also regularly appears on ITV’s This Morning, Sky news & The BBC.
This was originally a Friday Q&A for 5 weeks which is now combined into one informative post. As parenting children with eczema brings unique challenges, such as scratching (till bloody) when being disciplined, MarcieMom invited Sue to help with some thorny parenting issues that parents may face with their eczema kids.
Do you still carry on with discipline if your eczema child starts to scratch?
When it comes to discipline, many moms feedback that once they try to do so, their toddlers will start scratching (I’ve even drawn a cartoon on tantrum scratching!). Then, we are faced with the decision – do we continue to follow through our intended discipline method or do we stop and persuade our child to stop scratching. What would be your advice on this and is there a particular discipline method that you’ve seen worked better for children with eczema?
Also, when children with eczema throw tantrums, they tend to scratch too! Given how fast blood can easily come from the already defective skin barrier, it’s difficult to leave our child alone to ‘finish’ throwing tantrum. How do you recommend parents to deal with this?
Sue Atkins: I do think that children with eczema have a tough time. Of course having an itchy skin makes your little one irritable However I am not sure which comes first the irritability, where they are crying and getting themselves hot and bothered which makes the eczema worse, or the eczema being extra itchy and making them irritable.
I always say that the toddler years are a bit like taming jelly – all wobbles and no rules, for all parents as all toddlers are striving for independence, which can lead to frustration and tantrums and tears but add in guilt from the parent, and you have a difficult mixture. But I think knowing WHY you are being firm, fair and consistent also helps as your child will feel more secure, relaxed and safe which will also have a bearing on their eczema as they will be more at ease.
Toddler years are a bit like taming jelly
I work with many parents who feel a tremendous sense of guilt around their child’s eczema and over compensate by giving in to their children’s tantrums and demands but really you are setting yourself up for a short term gain but a long term nightmare. Children, of all ages benefit from firm, fair, consistent boundaries. I also teach the parents I work with to “tap” out their feelings of guilt using the latest cutting edge Emotional Freedom Technique.
MarcieMom: Thank you Sue for sharing your advice; I’ve to check myself that I’m not over-compensating but some days, parenting an eczema child can be stressful!
Parenting Made Easy
MarcieMom: I read your interview with Reading Kingdom with interest – your 5 tips to raise happy children are (i) play with them, (ii) teach them to be organized, (iii) don’t shout, (iv) keep your patience and (v) respect each other’s privacy, possessions and personal space. My guess is in eczema families, not shouting and keeping patience would be more difficult. We sometimes end up shouting ‘Not Scratching!’ (which isn’t the best way to stop the scratching!) or lose patience with each other as both of us are tired and having to keep an eye (and an arm) out for scratching is really energy consuming!
Do you have any tips for stressed out parents to (miraculously) relax while parenting our child with eczema?
Sue Atkins: My Pause Button Technique is a really simple way to empower all parents no matter what situation they find themselves in, as it allows you to press your imaginary pause button, freeze time and consider the consequences of the actions you are about to take, before making a more informed, better choice.
Sucking fingers or putting items into the mouth is obviously not hygienic. In particular, hand food mouth disease (HFMD) which Marcie has got twice, is at epidemic level in Singapore. Most parents urge me to STOP this bad habit, by either slapping my toddler’s hand, slapping her mouth, implementing naughty corner or even putting chilli on her fingers! I haven’t implemented any of these and frankly, sometimes I’m glad she’s doing something with her fingers instead of scratching!
How would you recommend a parent to get the toddler to stop this unhygienic habit? And is this something you think warrant ‘punishment’ or ‘discipline’?
Sue Atkins: We are our children’s first role model and of course we all love our children so my views on smacking are well known on British Television as I ask parents to ponder what sort of message they are sending to their children if they hit them I wonder…..? ……that’s OK to get physical when you feel annoyed, frustrated or angry? And because you are a role model in everything that you do…. guess what your kids will do when they get annoyed, frustrated or angry……. lash out too.
https://youtu.be/JwdJapH9Pe8
I know lots of parents feel a little “tap” never hurt them …… but times change, we evolve and a little smack can escalate……. I think a mum who came on one of my workshops put it really well when she said, “I didn’t smack my 13 year old son, but I did smack my 10 year old daughter because she was so strong willed. One day when I smacked her, she said, “That didn’t hurt!” I knew then that I mustn’t smack her again because of what might happen.” Read more at ‘Is it Ok to smack your child?‘
Clearly it’s very important to prevent the spread of the virus so
Wash your hands frequently and properly with soap and running water, especially after changing nappies/diapers and after using the toilet.
Teach your child good hygiene and to wash their hands frequently using soap substitutes after having their nappy changed or after using the toilet or playing outside or sharing eating and drinking utensils.
I encourage all the parents that have toddlers to use my Easy Button Technique where your toddler gets rewarded for the positive behaviour you do want to see more of by running over and pressing their Easy Button – as this using positive psychology instead of negative association which lots of fun and brilliant for your child’s self esteem.
Co-Sleeping & How to Wean your Child off it
Many moms who have children with eczema do co-sleep part of the night with their baby or toddler. I co-sleep with Marcie but aware that there’re pros and cons; related to eczema, co-sleeping may help the parent to check on the child’s scratching at night but also possible to increase dead skin cells and overheat (both dust mites and heat can trigger eczema flares). What I commonly hear from other moms (without eczema children) is that babies should be taught independence from young and sleep in their own cots. There is of course little couple time with a toddler in our bed and we’ve tried to wean her off co-sleeping so many times, but once we’re on holiday and sleep together, or if she had chickenpox/ HFMD and her skin was really affected, we would switch back to co-sleeping.
Is there any technique to get a child to sleep on her own?
Sue Atkins: It helps to think about the message you are sending to you child if you co sleep indefinitely – so this issue is usually around the clarity and confidence of the parent when they decide to change the co sleeping habit. Here is an article I wrote when I was coaching a mum on my ITV Parenting Power slot on “This Morning”
The simple secret is routine and consistency and not giving in too soon! Think long term and keep the bigger picture of success in your mind at all time and don’t send out mixed messages.
TV for Scratching Distraction?
We know the American Academy of Pediatrics does not recommend TV before the age of two. I’ve tried my best to limit TV to Barney, Signing Time (which distracted her from scratching when she was a baby!) and 2 to 3 other kids’ DVDs series. I wouldn’t let her watch TV or iPad if I can help it, but it really gives me some breathing time when she’s entertained by TV and forgets about her itchiness.
The strange thing is that my friends who let their toddler watch cable TV such as BabyTV, Disney or Nick Junior, actually swear by these cable programs improving their toddler’s language skills. The even stranger observation is that their children indeed can talk much better than mine!
What age to let baby/toddler watch TV, what kind of programs are preferred and whether cable TV with lots of programs are indeed better than selected DVD series or no TV at all?
What is a reasonable, balanced amount of time for you?
What programmes and games are suitable for your children?
What boundaries do you set for your kids and are they flexible as they get older?
What’s your gut reaction and instinct to this whole topic?
What do you do if you and your partner disagree?
Are you able to stand firm and say “no” to your kids…. if not why not?
Just spend a few minutes making up your mind, setting your limits that feel right for you and doing your kids a great service by standing by your limits, consistently – no matter what!
MarcieMom: Thanks Sue for the post above; I’ve also read the Daily Mail article mentioned in your post and it’s mentioned that ‘Researchers in France found that watching television impacted on the development of children under three‘, leading to delayed language learning, encouraged passivity, reduced concentration, increased agitation and caused sleep disorders. TV channel in France has been banned from promoting educational benefits on shows aimed at under 3 year old and largely seen as a move against foreign baby channels such as BabyFirstTV and BabyTV.
Thanks again Sue, for joining with me for July’s Friday Q&A.
This is the 38th of my “101 Things that Moms with Eczema Child Do Differently“, a tongue-in-cheek look at the many unique situations that we face. For more cartoons, click here to view.
My hubby got me an IPad recently, so that I can tweet at night while still making sure that Marcie doesn’t scratch in bed (I’m @MarcieMom!). As expected (going by how the kids are hoarding the display Ipad in stores), Marcie loves the IPad and intuitively can swipe, squeeze (to zoom out) and stretch (to zoom out) her fingers! As all parents of eczema child know, scratching is bad but seems to feel good for the child, and we’re always looking for a way to keep them off scratching.
So, we’ve let Marcie play with the IPad, but only for no more than 30 minutes and only when she catches me tweeting on it (I don’t play any game, not yet anyway). I find that it’s effective when it comes to occupying her fingers, and the apps are so interesting! In the picture are Marcie’s favorite free apps – ABFree, Music Sparkle, Doodle Buddy and Coloring Book. Her fingers can be occupied with tapping the ABC, flicking the circle up and down the screen, tapping on crayon and drawing on the IPad! But as with all things, I googled to find out the impact of IPad on kids and I’m amazed that it helps special kids. Here’s a quick pros and cons list.
Pros
1. Catches the attention of the child – It’s better than scratching till blood and reinforces learning; you can always go for apps by trustworthy developers, see recommendations from Mums with Apps and here.
3. Helps with motor skills, see this inspiring story on how it has helped a boy with debilitating motor-neuron disease
Cons
1. Makes the child become used to being distracted and switching tasks, instead of focusing (see here for NYT article)
2. The intense visual/mental interaction deprives the child’s brain from needed rest (another great NYT article)
3. Causes temporary deafness disorder as the ears tune out because the mind is tuning in so much (so kids really can’t hear what you’re telling them to do while they’re on IPad)
4. Not a replacement for human interaction and guidance which can build social skills and critical thinking skills
5. Rewards the child for short attention span and insignificant acts (think of games that give you a goodie/point when you just point here, go there)
6. Exposing your child to more advertising (as if TV is not enough!)
7. Lack of regulations on privacy and on tracking use of your child’s behavior when he/she is on the app
Lastly, we as parents can’t be hooked on the IPad ourselves (“Plugged-in Parents“) and deprive our children of needed attention! What’s your take on this?
I'm guessing another kid's tantrum won't come with scratching head and eyes! (sshhh..my hubby has been complaining about my lack of discipline in disciplining my kid!)
This is the 32nd of my “101 Things that Moms with Eczema Child Do Differently“, a tongue-in-cheek look at the many unique situations that we face. For more cartoons, click here to view.
'Don't Scratch! Drink some juice? Oh well.. on the light, off the light'
This is the 31st of my “101 Things that Moms with Eczema Child Do Differently“, a tongue-in-cheek look at the many unique situations that we face. For more cartoons, click here to view.
This is the 26th of my “101 Things that Moms with Eczema Child Do Differently“, a tongue-in-cheek look at the many unique situations that we face. For more cartoons, click here to view.
Girl wearing Dermasilk garments and glove (picture from dermasilk.co.uk)
DermaSilk is a range of specialist garments especially suited for eczema children that MarcieMom first came across on twitter. Interested to find out how it can help parents manage their children’s eczema, MarcieMom contacted Jo Fletcher, the Operations Director of Espere Healthcare Ltd, the company that manages the sale of DermaSilk. (2018 update: Alpretec is selling Dermasilk directly). DermaSilk is produced by ALPRETEC, an Italian company that has extensive experience manufacturing allergy protection products. DermaSilk is developed with a patented process that binds the medical grade silk to an anti-microbial shield that can reduce 94% of staphylococcus aureus (staph), a bacteria that commonly colonizes eczema skin and causes skin infection.
Marcie Mom: Jo, thank you so much for taking time to explain DermaSilk to us. I’ve read your very informative website and understand that DermaSilk is not the same as shop bought silk because the outer coating of the silk (sericin protein) has been stripped off, leaving the core known as fibroin. This is because the outer layer has been shown to cause allergic reactions. Do you know if the sericin protein is a common irritant? Also, does stripping this layer remove the antioxidants present in silk?
Jo: Sericin-free silk has been used in medical practice for many years in the form of surgical sutures (stitches). Hospitals use this form of silk as there have been reports in the medical literature of allergic reactions to sericin both in patients and in people working in the silk manufacturing industry. It is not a common irritant but with most eczema patients the irritation of sensitive skin is the last thing you would want to promote so it is logical to use medical grade fibroin silk. We’ve never measured the anti-oxidant properties of silk as our aim is to control temperature and humidity to prevent itch.
Marcie Mom: DermaSilk has taken the silk, modified it to medical grade, and enhanced it with the anti-microbial shield. I viewed with interest your video that this shield can reduce staph as it pierces the microbes and destroys it without using chemicals such as silver or nano-particles that will leach to the skin. In fact, DermaSilk can even be an alternative to steroid. Under what circumstances would you recommend parents to use DermaSilk instead of steroids? For instance, only in mild cases or certain types of eczema such as those not triggered by food?
Jo: As silk is a natural protein fibre it can be prone to attack by bacteria and fungi so it is important that we protect it from colonisation by microbes which would make eczema worse. Unlike silver, our antimicrobial is designed to bond with the silk and it cannot be washed or worn off. This means that it does not get onto the skin or into the body of the wearer so continues to work for the life of the garment. We’ve run a large number of clinical trials with DermaSilk, one of them comparing DermaSilk with a topical corticosteroid to compare efficacy. What the researchers found was that there was no difference between arms treated with 7 days of steroid and arms clothed in DermaSilk. We would not advocate that DermaSilk replaces any prescribed medication. It is intended to be an “add on” treatment which will help to control the symptoms of eczema in such a way as to possibly reduce the need for topical steroids in the future as the frequency and severity of eczema flares tends to reduce when using DermaSilk.
Marcie Mom: So what is it that DermaSilk does?
Jo: It’s really very simple. DermaSilk stops itch! It is made of a knitted fabric which helps to control temperature and humidity close to the skin. When skin is too hot or cold or too dry or too damp it itches and scratching the itch leads to more itching and skin damage. Worn as underwear, DermaSilk helps to keep optimal levels of moisture and temperature close to the skin, even in hot and humid environments.
Marcie Mom: I think we have a clearer picture of DermaSilk’s features. Let’s learn how to use DermaSilk. Parents may be mistaken to use DermaSilk as a wet or dry wrap because that is the main use of other types of medical clothing. This is incorrect as large quantities of moisturizers used in “wrapping” can impede the function of the product. Also, DermaSilk is to be worn at all times. Practically, does this mean parents who need to moisturize their child frequently have to remove DermaSilk garments, apply moisturizer/steroid, wait for them to be absorbed then put the garment back on? Or would you say it’s more suitable for night time use in young children?
Jo: Many people confuse the use of DermaSilk with wrapping garments so it is good to have the opportunity to put the matter straight. Wrapping garments are used for getting difficult eczema cases under control and may only be needed for a short period of time. During their use the child has to be covered in thick layers of sticky emollient ointments and the garments are pulled over the emollient to help force the moisturiser into the skin. Wet wraps involve two layers of garments and dry wrapping a single layer but these garments are to keep the moisturiser in place for a short time.
By contrast, DermaSilk is designed to help control stable eczema and this is achieved by constant wearing 24 hours a day, 7 days a week, whether the eczema is causing a problem or not. Think of it as normal underwear. It is always advisable to let moisturisers dry before you put the DermaSilk on but we find that in many cases the need to apply moisturisers frequently drops to a couple of times a day because the silk is helping to protect the skin. This means that DermaSilk can be used both day and night.
Marcie Mom: We know that eczema children are very good at scratching hard. Will their scratching damage DermaSilk garment? Is the DermaSilk glove recommended for young children who can’t keep their mittens on?
Jo: DermaSilk removes the itch so the desire to scratch reduces. The garments are pretty robust and, providing they are worn under normal clothing, little fingers are not likely to damage the clothing. For the smaller children, aged up to 4 the DermaSilk body suits have integral mits which can be folded over the hands to protect them. DermaSilk gloves, used from age 4 upwards are not intended to stop fingers from scratching but to stop hands from itching. Remember it is the anti-itch properties of the clothing which sets DermaSilk aside.
Marcie Mom: One interesting point is that DermaSilk doesn’t have to dry completely before the child can wear as it can retain 30% moisture without feeling damp. Does the higher moisture retention make DermaSilk susceptible to mould? And will it expand and become loose overtime?
Jo: Silk needs to be humid in order to function properly and just like healthy skin it performs best when at 30% humidity. As with skin, silk will attract bacteria and fungi and this is why the antimicrobial is bonded to the silk to help prevent this buildup and keep the garment fresh and the skin free of excess microbes.
Marcie Mom: A final question on the durability of DermaSilk. I note that DermaSilk’s anti-microbial shield has been tested for over 50 washes. My child with eczema showers twice a day so does that mean DermaSilk can last 25 days?
Jo: Not at all! We tested the durability of the antimicrobial for over 50 washes and found that less than 1% of the activity of the antimicrobial had been removed. Our garments will last for as long as they are the right size for the child to fit into them and we’ve even had instances of families passing them down to younger siblings. 6 to 12 month lifespans are not uncommon.
Marcie Mom: Thanks, I’ve learnt a great deal about DermaSilk and must say I’m impressed with the technology. p.s. to readers of eczemablues.com, I did not receive any money from Espere Healthcare or Alpretec for this interview.
My girl, two year old, just passed the 14 days medical certificate required for chickenpox. With some sanity finally restored in the house, I could post a short account of what happened.
Before the 1st Day of Chickenpox
Actually, her pre-school already had a round of toddlers getting chickenpox and the teachers thought Marcie’s tiny red spots somewhat resembled what the other kids got. I took her to the doctor and he said it’s eczema and not chickenpox. To me, she normally didn’t have so many tiny red spots but it clearly didn’t look like chickenpox. Here’s her picture during this period.
Marcie posing under a christmas tree in a mall (and I’m surprised she knew how to pose!)
First 3 Days of Chickenpox
About 15 days later, we noticed her high fever and red spots clearly didn’t look normal. Brought her to doctor and confirmed chickenpox. Though she had fever, felt very hot at night, she managed to retain her good spirits and appetite. The chickenpox started on her face and neck.
Next 7 Days of Chickenpox
These were the days when it got worse – the chickenpox itch and the eczema itch. Parts of her skin which normally were fine started becoming dry, peeling and turning reddish – brought back memories when her eczema was severe. The chickenpox spread to the whole body and we had to cool her down by letting her play in the indoor playpool. I think most people don’t bathe and limit spreading lotion/water from one part of the body to the other, but with Marcie, we bathed and moisturized her as usual. We did apply calamine lotion and gave her anti-itch syrup from doctor.
Frog Play Pool
After 14 Days
This is a picture of her, finally able to go out, happily playing with a number-block book while waiting for her noodles!
Finally! There’re pox scars everywhere but as long as it’s not itchy, I’m glad.
Frequent scratching or rubbing of eyes can be due to itchiness caused by eye allergy or infection; but for a child with eczema, it is possible that he or she has eczema on the eyelid. Though eyelid eczema is more common in adults wearing cosmetics, children can also suffer from dry, sensitive and itchy eyelid. The skin around the eye is thin and sensitive, and also vulnerable to irritants and allergens just as other parts of the body of an eczema child. My baby Marcie sometimes scratches her eyes, and the eyelids look red, dry and sometimes a little swollen.
Here’s a little bit more of how you can identify eyelid eczema in your child:
– Eyelid is itchy, looks inflamed or scaly.
– Eyelid is red or swollen.
– If scratching is vigorous and prolonged, it may cause a change in the appearance of the eyelid, e.g. extra fold of skin under the eye or darker eyelid.
– Extreme rubbing can even lead to deformed cornea (keratoconus)
I haven’t asked for any medical advice regarding eyelid eczema, but I usually wipe Marcie’s eyelid with cooled boiled water on cotton pad. If her eyelid looks oily (at the place where mascara is applied, not that I apply eye makeup on her), I will use slightly warm cooled boiled water that can remove the oil better. I will then sparingly apply Physiogel AI cream on her eyelids, and usually, she stopped scratching after a few days since her eyelid eczema is not severe. Do do see a specialist and seek appropriate treatment as you can read below, it’s a little trickier to treat the eyelid eczema.
– Certain irritant/allergen in moisturizers may worsen the eyelid eczema, see this post and the comment section for some of these irritants.
– Eyelid can be moisturized, but avoid doing it too generously that it flows into the eye and irritate the eye.
– Check with the doctor if the steroid lotion/cream that you have can be applied on the eyelid. There’s some research that shows increased risk of cataract and glaucoma with steroid use. (Also read that the risk of cataract is higher for people with severe eczema for more than ten years…but let’s not scare ourselves too much now and just focus on managing our children’s eczema for now)
– As the eyelid is already thinner than other skin, and extensive steroid use causes skin thinning, do consult your baby’s doctor on the frequency you can apply the steroid. (note: don’t get put off steroid use, as there’s research that there’s no long term adverse effect if used as doctor prescribed)
– For cleaning the eyelid (if need to), ask your baby’s doctor first if you want to use eye lid cleanser as most of these are for adults only.
Update: Since this post, I have interviewed several dermatologists on eyelid eczema and how to clean and treat it, here are the posts:
Are you running out of ideas to distract your child with eczema from scratching? Marcie (in photo) knows about 200 signs from Amercian Sign Language (ASL) and sometimes when she wants to scratch, I’d quickly distract her by asking her how to sign certain animals, like “Mouse”, “Monkey” or “Bird”. Most of the time, it works as Marcie would respond by doing the sign and soon forgot about scratching.
Here’s Marcie’s Signing Story:
At about 3 month old, when we decided she could watch TV and hence, should watch programs suited for her, we went to the library and borrowed a few children DVDs. She’s really taken to Signing Time and watching the DVD already distracted her from scratching.
By about 6 month old, she already started signing back. Her first signs were “More”, “Milk” and she loved signing “Cat”, “Dog” and “Bird”.
By about 15 month old, she actually knew more signs than my husband and I! We left her to watch the DVD on her own, while we quickly did household chores and given her good memory, she actually learnt more than us.
Now, at almost 2 year old, Marcie knows almost 200 signs (she could know more, cos I only counted those I learnt with her). Marcie is scratching less and likes dancing now, so although she’s signing less, signing has helped us for almost a year with distracting her from scratching.
So, are there other benefits to Signing? Marcie’s “True/False/Not Sure” response.
Yes, you won’t find helping eczema children as a benefit listed but there are many other listed benefits:
1. Able to communicate with caregiver, thus reducing frustration/tantrums (from your baby, not you!) – True. Marcie, despite her eczema, did not show sign of frustration of not being able to communicate with us.
2. Improve motor skills – Not sure. Being an eczema baby from 2 weeks old, Marcie has better finger dexterity than other babies her age. Before others discover their fingers, Marcie was already scratching! Baby’s finger muscles develop earlier than speech muscles, so they can sign before they can talk.
3. Understand English earlier and Increase Vocabulary – True. Marcie knows 200 words already, and she knows her A to Z at about 14 month old. By knowing, I meant she can sign and she can pinpoint the alphabet if I ask her which is “M”. Also, I read that alphabet like C and Z may confuse a child, and knowing that they have different sign allow the baby to know they are different alphabet. Also alphabet like W may mislead the child to thinking it’s three alphabets. Also, teaching a child using a multi-sensory approach can help him/her remember better. Read interview with MySmartHands founder on benefits of baby sign language.
4. Deeper bonding with parents, higher trust level- Unsure. I co-sleep with Marcie and was stay at home mom for 11 months, without hiring a maid/au pair. So, I can’t tell if she’s bonded with me because of the signing or not.
5. Helps talking, does not delay speech – Unsure. Marcie, at almost 2 year old, hasn’t talked much though she sings to herself, dances and tries to say certain words.
6. Stimulates intellectual development – Unsure. Research conducted showed higher IQ of signing babies (114) compared to non-signing babies (102). I think Marcie is already smart, so I can’t tell this one (lol, I know I’m one of those moms who think her baby is smarter than others).
7. Boost self-esteem and confidence – Unsure. Marcie is quite shy around strangers, say in sunday school.
8. Learn a recognized 2nd language, rather than make-up signs – Yes. I’m intending when Marcie is older to sign up to volunteer with the deaf association. You need to go through their sign language course but I’m sure we’ll pick up quickly given the head start.
All in all, I love signing with Marcie and I love seeing her stop her scratching and sign in response to my request for “What’s the Sign for Eat?”
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