By John Lee, MD
If your child has ever had a severe eczema flare-up, you are familiar with the inflamed, dry, thickened skin and constant, intense itching and scratching. Fortunately there are ways to ease symptoms.
An estimated 30 percent of the U.S. population experience eczema symptoms, according to the National Institutes of Allergy and Infectious Diseases,but this skin disease is more common among children. Symptoms usually start within the first 5 years of life, often the first 6 months. With time and treatment, as children mature, eczema will often go away – but it sometimes continues into adulthood.
Many different factors contribute to eczema including food and environmental allergens, excessive skin dryness, injury from scratching, and inflammation from bacteria in the skin. Addressing each is essential to controlling the condition.
Although eczema is not necessarily an allergic disease, allergens can play a role. Among infants and toddlers with moderate to severe eczema, it’s often a food allergen.
The most common food allergies in the United States are cow’s milk, egg, wheat, soy, peanuts, tree nuts and seafood. Before removing any food from your child’s diet, however, it’s important to consult a board-certified allergist for an accurate diagnosis and to address any nutritional concerns.
If a food allergen is inadvertently reintroduced into the diet, there’s not only a risk of an eczema flare-up but also anaphylaxis, a severe allergic reaction. Always carry two epinephrine auto-injectors with you if you have a food allergy.
Common indoor allergens that affect eczema include dust mites and pet dander. To minimize dust mite exposure, encase pillows and mattresses with dust mite covers, wash linens weekly in hot water (130 degrees), vacuum with a HEPA (high efficiency particulate air) vacuum, and reduce indoor humidity to 40-50 percent (dust mites need moisture to live).
No measures can effectively reduce pet dander if the animal remains in the home, but it may help to keep pets out of bedrooms and off upholstered furniture, remove carpeting and rugs, and use HEPA cleaners. When all else fails, finding a new home for the pet may be the only option.
Preventing Dry Skin
The skin of children with eczema dries out more rapidly than healthy skin, so it’s important to keep it well hydrated.
I recommend the “soak and seal” method – sit the child in a tub of lukewarm water for 15 minutes to let the water soak in, then either shake off excess water or gently pat dry with a towel and immediately apply moisturizer in a thick layer. Reapply moisturizer frequently.
Topical Corticosteroid Medications
Many children require topical corticosteroid skin ointments or creams to fully control their eczema. These come in a wide range of strengths, so always ask your physician which medications and treatment options are best suited for your child.
Controlling the Itch
Controlling the itch is crucial: The more the child scratches the skin, the more the eczema worsens and symptoms can spiral out of control. Over-the-counter antihistamines such as Benadryl® or Claritin® may help take the edge off the itch and allow for a better night’s sleep. Some parents find wrapping wet cloths around affected skin eases the itch and stops scratching.
If your child’s eczema remains poorly controlled, consult with your board-certified allergist for further treatment options.
John Lee, MD, is the clinical director of the Food Allergy Program at Boston Children’s Hospital.