The big itch

 

 

The big itch

 

Eczema is one of the most common

skin conditions – and also one of the most uncomfortable. Around one in five children is affected, suffering itchy, irritable skin on a regular basis. Lucy Jolin has answers to all your questions

 

Eczema is a skin condition that makes the skin red, flaky, itchy and irritable. Nobody really knows what causes it, but it could have a genetic link. It’s also linked to conditions such as asthma and hay fever. So, if you or your partner have any of these conditions, your child has a higher risk of having them, too.

 

‘We are beginning to think that there are actually structural differences in the skin of children who have eczema,’ says Helen Dennis, dermatology nurse specialist and nurse advisor for the

National Eczema Society. ‘That means their skin has what we call impaired barrier function, allowing airborne particles to actually enter the skin and trigger an immune response which is inflammation, itching and redness.’

 

What are the signs?

 

It can start showing very early – almost from birth, says Helen Dennis. ‘Most children develop it around three to six months or in the first year. We do hear of cases where it doesn’t show until after the child turns four, but that’s quite rare. Parents will initially

spot redness, dry patches of skin and inflammation. Children might also be noticeably itching, so they might rub their bodies. It can appear all over the body, anywhere.

 

What is the treatment?

 

It’s essential to get a proper diagnosis. Most children will be treated by their GP. Childen whose eczema is very severe will be referred to a specialist.

 

Treatment depends on the severity of the eczema. All children with eczema will need to have an emollient regularly applied to moisturise the skin and create a barrier. This can come in the form of a cream, an ointment or a lotion. The ointments have the highest oil content, followed by creams and then lotions. There are plenty on the market and they can be bought over the counter. ‘I advise parents not to experiment with too many, as they don’t vary that much,’ says Helen Dennis. ‘Just find one that suits you

– as long as it does the job of adding moisture and restoring the barrier function, that’s fine.’

 

If emollients aren’t enough, your GP may prescribe a steroid cream. ‘Topical steroids are the fi rst line of active drug treatment, as emollients don’t contain drugs as such. They are still the number

one choice, as they have the least side effects and are considered the safest of the treatment options available,’ explains Helen Dennis. ‘They come in different strengths. For children, mild topical corticosteroids are absolutely safe to use. Some children will require the next strength up, which is moderate. If they require something stronger, it’s probably appropriate to refer to a specialist.’ For more severe cases, specialists can prescribe drugs called calcineurin inhibitors. Phototherapy – treatment with a

special kind of light – is also an option.

 

 

 

‘His bed clothes would be covered in blood’

Lorna Parkes’ son Austin, now three, was born in Australia and showed no signs of eczema. But when he was three months old, they returned to the UK, and Lorna noticed what she thought was a rash –

inflamed, sore skin that Austin was trying to rub. ‘I took him to the GP, panicking a bit, and he told me it was an eczema  are-up,’ she says. ‘From then on, flare-ups just kept happening.’

 

At first, Lorna’s GP recommended just an emollient, but that wasn’t enough to keep the eczema under control. He then prescribed a steroid cream for Austin, which helped. But flare-ups still happened. ‘He used to make himself bleed,’ recalls Laura. ‘I’d go in in the morning and the bed clothes would be covered in blood. Funnily enough, he never used to get that cranky with it, so luckily our sleep didn’t suffer. You could see it was inflamed and red and bleeding but it didn’t

often make him cry.’

 

Lorna manages the eczema by ‘trial and error,’ she says, seeing what works and what doesn’t. ‘We’ve tried mittens but he would pull them off. The ones that attach to sleep suits and folded over were the best ones for him as a small baby. He has particularly bad spots on his body – behind the neck and the wrists and the ankles. He used to bleed from his ankles because from a very early age he learnt to rub his ankles on carpets or the bed or anything where he could get some friction. We also tried strapping his feet up using gauze at night, and that worked well, but only for his ankles.’

 

Austin’s eczema has improved over time. Lorna advises other parents to seek out the products that work for their child as soon as possible. ‘It took quite a few months for us to find an emollient that we felt really helped. We now use Aveeno, which is great. We’ve been looking into things which might trigger the eczema and we are pretty sure that cows’ milk doesn’t help but it’s very hard to pin it down. I also try to use natural fabrics, such as merino and organic cottons, for items like pyjamas, as they help the skin to breathe.’

 

 

What are the challenges?

 

Applying the emollient is the big one, particularly as your child gets more mobile. Children will probably need to be creamed in the morning, then in the evening, followed by an application of the emollient before bed. If the eczema is very severe, you might need

to apply the emollient several times a day and at night.

 

‘Babies are quite easy: you put a big towel on the fl oor and put them under their baby gym,’ says Helen Dennis. ‘Once they are crawling, we’d recommend that you try and contain them within the bathroom.’ Trying to stop children scratching is also a big

challenge, so keep their nails short to limit damage to skin and try putting mittens on them at night time.

 

It’s likely that children will want to cream themselves when they start to develop their own independence – Helen Dennis advises to let them get used to it. ‘You will have to watch them make a mess, but there is huge value in being independent – and they will get better at it, if you let them try.’

 

The itching can affect a child’s sleep, meaning that the whole family ends up tired. ‘If you’re finding it hard to cope, ask your GP if your child’s eczema is severe enough to be referred to a specialist,’ suggests Helen Dennis. ‘The National Eczema Society also has a helpline (see below) so please call us.’

 

How will nursery and school manage it?

 

When you’re looking round a nursery, ask them how they would cope with having to look after a child with eczema, suggests Helen Dennis. ‘The nursery should meet their needs but it does vary from place to place.

 

‘If they say they are short staffed and might not have time, then I would steer clear,’ adds Helen Dennis. ‘Schools

have an obligation to assist the child with their learning. It’s reasonable for the child to be able to put cream on themselves when they get to school age. But they need prompting and

reminding, and somewhere to do it.’

 

What does the future hold?

 

About 70 per cent of eczema will no longer be visible in the teen years, but around a third of sufferers will have it into adulthood. It could also return during stressful times in your child’s life. ‘The approach is to treat it in the early years so it’s well controlled, even if that means being more aggressive with treatment,’ explains Helen Dennis.‘If it’s managed well when children are little, the long

term prospects are better.’ For more info, visit www.eczema.org or call the society’s helpline on 0800 089 1122.

 

 

 

 

 

 

 

 

May/June 2017

All information is correct at time of publishing

 

Health