My five-year-old son was diagnosed with eczema as a baby. His skin flares up every two to three months and I often have to take him to the doctor as his scratches himself until he bleeds. Last month his eczema got infected and he needed to take antibiotics. How can I manage his eczema at home? Is there a way I can avoid flare ups?
Eczema is a non-contagious, inflammatory skin condition that causes itching, redness and thick dark scaly rashes. The constant scratching can cause painful cracks in the skin and sometimes bleeding.
Bacteria get into these cracks leading to infection (which is probably what happened to your son). The itching in eczema is sometimes so severe that it interferes with a child’s sleep.
Hay fever history
Eczema usually starts within the first five years of life, most often in the first six months. It affects the face, arms, legs, neck and even the sometimes the trunk. It tends to be more common in families that have a history of hay fever and asthma.
It tends to wax and wane—there are periods of time when the skin appears mildly affected or even normal, alternating with periods in which the skin becomes moderately or severely inflamed (the so called ‘flare-ups’).
Most flare-ups are caused by triggers.
Common triggers include allowing your child’s skin to get too dry, harsh soaps and detergents, certain skin care products, perfumes and colognes (particularly those that contain alcohol), constantly wearing certain fabrics such as wool and synthetic fibres, dust mites (in bedding and furniture), pets, tobacco smoke, excessive heat and sweating.
Emotional stress is also thought to play a role in flare-ups although the exact mechanism is poorly understood. In babies, saliva from drooling may cause irritation, particularly to the cheeks, chin and neck.
Some children with eczema have food allergies, but that does not mean that the food allergies actually cause the eczema. If your child gets red, itchy swollen skin bumps within one hour of eating a specific food, this is a sign of a food allergy and this food should be avoided.
Common culprits are dairy products, eggs, wheat, soy and nuts. In babies, eczema is rarely related to diet. Do not stop breastfeeding or giving cow’s milk or formula without first talking to your child’s doctor. In most cases, the eczema clears with just good skin care.
To deal with eczema at home, it is important to identify possible triggers and remove them from your child’s environment.
Daily bathing is recommended for children with eczema (whether or not they are having a flare-up). Baths should be warm (not hot) and they should be short in duration, lasting about 10 minutes.
Hot water dries the skin. Use mild soaps or non-soap cleansers when bathing your child. Avoid using scented soaps.
Also avoid the use of scrubbers, and rough washcloths (although the child may enjoy the sensation of being ‘scratched’ by a rough washcloth, it is harmful to the skin in the long term). Do not let him have bubble baths.
Immediately after bathing, pat your child’s skin dry (never rub it down) and apply moisturizer within three minutes of him leaving the tub. Use fragrance-free moisturisers. Ointments and creams are more moisturising than lotions.
This is because ointments have the greatest oil content, followed by creams, and then lotions. Ointments also tend to cause less burning when applied to broken or inflamed skin.
Apply the moisturiser to the entire body (you can then re-apply the moisturiser to the areas with eczema two to three times a day). Avoid alcohol-containing lotions and moisturizers, which can make skin drier. Some baby products (especially the lotions) have been known to contribute to dry skin.
No fabric softener
Dress your child in loose-fitting, comfortable fabrics (such as cotton and cotton blends). Avoid wool (and other coarse fibres) and synthetic fabrics since they can irritate your skin. Do not ‘over dress’ your son as this could lead to him becoming overheated, which can lead to flare-ups.
When washing his clothes, use mild laundry detergent with no dyes or perfumes. In addition, stop using fabric softener.
Keep your son’s fingernails short to prevent skin damage. If you find that he scratches a lot at night, try putting him to bed with gloves (preferably cotton ones).
Certain home remedies such as adding oatmeal have been found to help improve symptoms during a flare-up. Oatmeal helps ease the itching. Your son should be allowed to participate in normal childhood sporting activities including swimming.
However, your child’s skin may not tolerate long periods in the pool, as the chemicals can dry the skin. Teach your child to shower and apply moisturiser before and after swimming in a chlorinated pool.
DR NG’ANG’A will answer your questions on lifestyle and other diseases and medical issues for both children and adults. Send questions to: [email protected]