The truth about eczema
With up to one in three infants being affected by eczema, there’s no doubt it’s a growing and serious problem. But the condition is confusing and difficult to treat, and parents often go down the wrong track in trying to control it. Paulette Crowley talks to the experts to find out what the real deal is with eczema
Eczema is mostly an inherited condition that nothing can prevent: you can’t change your genes. Only 10-20 per cent of eczema is caused by food allergies. You can spend a lot of time trying to figure out the root cause of this disease but it’s like trying to herd cats – just when you think you might have pinned something down it slips through your hands like jelly.
When my daughter was diagnosed with eczema, I searched high and low for information that I hoped would lead to understanding and better treatment for my little girl. Seven years later, the original seemingly rudimentary advice that the GP gave me was pretty much on the money. Protect the skin, use the creams and wait and see. Looking back, I wish I had spent more time paying attention to looking after Maggie’s skin and preventing the terrible infections she got from scratching, rather than trying to unsuccessfully figure out if eating peanut butter, milk or oranges were setting her skin off.
What is eczema
- Eczema is a genetically determined condition that tends to be most severe in early life. The basic problem is skin dryness, which affects the skin barrier leading to inflammation and infection. It can be intensely itchy. Eczema has a number of triggers (mainly environmental, such as soap) but
- it is not an allergy.
- Eczema is rarely diagnosed in babies under six weeks, and will often settle or disappear by the age of five.
- It’s important to have a proper diagnosis for eczema, as it could be something else. For example, babies can get rashes on their skin from constant dribbling when they’re teething, which might not be eczema at all and require different treatment.
Eczema is not an allergy
Eczema is a condition in its own right and is not an allergy, Penny Jorgensen, allergy adviser at Allergy New Zealand says. “Unfortunately parents can spend a lot of time trying to find a cause for their child’s eczema when it is most likely due to genetic (hereditary) factors they can do nothing about.”
The message of looking after the eczema first is one Mrs Jorgensen promotes to parents. “The main thing to do is try to keep on top of the day-to-day routine of moisturising to help the skin maintain its barrier function, use topical corticosteroids to reduce the inflammation and itch, and antibiotics when it becomes infected.”
Educating yourself about the relationship between eczema and allergies is important – babies with moderate-to-severe eczema have an increased risk of developing food and other allergies, for example – but the skin has to come first. “Bleach baths can help reduce infection, and it is important to avoid using soaps and detergents which can dry the skin out. By helping the skin maintain its barrier function, they can also reduce the risk of developing allergies, particularly to food.”
Topical steroids friend or foe?
Looking at Maggie’s beautiful little baby body (albeit marred by eczema), the thought of lathering her in steroid creams filled me with dread. Didn’t they thin the skin and even create scarring? I’d heard these stories somewhere. How could that be good for baby skin that was already traumatised?
It turns out my experience was typical. Many parents shun these prescribed creams believing they might cause more harm than good, although this is a myth that often leaves eczema to thrive and become infected, according to paediatric dermatologist Diana Purvis. “People have become terrified to treat eczema because they’re so concerned about using topical steroids that they leave their children with untreated disease.” “There are many myths about the dangers of the use of topical corticosteroid creams and ointments,” agrees Dr Young. “Used sensibly these will not do any harm and provide marked relief in what is a very uncomfortable disorder.”
The concerns about these creams have arisen from the old preparations used back in the 1960s and ‘70s. However, modern versions of topical steroid creams are often milder and safe to use as prescribed, Dr Purvis says. “We know a lot more about how to use them now and how the body responds to them.”
Every day at her clinic at Starship Hospital, Dr Purvis sees many children who have complications of untreated eczema. “But I can count on one hand the number of children I’ve seen who’ve had side effects of topical steroids. We actually see more problems like this in adults, not kids.”
The impact of eczema
People downplay eczema because it's not a life-threatening condition. "But having severely inflamed skin with constant scratching, itching and skin infections, as well as sleeping poorly at night, all have a really big impact on the child's growth, development and quality of life, and also their wider family as well," Dr Purvis says.
The back-to-basics approach of skincare first (see sidebar) is also what Dr Purvis recommends to parents to treat their children’s eczema.
No quick fixes
Eczema can take a long time time to heal, and it’s important to commit to a consistent treatment regimen, of which topical steroids are an important factor. “It takes a good six-to-eight or even more weeks for eczema to heal under the microscope,” Dr Purvis says. During that time the eczema can appear to get better but still flare occasionally, so it’s important to keep using the steroid creams for the prescribed time, even though the skin might be clear. “You’d then wean off the steroid cream.”
However if the skin gets worse, it’s important to return to your doctor to review the treatment.
The role of food
Only 10-20 per cent of eczema is caused through true food allergies, which can also produce other serious symptoms, such as anaphylaxis, breathing difficulties and vomiting. A food allergy needs to be diagnosed and proven through expert testing via your GP, and must be managed with strict avoidance of the food allergen and antihistamines, Dr Young says.
For everyone else, food has little to do with eczema, Dr Purvis says. Previous thoughts that babies should not be exposed to potentially allergenic foods, such as wheat, peanuts, eggs and dairy products, are no longer recommended by doctors.
In fact, keeping a baby’s diet as normal as possible could help prevent food allergies later in life.
“We don’t routinely stop food for treating eczema. We’re trying to keep the baby’s diets as normal as possible. There’s an increasing body of evidence that shows that keeping the diet normal helps prevent development of lifelong food allergies. There aren’t any good studies that show taking food out makes eczema go away.”
However, many parents swear their child's eczema responds to eliminating certain foods. "You have to weigh up the risks and benefits of that. Mild eczema can be managed just as well with topical steroids and moisturisers and keeping diet normal."
And it's not all bad news. Since around the age of five Maggie's skin has all but cleared up, as long as we avoid sandflies, which she reacts to severely and will cause her eczema to flare. We still moisturise regularly but otherwise her life is normal, including eating a standard diet. I guess the doctors knew what they were talking about, after all.
Get specialist support
It’s easy to get stuck on the eczema merry-go-round. In the first few years, Maggie’s eczema flares seemed to be never-ending, with many infections and barely any times when her skin was healthy. It was heartbreaking having to bandage up her open wounds to send her off to kindy, and for her to be sent home because she was scratching and bleeding everywhere.
This frustration is something Mrs Jorgensen sees all the time in her work at Allergy NZ but she stresses it doesn’t have to be this way with proper treatment and support.
“Eczema is a very difficult condition to live with for children and their families, and it is often underestimated how much impact it has on their lives. Please see your doctor if your child can’t sleep because of their eczema, or they seem to be on antibiotics a lot, and ask for a referral to a paediatrician or specialist.”
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