Eczema is defining my child

My toddler has eczema that just doesn’t go away. We have tried so many things, and some help and some don’t. At times it gets a little better, and I get hopeful, but in fact I have to face the fact that this is chronic. How can I help him? In a way I even feel like it is affecting his personality, as he is so often uncomfortable and miserable, and I am so tired of saying ‘don’t scratch’. I want to throw everything I can at this problem, so please give me advice on the best tests and treatments that are out there.

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DR KHOZA ANSWERS:

As a parent, your instincts to help and protect can be overwhelming. In my clinical practice, I’ve never seen a calm parent faced with the realities of her child’s eczema. Eczema (atopic dermatitis) is a complex, chronic condition that cannot be cured but can be managed. Sadly, it’s one of the most common health problems seen in children and infants. Children suffering from eczema require a great deal of understanding from others.

It presents as patches of dry, red and itchy skin. Itching is the hallmark of atopic eczema and is responsible for relapses and poor-quality sleep. A chronic condition is like a shadow that follows you, often impacting on the quality of life. Although the exact mode of inheritance remains unclear, eczema is thought to be largely hereditary. Whatever the genetic basis may be, eczema occurs because of an impaired skin barrier and dysfunction of the skin’s immune system.

The disruption in the skin barrier causes the skin to be highly sensitive to irritants, environmental allergens and infections. These may include pollen, dust, house dust mites, animal dander, mould and just about anything. Irritants like harsh detergents, soaps, synthetic fabrics, fragrances and seasonal changes may also worsen the rash. As does emotional stress.

And so, when we try to address eczema, the goal of therapy is to:

• avoid trigger factors

• optimise hydration

• restore the skin barrier

• stop the inflammation

• stop the itch

• maintain and keep flares away Avoiding trigger factors can be a challenge for most parents, as it can be difficult to identify and manage triggers, especially environmental allergens. But sometimes simple things, like avoiding exposure to solvents and detergents and finding ways to address emotional stress, can help. General measures to optimise skin hydration when it comes to bathing include soaking in short quick baths in warm water (quick in and quick out) and using moisturising soaps or oils that don’t irritate. Remember, bathing is not complete until moisturiser is on! Skin-barrier repair is the most crucial step in the management of atopic eczema. Emollients and moisturisers help restore the barrier and retain water within the skin. When used correctly, emollients will help decrease the itch, decrease the severity of eczema, prolong the interval between flares, decrease the need for topical corticosteroids and reduce inflammation. Therefore, use appropriate emollients. Some moisturisers may cause irritation due to preservatives and fragrances. Moisturisers and emollients that contain glycerine, petroleum, ceramides and natural moisturisers can be beneficial. Discuss the choice of moisturiser with your dermatologist.

Apply frequently and liberally more than once a day; ideally, twice daily is advised. Frequently top up during the day, if necessary, sometimes up to four to six times a day. When it comes to moisturising, slather!

More is definitely more in atopic eczema!

Itching is present in all phases of eczema. Dry skin itches! Controlling the itch helps stop the itch-scratch cycle. First moisturise. Secondly, oral antihistamines can help a great deal, as they also improve the quality of sleep.

The mainstay of therapy in atopic dermatitis, topical steroids reduce inflammation and the itch. The choice of the corticosteroid depends on the area involved, age of the child and severity. Your doctor can help prescribe the appropriate strength of topical steroid for the appropriate area of the skin.

Other anti-inflammatory creams include topical calcineurin inhibitors. These are non-steroidal antiinflammatory creams that do not cause skin atrophy and other adverse effects. They are used for mild to moderate afflictions on the face and eyelids as well. They’re great for maintenance therapy, as they prolong intervals between flares. Ask your doctor about calcineurin inhibitors as an alternative to topical steroid therapy.

In cases of severe eczema not controlled by topical therapy and antihistamines, dermatologist can suggest phototherapy or oral medications.

Remember, regardless of how rigorously healthy your child is and how consistent you are in sticking to treatment, flare-ups happen. Accepting this reality will better equip you to deal with the challenges. ●