Treating Eczema During Pregnancy

Some women see their eczema suddenly flare and want to know if there is anything they can do to treat it. Others are concerned about continuing to use medication while pregnant or nursing. Here’s what dermatologists recommend.

1. Talk with a dermatologist before continuing to use eczema medication. Women who are pregnant or breastfeeding should not use eczema medication before discussing this with a dermatologist or obstetrician. Some medications can cause birth defects or harm a nursing child. For this reason, the U.S. Food and Drug Administration (FDA) requires that all medication be classified according to its potential effects on a pregnancy. Some medication is safe to use during pregnancy; others should be stopped. Some medication should not be used while nursing. A dermatologist can help a woman weigh the risks and benefits of the medications and other eczema treatment options.

2. Communicate openly with the dermatologist. While dermatologists are the experts when it comes to weighing the risks and benefits of each treatment option for eczema, you know best how the eczema is affecting your life. For example, if the eczema is keeping you awake at night or interfering with your life in any other way, be sure to tell your dermatologist. Open communication can help the dermatologist develop a treatment plan that best meets your needs.

3. Consult a dermatologist or obstetrician before trying any remedy advertised as “herbal” or “all natural.” While “all natural” or “herbal” may sound like a safe alternative to medication, some of these products have proven extremely harmful, even lethal. The FDA cautions women not to take any herbal product before consulting a healthcare provider. Some of these products have been linked to miscarriage, premature birth, and even birth defects. Others can harm the mother’s health.

4. Follow a skin-care plan designed specifically for skin with eczema. Taking good care of your skin while pregnant and
nursing can minimize flare-ups. Good skin care practices for a person with eczema include:

· Avoiding hot water. The water should not feel hot nor redden the skin because hot water dries skin. Dry, irritated skin can cause a flare-up or worsen existing eczema.

· Taking short lukewarm showers or baths. A lukewarm shower or bath once a day for 5 to 10 minutes can hydrate skin effectively. Staying in the water longer can dry the skin. For best results, be sure to apply moisturizer within 2 to 3 minutes of bathing.

· Using a gentle cleanser. A recent survey found that 29% of adults living with atopic dermatitis, a type of eczema, say they do not use a cleanser. For anyone who has eczema, a gentle cleanser is essential. It is vital that dirt, bacteria, and other substances be washed away without causing further irritation. When looking for a cleanser, be sure to select one that is free of fragrances, antibacterial agents, and other chemicals that can irritate the skin. Cleansers should not be used on skin that has flared as even the mildest cleanser can be quite irritating.

· Eliminating washcloths, mesh sponges, and similar products. Dermatologists recommend that their patients with eczema avoid all products that rub, scrub, or exfoliate the skin. This irritates the already sensitive skin and can cause a flare-up. To wash, dermatologists recommend using your fingertips to gently apply the cleanser and using your hands to gently rinse.

· Moisturizing frequently. Dermatologists consider moisturizer the first line of defense when treating eczema because it can help relieve dry skin and the associated itch. Moisturizer should be applied immediately after bathing, hand washing, and as needed to keep the skin moist.

5. Grab a cool compress to relieve that itch. Scratching can lead to infection. Applying a cool — not cold — compress can help lessen the itch.

6. Reduce stress. Decreasing stress can be a challenge, especially with the anticipation of a baby. However, finding ways to unwind are essential during pregnancy. Research shows that stress can increase the risk of a pre-mature birth, delivering a low-birth-weight baby, as well as the child developing learning and behavioral problems. Stress also exacerbates eczema.

7. Know your triggers and take extra steps to avoid them. Do you know what causes your eczema to flare? If not, a dermatologist can help you identify everyday activities and objects that may trigger your eczema. Some common triggers are fragrances, immersing your hands in water often or for long periods of time, bubble bath, laundry detergents, wool, and pet fur. However, different people have different triggers, so it is important to learn what triggers your eczema and avoid those objects and activities.

8. Try to avoid sweating and overheating. These are common triggers that can cause itching and lead to scratching and flare-ups.

9. Wear clothing made of cotton or another fabric that feels smooth to the touch. Wool and other fabrics that feel rough to the touch often irritate the skin and can trigger a flare-up. Cotton, cotton-blends, and other fabrics that feel smooth to the touch usually make skin feel better.

10. Get regular medical checkups. Regular checkups with your obstetrician play an important role during each and every pregnancy. Women who have eczema should be sure to tell their obstetrician. Skin affected by eczema is more susceptible to infection, and it is important that any skin infection that develops during pregnancy be properly treated.

If you want specific medical advice about how to treat your eczema during pregnancy or while nursing, be sure to see a dermatologist. By considering a number of factors, such as your overall health and the trimester of your pregnancy, a dermatologist can develop a treatment plan to help you effectively manage your eczema. This may include identifying your triggers and providing you with a skin-care plan.

Reference:
Berson D. “Recommendation of Moisturizers and Cleansers: A Study of Unmet Needs Among Dermatology Patients.” Cutis. 2005 December;76(6S):3-6.

Eczema sufferers test water softeners

More than 300 families are being recruited to find out if water softeners can help in the treatment of childhood eczema.

Researchers from the University of Nottingham will focus on hard water areas in the Soft Water Eczema Trial (SWET) to discover whether eczema can be improved by deliberately softening all water used in the home (except one kitchen tap for drinking water).

The trial follows on from earlier research that found that eczema is more common in primary school children living in hard water areas in the UK, compared with children living in soft water areas.

Professor Hywel Williams from the Centre of Evidence-Based Dermatology said the first study did not explain why children living in hard water areas were more susceptible to eczema. However he said this could be because hard water contains high levels of calcium and magnesium, leading to increased use of soaps which can act as a skin irritant.

“If ion-exchange water softeners are found to improve the symptoms of eczema, this will be an extremely important finding for both patients and doctors. Many patients worry about the possible side effects of the usual treatments for eczema, so this would be a welcome addition to their treatment options,” Prof Williams said.

The trial will run until the end of next year and the results won’t be known until the end of 2009 when all the information has been analysed.

Source:
www.irishhealth.com

The Frequent Usage of Manuka Honey for Eczema Treatment and More

After the breakthrough discovery of the benefits of Manuka honey in eczema treatment, more and more companies are using it in their products for eczema treatment.
London, 28^nd November 2007: Following the discovery of Manuka Honey and its benefits in eczema treatment, most of the manufacturers of health care products have started including natural ingredients in their eczema treatment skin care products.
Eczema is a common disease in UK. Infants are the most affected ones due to this skin disease. Research proved that out of every five children, one suffers from some form of eczema. There are basically two forms of eczema – atopic dermatitis and contact dermatitis. About 10 – 20 percent of the total population in the world is suffering from eczema. The most common symptoms of eczema are dry, itchy and red skin that may also bleed in worse cases.

According to recent breakthrough discovery, Manuka honey is found to be quite beneficial in healing eczema and skin rashes. The antibacterial, antimicrobial, antiviral, antiseptic, anti-inflammatory and anti-fungal properties of Manuka honey makes it effective on skin afflicted by this condition. Manuka honey also is great for moisturising and soothing dry and damaged skin. And, therefore, some of the skin care products companies are also using Manuka honey, especially in their winter care products.

Source: Freepressreleases

Results of the Relieva® Clinical Trial in Eczema Treatment Published

Study results showed significant improvements in Erythema, Infiltration, Excoriation and Lichenification scores. In addition, subjects responding to a post treatment evaluation questionnaire indicated a substantial benefit when rating effectiveness, itching and appearance. This study indicates that Relieva® is useful in adult patients with atopic dermatitis.
Oldsmar, FL (PRWEB) November 28, 2007 -- The results of the study conducted in the USA. to determine the efficacy and tolerability of Relieva® in adult patients with Atopic Dermatitis (eczema) were just published in the September issue of the American Journal of Therapeutics (14:442-446, 2007).
Previous laboratory studies showed that Psorberine®, the active ingredient of Relieva®, a non-corticoid, non- immunosuppressant but potent anti-inflammatory compound might be effective in atopic dermatitis. A clinical trial was conducted to determine if indeed Relieva® is efficacious in these patients.

Patients enrolled in this 12 week trial carried out by Global Clinicals Inc. were treated with Relieva®, a topical preparation containing Psorberine in Novasome®, a proprietary liposome formulation. Efficacy and safety was assessed using EASI (Eczema Area and Severity Index), an established index used for evaluating the severity of the signs of atopic dermatitis and a Subject Reported Evaluation of Treatment. Study results showed significant improvements in Erythema, Infiltration, Excoriation and Lichenification scores. In addition, subjects responding to a post treatment evaluation questionnaire indicated a substantial benefit when rating effectiveness, itching and appearance.
This study indicates that Relieva® is useful in adult patients with atopic dermatitis.
Apollo Pharmaceuticals continuous research in dermatology offers another option for the treatment of adult patients with Atopic Dermatitis (eczema).

Eczema Study Points to Skin's Protective Layer as Key Factor
Shielding Lotion a Superior Skin Care Option Says Dermatologist

BEVERLY HILLS, CA--(Marketwire - November 20, 2007) - 21st Century Formulations, manufacturers of Skin MD Natural, applauded the Australian Eczema Society's research that suggests a defective skin barrier is the primary cause of this skin disease that plagues millions the world over. Previously it has been thought that the immune system was responsible for eczema outbreaks.
This research shows that a key factor in developing eczema is the structure of the skin barrier and the integrity of the cells' lipids and binders. These findings support Skin MD's research into how the skin heals and paves the way for better skin care treatment and management of the debilitating disorder.
Dr. Peter Helton, medical director of the Helton Skin and Laser Institute in Newport Beach, California, says shielding lotion is superior to conventional moisturizers for treating dry skin and eczema. "With a shielding lotion we get faster results and the patient has to use less medication," says Dr. Helton.
Airline pilot Rod Wilkinson has suffered from severe eczema for the past eight years. Like many other eczema sufferers, Wilkinson has invested time and money in seeing doctors and specialists, not to mention the lotions and potions that promised a 'cure.' He has been prescribed, and/or recommended, a long list of skin care products and treatments ranging from steroids to warm olive oil and orally taken oregano drops.
"I even tried a remedy off the Internet that consisted of a root extract to take orally and a cream," says Wilkinson. "The tincture tasted as bad as the oregano drops I had used earlier. I couldn't follow through with it, it just tasted too bad. I did finish using the cream, but it didn't do any good."
His is not an unusual story -- many eczema sufferers try one remedy after the other with little or no result. "If it's out there, I've tried it," says Wilkinson. "Nothing worked until I used this shielding lotion."
Wilkinson began using Skin MD Natural on his eczema in January and noticed a difference within three weeks. He began a strict routine of applications morning and evening. At first he saw improvement only at the edges; the spreading had stopped. Then the bright colors started to fade and the scabbing went away. Most impressive was that the persistent itching was gone. "That was a big relief!" says Wilkinson. "After approximately a month it was obvious that the eczema crud was on the retreat."
Wilkinson continued this treatment for almost a year and documented the improvement month to month. He is still applying Skin MD Natural every other day as insurance against a return of the eczema. "It doesn't happen overnight," says Wilkinson. "Just keep using the shielding lotion and don't give up."
Skin MD Natural is available in thousands of pharmacies and some CVS stores across the country. For a limited time this effective skin care product can be purchased in these stores at a considerable saving.


SOURCE: 21st Century Formulations

Eczema video

Apples, fish benefits for unborn babies

Consumption of apples and fish by mothers during pregnancy could be extremely beneficial for babies, latest research suggests.

Apples are already linked to better lung health when taken by adults, perhaps due to their antioxidant properties, and oily fish in particular contain Omega-3 oils, which, scientists suggest offer several health benefits.

Scientist Graham Devereux and other researchers at the University of Aberdeen quizzed 2,000 pregnant women on their eating habits, and then observed their children's health over a period of five years.

They found that those women who ate four or more apples a week were half as likely to have an asthmatic child compared with those who ate one or fewer.

The researchers also discovered a link between eating more fish during pregnancy and a lower chance of children developing the allergic skin condition eczema, the online edition of BBC News reported.

Women who ate one or more portions of any type of fish during pregnancy had almost half the chance of having a child diagnosed with eczema within the first five years, the researchers said.

The study presented at the recently held American Thoracic Society conference suggests that a simple modification that can be made to a pregnant mother's diet may help protect her child from developing asthma.

Source:

Hindustan Times

Kids with sensitive skin may be allergic to oats

NEW YORK (Reuters Health) - Children with skin allergies may be allergic to oat proteins commonly found in skin products, study findings suggest.
Of 302 children seen at a pediatric dermatology unit in Bordeaux, France, nearly one third had a positive skin reaction to oats, report Dr. Franck Boralevi, at the Hopital Pelligrin-Enfants, and colleagues.
The researchers used skin patch tests and skin prick tests to determine the sensitivity to oat proteins among children, ages 4 months to 15 years old, with eczema. Also referred to as atopic dermatitis, eczema is a chronic skin disorder that causes scaly and itchy rashes.
Overall, 32.5 percent of the children were sensitive to oats, study investigators report in the medical journal Allergy. Skin patch tests showed oat sensitivity among 14.6 percent, while skin prick tests identified oat sensitivity among 19.2 percent of those tested.
Hospital-based oral food challenges, completed by 32 of the 98 children who tested positive for oat sensitivity, further identified 16 percent with sensitivity to oat meal.
None of the parents of these children suspected an oat allergy in their child. Previous history taking and clinical examinations also had not identified these allergies, the researchers note.
Of the children who were tested with oat protein allergy by repeatedly applying oat cream to a skin area previously unaffected by atopic dermatitis, 28 percent developed eczema or other skin eruptions.
Three quarters of all of the children had been previously treated with oat-containing emollients. Thirty-two percent of these children who used skin produces containing oat previously tested positive on the skin patch tests.
The investigators suspect the repeated application of oat-containing skin products appears to be associated with oat sensitization in this study population, the investigators report.
Boralevi and colleagues also found that the percentage of children with positive skin patch reactions decreased with age, a finding that is in accordance with previous studies, they note.
The researchers suggest that oat-containing skin products be avoided in children younger than two years old.
SOURCE: Allergy, November 2007.

Ceragenix Epiceram product phase 4 results positive

Analysis of: Ceragenix Announces Results from Phase IV Study of EpiCeram(TM) Meet All Primary and Secondary Endpoints www.irconnect.com

Implications: The recent Epiceram phase 4 data comparing it to Cutivate are positive, and bode well for the product. The concept of barrier repair makes sense in light of the recent findings in regards to the genetic basis of atopic dermatitis. Repairing the barrier with Epiceram will reduce inflammation, and the results show that this reduction approaches that with a steroid. The biggest potential is using Epiceram as the base for many other compounds/conditions where the barrier is impaired like psoriasis, etc.Analysis: This study will increase the market significantly, because there is a non steroid option which has good efficacy, and repairs the barrier. Epiceram can be used as the base into which other compounds can be mixed, so that you can treat the primary condition, and repair the barrier. Dermatologists and other physicians, as well as patients are looking for a new treatment modality for atopic dermatitis, especially one that will have minimal or no side effects.

Skin Scare: A Natural Disaster
Omaha, NE--The demand for organic isn't just growing, it's booming. And now the trend is leaping from food to skincare. In fact, industry analysts say people spend more than six billion dollars on natural products for face and body. That number is expected to reach 10+ billion by 2012.
Part of the appeal or organics is just what it implies--all natural ingredients, grown without pesticides. Most people assume that since organic food is so good for you, the same can be said for other products.
Shopper Danielle Kohlander agrees. "It seems like you're not hurting your skin or what you're putting in your body. It seems like it would be better."
Dermatologists say there are some pluses with going all natural. Eliminating artificial fragrances and preservatives do help some people with allergies and skin sensitivities to those ingredients. But it can also lead to rashes and itchy, red skin in others.
"I certainly see a lot of patients with atopic dermatitis or eczema or very sensitive skin that actually get irritated by a natural product," says Methodist dermatologist, Dr. Jill Nelson.
Dr. Nelson says the longer the list of ingredients in a product, the bigger your chance of having an allergy or sensitivity to something inside. She says two biggies that affect a lot of people, fruit acids and nut oils.
She says the assumption that organic and all natural is better isn't always true. "One could assume poison ivy could be grown organically without any pesticides but that would not be a good thing to use on your skin."
The lack of preservatives in many organic products also means the shelf life is much shorter than your regular goods and they can contaminate easier. Dermatologists recommend organic foundations, cleansers, and lip products get tossed every six months.
That news, plus, the higher price of going pure have some shoppers hesitant about jumping on the bandwagon.
"I'm not sure they're really doing what they say they're going to do especially at the kind of price they're sold at," says Jackie Hansel.
Doctors say there is a way to make sure you and the product have no problems.
"Test them in an unaffected area like the crease of the arm to see if they're developing irritation there," says Dr. Nelson. She also suggests reading labels so you know what's inside.
And if you think something is irritating your skin, Dr. Nelson says you can check by simplifying your routine and using bland products for a while--even water in some cases will work. Then eventually add your normal products--one at a time--to see what's causing problems. If this doesn't clear up the irritation, you may need to see a dermatologist.
Reported by Carol Wang,
Source:
www.action3news.com

Children With Atopic Dermatitis Show Hypersensory Profile

Responses to a sensory profile questionnaire indicate that children with atopic dermatitis (AD) have hypersensory sensitivity, according to Israeli researchers.Senior investigator Dr. Ayelet Shani-Adir told Reuters Health that this was the first time such a study has been conducted. "We believe," she added, "that understanding the sensory and behavioral characteristics of AD patients can promote a multidisciplinary intervention program for children with AD and improve their quality of life."
As reported in the October issue of the Journal of the American Academy of Dermatology, Dr. Shani-Adir of Haemeq Medical Center, Afula and colleagues used the Short Sensory Profile, which covers a range of sensory modalities including tactile sensitivity and taste and smell, to study 53 patients with atopic dermatitis and 61 healthy controls aged 3 to 10 years.Assessment included behaviors such as avoidance of being barefoot in sand or grass, fear of falling, and reacting emotionally to touch.The AD children "had significantly higher sensory sensitivity than the control group (p = 0.013) ... in all sensory modalities except vestibular sensation," the investigators found. The highest difference was in the tactile subscale.The researchers therefore call for larger and more detailed studies of the sensory modulation dysfunction in this population in order "to promote development of effective intervention processes."
J Am Acad Dermatol 2007

Gene mutation discovery might help improve eczema treatment

LONDON - A gene called 'filaggrin' undergoes different mutations in people from differing ethnic backgrounds and leads to dry skin, eczema and skin ailments, researchers from the Dundee University have found. The discovery has the potential to accelerate treatments for eczema of the skin.Lead researcher Professor Irwin McLean and colleagues had already found that defects in filaggrin were the cause of eczema. Now they have discovered that mutations in this gene are not uniform in people from all ethnic backgrounds. Some 15 different mutations have so far been identified in the gene.The findings are described in detail in the journal NatureMcLean's team has worked in conjunction with Dr Alan Irvine in Dublin in identifying the gene and its different mutations. Any person with only one mutation has a 60 percent risk of developing eczema, the team reported. However people with two mutations almost certainly develop eczema, the team added."Once we cracked this exceptionally difficult gene, we were surprised to learn how many different defects in filaggrin were waiting to be discovered, not only in European people, but other populations worldwide," McLean said.Eczema is a disease that affects one in five UK children. With the knowledge of these mutations doctors can start treatment protocols early.

Eczema Care - Food Additives


The vast majority of foods we consume today contain additives. Additives can be natural or synthetically made and their are about 300 additives listed for UK use. There are 6 main groups:
Preservatives
Chemical preservatives are used to increase the shelf life of products by delaying the growth of bacteria and fungi.
Colourings
Colourings are used to make our food look attractive to eat. Many processed and pre-packed foods would not look at all appetising with the absence of colour.
Flavour Enhancers
These make our foods taste stronger and are often used in savoury products. For example monosodium glutamate to which some people are sensitive.
Antioxidants
Antioxidants prevent fatty foods from becoming rancid.
Stabilisers and Emulsifiers
Emulsifiers help to mix oil and water together whilst stabilisers help keep them together.
Sweeteners
These are mainly used in low calorie products, eg fizzy drinks, sugar substitutes.
There has been a great deal of interest in food additives over the past 20 years, mainly due to the changes in food labelling in the 1980's. Rather than just using generic terms on packing, each additive needs to be listed. Approved additives usually have the number 'E' and these have been approved by the EC (European Community).
It is extremely difficult to pinpoint the foods that may be affecting an individual's eczema. But, the general rule of thumb is to eat a diet based on fresh, home cooked food. When using processed or pre-prepared foods, check the labels for any particular additives you wish to avoid.
There are 11 azo colourings and 10 benzoate preservatives and these are the two groups of food additives believed to irritate eczema. The most commonly used additives are tartrazine E102, sunset yellow E110, armaranth E123 and ponceau E124.

Recommended Eczema Goods

I have been riddled with eczema from a young age right through to my adulthood, and throughout that time I have tried many different products to help my skin condition. Some of the products are only available via prescription, but it is well worth a simple trip to your local doctor!
Here is a list of my favourite products.
• Mosituriser - Diprobase - This stuff is brilliant. It is really thick and will keep your skin moist for longer than any other moisuriser.
• Steroid - Betnovate - When you eczema becomes really bad, the doctor may prescribe you with a mild steroid cream. Betnovate works wonders and has really helped clear my skin.
• Soap - "Simple Soap" - You wash every day, so why not wash without irritating your skin. Simple Soap or any un-fragranced soap will not irritate your skin.
• Washing Powder - "NON-Biological" - any washing powder with those words on it will not irritate your skin!
• Deodorant - "Sensitive" - as long as the product has "Sensitive" written on it, then it shouldn't worsen your eczema.
• Dairy - Soya or goat's milk - I personally continue with regular milk, however Soya or goats milk is recommended by doctor's.
Most products are by trial and error. None will completely stop your condition but they won't worsen it. It may take some time before you have things right, but the effort is well worth it.
Sponsored links

Latin Names?
This can cause a problem when common ingredients are not recognised. An example of this is arachis oil', which is the International Nomenclature of Cosmetic Ingredients (INCI) name for peanut oil. The only answer is for you to have a list with the Latin names of the ingredients that you must avoid and refer to this whenever buying products.
Ingredient (INCI Name)
Avocado (Persea gratissima)
Bitter Almond (Prunus amara)
Brazil Nut (Bertholletia excelsa)
Coconut (Cocos nucifera)
Cod Liver Oil (Gadi iecur)
Egg (Ovum)
Hazel Nut (Corylus rostrata/americana/avellana)
Macadamia Nut (Macademia ternifolia)
Melo (Cucumis melo)
Milk (Lac)
Mixed Fish Oil (Piscum iecur)
Pea (Pisum sativum)
Peanut Oil (Arachis oil)
Sesame (Sesamum indicum)
Soya (Glycine soja)
Sweet Almond/Almond Oil (Prunus dulcis)
Walnut (Juglans regia/nigra)

What Do Steroids Do?
Steroids are essentially hormones and there are many different types with quite different actions. The human body makes it own steroids in the adrenal gland and these are vital for the body's normal function. Different types of synthetic steroids have been developed for use in medicine. There is a group called anabolic steroids, which some athletes take (illegally!) to help build up muscle mass, and these should not be confused with the steroids used in eczema. The other group is called catabolic steroids or glucocorticoids e.g. prednisolone); they are used as an oral medicine for a variety of different diseases because of their anti-inflammatory and immunosuppressive properties. This means that they act by damping down the activity of various immune cells that cause inflammation. Catabolic steroids have proved a very useful medicine, even lifesaving, in some medical conditions such as severe asthma or rheumatoid arthritis. The down side of this group of steroids is that if they are used at a high dose for a prolonged period they have many side-effects such as weight gain, bone thinning, decreased growth in children, high blood pressure and loss of muscle mass. Because of this, doctors try to use these at the lowest possible dose for short periods. This type of steroid is occasionally used in the treatment of a very severe flare-up of eczema. However, for the reasons already mentioned, they would normally be used for only a few weeks, starting at a high dose and then slowly decreasing. This method should prevent or minimise any serious side-effects. Fortunately, these anti-inflammatory steroids can also be made into creams for topical application - directly onto the skin. They act in a way like that of their oral counterpart, as they have been developed to try to produce the same anti-inflammatory properties without all the general ('systemic') side-effccts on the rest of the body, even after long-term use. This approach has been very successful and the topical steroids provide one of the main components in eczema treatment

Hints & Tips

New emollient
If you are trying a new product, leave it on a patch of eczema-free skin for 24 hours, to check that your skin does not react to it.
Repeat Prescriptions
As most fellow suffers will know, repeat perscriptions for creams, dressings and antibiotics soon add up. Ask your pharmacist about a pre-paid perscription were £32.40 (2002 price) pays for every perscription you'll need for 4 months.
Handy emollient
Spoon the emollient into small pots to carry around with you. Baby food jars can be ideal for this.
Keeping a spare supply of your emollient at your workplace or in the car will help you to moisturise your skin when it is beginning to become dry and itchy, rather than by risking more problems by waiting until you get home.
Cool emollient
No, not a trendy emollient but rather if your skin is particularly hot and itchy, you may find it helpful to cool your emollients in the fridge before putting them on your skin. See also 'handy emollient'.
Body hair
Apply moisturising creams (emollients) downwards so that the hair on the arms and legs is combed. This will stop the hair from being itchy.
After bath
Apply creams as soon as possible after a bath, when the skin is well hydrated. This will help lock in the moisture. Adding an emollient to the bath water will also help lock in moisture - Remember bathing alone [ i.e. and not applying any creams afterwards ] will dry the skin out. Leave one hour between the application of applying emollients and topical corticosteroids.
Hand Held Games
Portable hand held games e.g. game boys are great ways for young kids to keep them amused when their eczema is bothering them. Because it helps to keep them distracted and keeps both their hands occupied so they don't scratch - it gives them something fun to do, and helps alleviate some anxiety during those times when they just want to tear themselves to bits. Save their use for those times and then the child can learn to use it as a positive self help strategy.
Face
If you apply emollients with your ringfinger ( second smallest ) you are less likely to put too much pressure on delicate areas such as your face.
Dab the lotion across the face and gently stroke it into the skin, using your ringfingers to stroke it out from the nose.
Soothing Sprays
In the warmer months keep a bottle of lavender water or rose water in the fridge. A quick spray every so often is wonderfully soothing and helps to prevent heat-related skin problems from gaining a foothold!
Shower Gel? Instead of Soap
Some people seem to find that they don't react to shower gels in the same way that they react to soaps. So you could try a shower gel instead.
Make-Up
Be careful - irritants, irritants, irritants....but not just make-up for the skin but also nail polish!
Sleep
In order to sleep I use to take a sleeping pill because the itching would keep me up for hours, now I put five to six drops of strong lavender on my pillow and read for a while. Usually I fall asleep much quicker and dont feel grumpy in the morning from the sleeping pills.
Housework
If you are about to wash dishes or do anything you know that will trigger your eczema, apply your emollients before and after the job. Some people find it helpful to use lotions underneath gloves, particularly if they are placing their hands in hot water.
Food
If you want to tackle the diet as a cause it is essential that you keep detailed records and seek the help of a dietician. Not all people with eczema find food makes their eczema worse.
Rubber seals
Emollients on clothing can cause problems with washing machines, as the rubber seals may be broken down. Washing emollient-smeared clothing inside old pillow cases can minimise the damage. Occasionally you should do a hot wash without clothes to help clean away the emollient deposits from previous washes. See also Boil Clothes hint below.
Dust Mites and Beds
An effective way to reducing dust mites is to hoover the matress of the bed on each side.
T-shirt Bath
Bath your baby in a long sleeve t-shirt to prevent scratching.
Nappy Changing
Undo the legs of the babygrow and pop each of them over the hands of your baby so that he/she cannot scratch their bare legs and tummys whilst your hands are occupied. It's also good fun!
Boil Clothes
I've been struggling with laundering my sons very greasy sleep suits for a couple of years, experiencing the common problem of trashed washing machine seals etc. But, I've found a solution, I boil them in washing-up liquid, rinse out all the soap suds and then wash them as usual in the washing machine with an extra rinse. The washing-up liquid dissolves the grease, saving a lot of time and effort. I hope this helps someone struggling with the same problem.
Toy warning
Be careful of itchy toys. Also tell your friends and relatives so that they do not waste their money on presents you can¹t use. Also tell them to buy cotton clothing.
Toy care
You can freeze soft toys overnight to kill dust mites.
Mix in Milk
If using sedatives then it is better to mix in with the milk. They can be strong tasting and could cause the baby to be sick which is the last thing you want. Mixing with the milk is a good way of getting it down without upsetting the baby.
File baby's nails at night time
Do the toe- nails as well. It is easier to file than it is to cut. If you have to cut the nails then it means they are too long and it will have already caused some bleeding.
Cover Hands
This is a tip to help those who have babies through to young children in helping them to cover one of the hardest parts of the body - the hands. I have found that using a pair of cotton socks over the hands then placing a piece of tubigrip - with a hole cut out along the side for the thumb to go through it - over the top of the sock is an easy, quick and cheap way of covering the hands. The tubigrip which holds the sock directly against the skin and prevents the sock from being removed -yet still allows kids to have the flexibilty to move their fingers around (even though covered). We came up with this idea when our daughter was in hospital - and all involved found it to be quite effective.
Torch to Distract
No! Don't set the baby alight! A great tip for distraction while dressing or changing a young child. A torch!! Show the child how to shine it on the roof/wall then let them go for it. Added tip.. keep the torch to change time so it doesnt lose its appeal so fast.

Emollients
Emollients have been used for over 5,000 years and they form an essential part of the therapy for all dry skin conditions, including atopic and contact eczema.
Emollients are safe and effective and, in the majority of cases, mild to moderate eczema can be successfully treated by using emollient therapy alone.
Unfortunately, emollients are under used, as people often perceive them to be inactive moisturisers and do not understand why they are so important in controlling eczema. When used correctly as a daily skin care regime, emollients become effective ‘active treatments’. Emollient therapy is not just about products but understanding how and when to use them.
.
Why are emollients so effective?
Dry skin is one of the main symptoms of eczema. Changes in skin moisture levels cause a reduction in the barrier function, which in turn increases water loss, thus allowing the penetration of irritants and allergens which trigger eczema.
Itching is another major and most distressing symptom of eczema and produces an itch-scratch-itch cycle. Scratching leads to the release of histamine, a chemical in the body, which makes the itching worse and leads to skin damage. This also allows entry for irritants, allergens and bacteria which trigger eczema.
Emollients soothe and relieve the itch, producing an oily layer over the skin surface which traps water beneath it. The resulting restoration of the skin’s barrier function by emollients prevents penetration of irritants, allergens and bacteria thereby reducing or preventing the development of eczema. A good skin care routine using emollients can soothe, moisturise, and protect the skin, thus helping to reduce the need for steroid preparations. In mild to moderate eczema, topical steroids and calcineurin inhibitors (e.g. Elidel and Protopic) should only be necessary intermitently for flare-ups of eczema.
What are emollients?
Emollient is simply the medical word for moisturiser. However, emollients are different from cosmetic moisturisers in that they tend to be unperfumed and do not have anti-ageing ingredients. Applying emollients can be very time consuming and tedious, but it helps to know what they do for your skin. Emollients help skin to feel more comfortable and less itchy. They keep the skin moist and flexible, helping to prevent cracks. There are many types of emollients and they can be classified according to how they are applied.
Lotions, creams and ointments: applied directly to the skin.
Bath and shower oils: added to the bath water or directly to the skin in the shower.
Soap substitutes: used instead of soap to cleanse the skin.
Lotions
Lotions contain more water and less fat than creams. They spread easily and are cooling, but are not very effective at moisturising very dry skin. They are useful for hairy areas or for quick absorbtion if time is short.
Creams
Creams contain a mixture of fat and water and feel light and cool on the skin. They are easier to spread over sore skin and are not greasy. All creams contain preservatives and people can become sensitised to them, although this is rare. Creams need to be used liberally and frequently so that the skin is not allowed to dry out.
Ointments
Most ointments do not contain water; therefore they do not need a preservative. This makes them ideal for people who react to preservatives. Ointments are often stiff and greasy and some people may find them cosmetically unacceptable. However, because they are very effective at holding water in the skin, they are useful for very dry and thickened skin, under wet wraps or if a heavier cream is required at night. Ointments should not be used on weeping eczema – use a cream or lotion instead. The absence of preservatives in ointments makes them vulnerable to contamination by bacteria transferred from your skin. It is very important not to put your fingers into the pots of ointment. Instead decant some of the ointment into another clean container before applying to your skin.
Bath oils
Bubble baths are extremely drying and potentially irritating to people with eczema. However, daily baths remove dirt and skin debris which could cause infection. Bath oils and warm water clean and hydrate the skin coating it with a film of oil to trap water in the skin.
Some bath oils are fully-dispersing while others are semi-dispersing, leaving more or less oil on the skin. As with emollients it can be a case of trial and error. Experiment to see which suits your or your child’s skin best. Some doctors prescribe emulsifying ointment for bathing. This needs to be dissolved with boiling water first and whisked with a fork. Some people find this helpful, while others find it messy and time-consuming. Discuss with your doctor to find an emollient regime
that works best for you.
Bath oils can be used in the shower, either on a sponge, or applied all over before showering off.
It is also possible to obtain emollients specially designed for the shower. If you find that entering the water stings the skin, apply a soap substitute or emollient all over before entering the water. Be careful not to slip – always use a bath/shower mat. Grab rails are also helpful. Placing a towel in the bath may also be helpful especially when bathing an active baby. Bath oils do make a mess of the bath. Wipe around the bath with paper towels or tissues – this will absorb excess oil and shine the bath. Warn other bath users that the bath or shower may still be slippery. The bath may be cleaned with a bath cleaner but be careful to rinse it thoroughly before use.
Soap substitutes
Soap is alkaline and very drying to skin with eczema. The hands are particularly at risk, as they are washed more frequently. Each wash degreases the skin. Detergent base soap-substitutes (liquid soaps/cleansers) and perfumed products should also be avoided as they tend to irritate eczematous skin.
Emollient soap-substitutes do not foam and may take a little while to get used to. It is not essential to have bubbles to clean the skin and emollient washing creams are very effective at cleaning the skin. Soap-substitutes can either be applied before bathing, showering or washing or scoop up a handful of cream and apply over the skin while in the water.
Choosing the right emollient
The best emollient is one which the patient prefers because then you, or your child, will use it more frequently. Dermatology nurses sometimes give out emollients for people to try. Always try new emollients on a small area of unaffected skin first to test for a reaction.
Once you have chosen your emollients they will need to be used frequently to have maximum benefit. Ideally this would be every few hours but it should be at least 3 to 4 times a day – getting through a 500g tub per week is not unusual.
It is important to use emollient products for the purpose for which they were designed. Aqueous cream was designed as an emollient soap substitute and for this purpose it is acceptable.
However if aqueous cream is used as a leave on emollient cream it can irritate the skin of children with eczema and make it worse rather than better. In an audit of children attending a paediatric dermatology clinic using aqueous cream caused irritant reactions in more than fifty percent of the children (Cork et al 2003).¹
When and how to apply emollients
When the skin is very dry, using a combination of the three types of emollients helps to give the best hydration and restore the skin’s barrier function to normal. Emollients can be used in combination with other treatments which your doctor may prescribe, such as topical steroids and topical calcineurin inhibitors.
There are no standard rules regarding whether to apply a topical steroid preparation after or before using an emollient. Some people are happiest using an emollient first to prepare the skin, followed by the steroid. However, whichever order of care you choose it is important that you leave as long a period as practical, approximately 1/2 to 1 hour, between the two treatments to avoid diluting the strength of the topical steroid preparation, and to prevent the spread of topical steroids and calcineurin inhibitors to areas not affected by eczema.
Emollient cream or ointment

Use liberally and frequently – every hour if the skin is very dry, but at
least 3 times a day.

Apply gently in the direction of hair growth. Never rub up and down vigorously as this could trigger itching, block hair follicles or create more heat in the skin.
Apply emollients after bathing, while water is still trapped in the skin, for extra hydration.
Avoid putting hands into large tubs of emollient cream. Use a spatula to take out the correct amount each time and replace the lid immediately.
Alternatively, ask your doctor or pharmacist about pump dispensers for emollients.
Continue to use the emollient, even when the eczema has improved, this will help prevent flare-ups.
Apply the emollients to all of your skin
Storage depends on whether you prefer your emollient warm or cold – try either the airing cupboard or fridge.

Bath oil

Adding oil to warm, not hot, bath water cleanses and hydrates the skin., Pat (do not rub) the skin dry. Apply emollient.

Emollient soap substitutes
Use whenever you would use soap, but particularly on the hands and
while bathing or showering.

¹ An audit of adverse drug reactions to aqueous cream in children with atopic eczema: M.J Cork
et al Pharmaceutical Journal, Vol 271 29 November 2003,
The National Eczema Society is grateful to Dr. Michael Cork, Head of Academic Dermatology, University of Sheffield Medical School and Honorary Consultant dermatologist at Sheffield Childrens and Royal Hallamshire Hospitals for his
help in the preparation and review of this sheet.
Disclaimer
These details are only as a general guide. Individual circumstances differ and the National Eczema Society does not prescribe, give medical advice or endorse products or treatments. We hope you will find the information useful, but it does not replace and should not replace the essential guidance given by your general practitioner, dermatologist and dermatology nurse..
Updated and revised 04/06
©National Eczema Society 2006

SUN SCREENS AND INGREDIENTS
WHAT TO LOOK FOR
Some people find that sunscreens can make their eczema worse. When you chose a sunscreen you will need to think about the same things as you would when choosing an emollient. You should always be careful and make sure that you test any new sunscreen before applying it to the whole of your body. Apply a small amount to the inside of the arm and wait 24 hours before using all over the body. If the skin becomes red and/or itchy do not use the sunscreen, but ask your pharmacist, nurse or doctor for further advice.
Sunscreens are made up of chemical absorbers, physical reflectors or a
mixture of both.
Chemical absorbers penetrate the skin and allow some UVA light to get to the skin but are a potential irritant.
Physical blockers such as titanium dioxide reflect the UVA, UVB and infra-red rays. They do not penetrate the skin and are therefore less Irritating. However, one drawback of titanium dioxide is that it tends to leave a white sheen on the skin, which may not be cosmetically acceptable.
Preservatives
Most sunscreens contain preservatives but one chemical in particular may cause an allergic reaction.
Methyldibromoglutaronitrile

This is a chemical found in a number of sunscreens which has caused an increase in allergic reactions in recent years. Typical reactions to the chemical are swelling, itching and acute dermatitis, which could be very painful. Products that are free from this chemical include:
Bergaderm Sunscreen mousse 12/20/30 UVA UVB
E45 Sun Lotions
Sunsense range of sun protection
Vichy Capital Soleil SPF60
Sunscreens on prescription are usually only prescribed for patients diagnosed with photo dermatosis/polymorphic light eruption (sun sensitivity). Prescribing sunscreens for eczema will usually be at the nurses/GP’s discretion.









On parts of the skin that are not covered remember to apply a high factor sunscreen, atleast factor 15, and reapply every two hours.
Whilst every effort has been made to provide accurate information in the following list, manufacturers may change their ingredients and you are advised to check the product contents on the packaging before use, or speak to your pharmacist regarding the contents.
Disclaimer
These details are provided only as a general guide. Individual circumstances differ and the National Eczema Society does not prescribe, give medical advice or endorse products or treatments. We hope you will find the notes helpful but they do not replace and should not replace the essential guidance, which can be given by your doctor.
©National Eczema Society 2007

ECZEMA AND THE SUN
Many people find that their eczema improves with exposure to sunlight (this is particularly true of the contact and discoid types) while others experience a worsening of their condition. Whatever your own experience, the skin will still need protection from the sun’s harmful rays, both during the British Summer-time and when you are away on holiday in a warm climate. In this factsheet, we offer ways of protecting the skin from exposure to the sun.
The damaging effects of the sun
The fairer your skin, the greater the chance of burning. In the short-term, severe sunburn can result in blisters, sickness, shivering and fever but it is also important to consider the long-term effects of over-exposure to the sun.
These include premature ageing of the skin and even skin cancers. The B rays are responsible for burning, while the A rays can damage fibres in the lower levels of the skin, causing wrinkles and ageing.
General advice
Even on an overcast or cloudy day, the sun's rays will still reach you. Wearing loose long-sleeved cotton tops and trousers will protect arms and legs from the sun and a wide-brimmed hat will shield the head and face. Cotton and linen are the best materials for keeping cool. Creams and lotions should be applied to protect exposed skin.
In addition to sunscreens, it is vital to be sensible about the amount of sun exposure, particularly when on holiday. Wherever you are, the sun is always strongest between 11.00am and 2.00pm. Babies under 6 months should not be exposed to direct sunlight, so keep them in the shade at all times.
Protecting your skin
All sunscreens give protection against B rays; some also protect against A rays. The sun protection factor (SPF) tells you the extent to which the sunscreen filters out the B rays. The higher the SPF, the greater the degree of protection. SPF’s range from 2 up to 50, but someone with very fair skin or who has eczema that worsens in sunlight should use a cream with a factor of 15 or above.

The star rating on products indicates their protective effects against UVA rays. The more stars the higher the protection. Sunscreen should be pplied about every two hours.
Water-resistant creams may be better when swimming, but should still be re-applied afterwards.
Sunscreens can be very expensive, especially if you need to use them every day. In some cases, it may be possible to get certain brands on prescription. Alternatively, sunscreens can be bought over the counter. Ask your doctor or local pharmacist for their advice. Own brand products sold by chain stores are increasingly available and can be just as effective as the more expensive ones made by cosmetic companies.
Sunscreens
Sunscreens can irritate eczema in some people. When choosing a sunscreen to use you will need to consider the same factors as you would when choosing an emollient.
Ingredient labelled products will help you to avoid substances to which you have a known sensitivity, but you should always be careful and make sure that you test any new sunscreen before applying it to the whole body. Try not to rub too hard when applying cream as this will set off itching.
Another factor that you may wish to consider is whether to use a sunscreen based on
chemicals, which can irritate eczema, one containing a non-chemical mineral as its base (usually titanium dioxide), or a product that is a combination of both chemicals and minerals. Chemical sunscreens are absorbed into the skin whilst those containing titanium dioxide sit on the skin and act as a barrier. Therefore some people with eczema prefer to use mineral based or combination products rather than chemical sunscreens. Titanium dioxide can leave a white sheen on the skin and this can be off putting, particularly for those with darker skins. However, as with all products used on the skin, what works for one person with eczema will not necessarily suit another, so a process of trial and error
will probably be needed.
Remember that sunscreens are not designed to allow you to spend unlimited time in the sun but to provide protection when you are exposed to sunlight.
Moisturising and avoiding irritation
Sun exposure is drying to the skin. If you can, apply your emollient about half an hour before applying a sunscreen. This will stop the sunscreen from becoming diluted by the emollient and will make sure that the sunscreen keeps its protective properties. If you are using a moisturiser that is greasy or oily, be careful not to overdo the application of the moisturiser as this can cause a ‘frying’ effect. A better solution may be the purchasing of a UV sun suit to minimise the need for sun creams.
Salt water and sand may be irritating for some people with eczema, particularly if the skin is broken or cracked. Particles of sand or salt can lodge in the skin cracks and sting.
Chlorine can also be irritating for some people. It may help to apply a thick layer of emollient before swimming. A tepid shower or a soak in a bath, with oils suitable for eczema, will remove all particles of salt and sand and help to soothe the skin after a trip to the beach or the pool.

Light-sensitive eczema
Some types of eczema are directly caused or made worse by exposure to the sun, although this is rare. The term for this kind of eczema is photosensitive.
Certain drugs and chemicals such as antihistamines and antibiotics can also cause the skin to become sensitive to sunlight. Therefore if you are taking these for your eczema and are planning to spend time in the sunshine, check with your doctor.
Temperature control
Many people find that heat is a key factor in triggering their eczema. Covering up in light trousers and tops will not only protect against sun exposure (see above) but will help to keep you cool. Natural fibres for clothing, such as cotton or linen, are preferable to synthetic fabrics, which can make you feel hot and sweaty.
List of Companies supplying UV clothing for adults and children
Disclaimer
These details are provided only as a general guide. Individual circumstances differ and the National Eczema Society does not prescribe, give medical advice or endorse any products or treatments. We hope you find this information useful but they do not replace, and should not replace, the essential guidance which can be given your doctor or nurse.
National Eczema Society 2007
All rights reserved

Moisturizers For Eczema Skin
Moisturizers have been found to help restore the skin barrier providing a protective layer on surface of the skin to trap water and prevent the penetration of irritants and allergens. As the diagram shows, an emollient cream is superior in trapping the moisture within the skin.

There are five randomized controlled trials showing benefit to emollient use in atopic eczema. Kantor showed a global improvement from the use of moisturizers. (Today Ther Trends 1993;11:157-66). Whilmer and Andersson showed the advantage of urea containing moisturizers.

CHOICE PRODUCTS:

Sticky: Vaseline, 25% water in Hydrophilic Petrolatum, unscented cold cream, aqueous cream.

Less sticky: Uremol, Dermalac, Lachydrin
Moisturizers Should:
Be perfume free and cosmetically acceptable to the patient
Protect – offer a layer of protection on the surface of the skin
Rehydrate - trap and hold water to return moisture to the skin
Restore - assist with restoring the barrier by filling in the holes and gaps in the skin barrier
As much as 400-500 grams of moisturizer (one to two entire bottles) a week is reasonable in children and proportionately more in adults. Several studies have shown that with increased moisturization the skin barrier can be restored, resulting in a significant reduction in the amount of topical medication used to manage eczema, especially in mild to moderate eczema. (Pediatri Dermatol 1997; 14:321-4) To have a maximal effect complete emollient therapy is needed to produce maximal rehydration, restoration of the barrier and prevention of penetration of potential irritants and allergens.
Complete Emollient Therapy Consists Of:
A mild soap-free cleanser
An emollient/therapeutic bath oil-not as effective as direct skin moisturizing
An emollient/moisturizing cream/lotion/ointment
When choosing a moisturizer look for the following ingredients: Petrolatum, mineral oil, silicone (protect), glycerin, panthenol, hyaluronic acid, propylene glycol, butylene glycol (rehydrate), stearyl alcohol, cetyl alcohol, tocopheryl acetate, prolipids (restore).

Eczema Treatment Selection Chart



If There Is Improvement:
Maintain through moisturizing and intermittent anti-inflammatory
If Persistent Or Severe:
Moisturize
Increase strength of steroid
Continue immunomodulators
Consider oral or steroids
UV light
Oral immune supressants

Asthma risk in young children with atopic eczema: A systematic review
October 31, 2007
A systematic review of published prospective follow-up studies concerning the relationship of early life atopic eczema (AE) to asthma in later childhood was conducted. Thirteen prospective cohort studies were included from 1960-2005; 4 birth cohort studies and 9 eczema cohort studies.
The pooled odds ratio (OR) for the risk of asthma after eczema (compared to children without eczema) was 2.14. The prevalence of asthma at age 6 years was 35.8% in inpatients with eczema cohort studies and 29.5% for a combined group of in and outpatients. The risk of developing asthma after eczema in early childhood was approximately one in every 3 children, a lower risk than previously reported (van der Hulst, A.E. et al. J Allergy Clin Immunol 2007, 120 (5): 565-569).

Prebiotics hinders development of skin allergy in babies at high risk

Prebiotics can cut the chances of developing atopic dermatitis in babies at high risk of the disorder, suggests a study published ahead of print in the Archives of Disease in Childhood.
Human breast milk contains natural prebiotics (oligosaccharides), which promote the growth of bacteria, such as lactobacilli and bifidobacteria that boost the development of a healthy immune system.This can help prevent allergies in a very young child.
Researchers developed an infant formula based on the prebiotic content of human breast milk and tested it out on a group of babies one of other of whose parents had atopic eczema, or allergic rhinitis, or asthma.
All the mothers were advised to breastfeed their babies, all of whom were born after a normal length pregancy. But for those unable to start or continue, their babies were divided into two groups, with 102 given a prebiotic formula feed and 104 given a normal formula.
The babies were seen on a monthly basis up to the age of 6 months, and their parents kept a symptom diary.
Over the six months, only 10 babies fed the prebiotic formula developed atopic dermatitis, compared with 24 fed the normal formula. An assessment of stool samples from 98 of the babies showed a significant increase in bifidobacteria in those fed the prebiotic feed.
This strongly suggests that formula feed supplemented with prebiotics can modify the bowel bacteria and so reduce the chance of developing atopic dermatitis among children at high risk of the disorder.

http://adc.bmjjournals.com/

Knowing Your Child's Eczema

What is eczema?

Eczema is a common skin condition affecting ten to twenty per cent of children. The exact cause of eczema is not known. However if there is a history of eczema, asthma or hay fever in the family, your child is more likely to develop one of these conditions. Unfortunately there is no cure for eczema, although there are many ways to keep it under control. Approximately fifty per cent of children will no longer be troubled by eczema by two years of age and eighty five per cent by five years of age.

Eczema is a red, hot, dry and itchy rash that can affect one or many areas on the face and body and it can be mild, moderate or severe. There are often scratch marks on the skin because of the itch. These areas may become infected with bacteria and this can worsen the eczema. If there is an infection, your child may need a course of oral antibiotics.

When the rash begins in the first few months of life it normally affects the face. The cheeks and chin become red, dry, hot and itchy. This is made worse by dribbling, hands touching the face and mouth and saliva irritating the skin. The scalp and facial blood vessels are dilated quickly if baby is overheated. At this age eczema may also affect the trunk and limbs, but the changes in these areas are not usually as severe. As the child becomes a toddler the eczema is less likely to affect the face and more likely to be present on the limbs and trunk. The napkin area is not usually affected. When the child becomes school aged the eczema tends to affect the hot areas of the body, such as the flexures of the neck, elbows, knees and buttocks for similar reasons.

What aggravates eczema?

HEAT, DRYNESS and PRICKLE aggravate eczema. It is important you are aware of these three factors and remove them from your child’s environment. You should keep your child COOL, well MOISTURISED and in LOOSE, LIGHT COTTON CLOTHING and BLANKETS.

Heat and Clothing

The skin of a child with eczema is very hot, and heat increases the itch. There are many things that can make your child hot. Clothing can aggravate eczema. It is best to dress your child in a couple of thin layers rather than a thick layer, as it is easier and more effective to remove the top layer of clothing to suit the environment and stop your child becoming hot and itchy than it is to change the environmental temperature.If your child is participating in physical activities, take a layer of clothing off before doing so to avoid over heating. Educate your child and his/her teachers about this too.

Heat and Bath time

A hot bath can heat your child and cause him/her to become itchy. Bath your child once a day in tepid water adding one capful of bath oil to the bath and use this as a soap substitute. Soaps and some pinetar preparations can be drying to the skin. Your child should be bathed at least two hours before bedtime. The bath should be a pleasurable experience; toys in the
bath are a good idea.

Heat and Car Trips

Travelling in the car can be an unpleasant experience when your child has eczema. The heat generated in the car can cause the child to become hot and itchy. Sunlight shades are beneficial in reducing the heat of the car. Heaters should be used minimally or switched off. It is important to try and predict the occurrence of overheating and also avoid clothing that may be applying pressure or trapping heat. Avoid long car trips if possible and dress your child for the car ride not for the destination. After the trip, assess the heat and itch of your child and institute the appropriate treatments, such as, removing clothing and if needed applying a wet dressing. If a long journey is unavoidable, ensure you take many breaks, use air-conditioning and apply wet dressings and cool compressing often. If your child scratches in the car, canvas armbands may need to be used.

Heat and Bedtime

Children often itch more at night because they get hot under the bed-covers, the skin has more contact with clothing and seams and many children are in a habit of waking. If the eczema is not in good control, children may have difficulty sleeping and may wake a few times each night. Children with eczema should ideally sleep in their own beds, so as not to overheat. Soft cotton or silk sheets and at most one thin cotton blanket are appropriate bed linen. Woollen underlies or blankets, plastic mattress protectors, or doona covers should not be used.

Frequent waking and scratching at night and blood on the sheets in the morning are signs that your child will need a wet dressing just before bed. Wet dressings improve the sleep pattern of children with eczema, by keeping them cool and reducing the itch. Your doctor may prescribe a sedative at night until the eczema and sleeping pattern improves. Antihistamines should NOT be used routinely, or for children under two years of age.

Heat and School

Your child should wear one to two thin cotton layers to school. Woollen jumpers will make them hot and itchy. It is important to educate your child’s teacher about factors that worsen eczema. Ask them not to sit your child next to the heaters. If your child is itchy at school they should apply moisturiser and a cool towel to the itchy area. The teacher should not make a fuss in front of the class. However, they should be aware to remind your child to apply treatment in a private place. On hot days, your child may wet his/her clothes to reduce the heat and itch of the skin.

Heat and Home

The home should be kept cool. Air blowing heaters are the most drying to the skin. It is best if your child’s bedroom is not heated. Remember, your child feels hotter and is more affected by heat than you. It is better to apply another layer of clothing rather than it is to turn up the heater. Do not be concerned about your child catching a “cold” from being under dressed as this is an old wives’ tale.

Dryness and the Skin

The skin should be moisturised many times a day to help with this dryness. There are many things that can dry the skin like water, air-blowing heaters, cleaning agents, soap, swimming and the environment, such as Victoria’s dry winds in summer and winter. Your child’s skin will be dryer in the winter as the humidity is lower and heaters are used more. You may notice the eczema will improve on a tropical holiday.

What moisturisers should I use and how often should I use them?

Children with eczema usually have very dry skin, which worsens the itchiness. Moisturisers are used to prevent the skin from drying and they should be used frequently, and are very important in the management of eczema. Moisturisers can be used alone and can also be applied over the steroid and tar creams and under wet dressings. They are applied as often as required to prevent the skin from becoming dry, which may be three to five times a day every day. And are applied all over the face and body and not just to the areas of eczema. They should be applied on a regular basis and continued until your child’s eczema has resolved. Your child should be encouraged to participate in and recognize the need for the application of moisturisers. If any creams irritate the skin, stop its use, apply a bland moisturiser, preferably in an ointment form and contact your local doctor or dermatologist if it continues. Some of the greasier moisturisers may cause blocked pores. The blocked pores look like small pimples. If this occurs, change the moisturiser to a cream or lotion base.

What clothes detergent should I use?

Detergents aggravate eczema skin and dry it by removing oil. Try to use Lux or Velvet soap in your washing machine and ensure a good rinse. Crepe bandages used for wet dressings may be washed in the washing machine. Disposable towels used for wet dressings should not be washed with detergents or soaps. Dry garments in a tumble dryer if possible, as clothes tend to dry softer than if hung on the line. Try to avoid baby wipes, as they tend to dry and irritate the skin.

Can my child go swimming?

Yes, your child is able to swim, however if they are having a flare of their eczema your doctor or nurse may suggest your child may need to stop swimming until the eczema improves. Prior to swimming apply moisturiser to the skin. After swimming remove the chorine/salt water in a cool fresh water shower with bath oil, and then apply a moisturiser before dressing.

Do dummies aggravate eczema?

Dummies may aggravate eczema around the mouth, chin and chest areas. This is because saliva wells up under the dummy and irritates the skin. Food products may also aggravate the skin around the mouth. This is not necessarily an allergy and the area is best protected with a thick ointment moisturiser. Eczema often gets worse during teething.

Prickle and the Skin

Clothing can worsen eczema especially when it has a “prickly” feeling. Large fibres, especially seams, wool, stitching, tags, frills and lace edges will make your child feel itchier. Small cotton or silk fibres are the fabrics of choice for clothing or bed linen. You need to be aware if your child is becoming itchy from a garment. If the seams are harsh turn the garment inside out and unpick the tags, or line areas with a piece of silk. Undergarments made of silk such as boxer shorts are popular with children with eczema for day and night time use. If you are unsure about a piece of clothing feel it. If it feels slightly rough or prickly to you it will be very irritating to your child.

My doctor has prescribed a cortisone cream. Is this safe?

Your doctor may prescribe a cortisone cream or ointment for areas of eczema on the face and body. These ointments help to settle inflammation and redness of eczema. Cortisone is a natural body hormone and if used as prescribed carefully by your doctor, is completely safe. Avoid strong cortisone ointments on the face and flexures, hydrocortisone is preferred for these areas. Ointments are preferred, as they are more moisturising than creams.

How do I apply cortisone ointments?

When using cortisone ointments apply a layer of the cortisone to the red areas. Cortisone ointments are best used once or twice a day only when the skin is red. Reduce its usage as the eczema settles. Cortisone ointments come in different strengths and your doctor should discuss with you what strength is appropriate for your child.

Is my child allergic to some foods?

Foods are not the single cause or cure of eczema. Only about ten per cent of children with eczema have proven allergies to diet. However if most of these children with food allergies stopped eating the foods they are allergic to they would still have some eczema and require the same topical treatments as other children with eczema. Children who have allergies to foods may be extremely itchy without a lot of redness. Other children with allergies to foods may develop a hive like reaction to foods immediately or within two or more hours after food. These reactions tend to start in the early months of life and are seen less often as children grow out of them. If you are concerned your child may have food allergies, keep a food diary and the reactions to these foods to show to your doctor. Some foods that may cause allergies are; egg, dairy, seafood and nuts, beef, chicken, wheat, citrus fruit and junk food. When starting a new food give only a small amount of each new food, do not give large amounts too quickly. Breast-feeding is the best form of milk for the baby with eczema. Do not restrict your child’s diet without consulting a doctor.

Dust mite and eczema

It would appear that the house dust mite can flare eczema. However, the degree of importance of the irritation of the house dust mite is controversial. Many people without eczema are allergic to house dust mite and many eczema sufferers do not improve greatly when they use anti-dust mite measures. From our experience, we think that house dust mite probably plays a minor role in most children’s eczema, but occasionally can be more important. Please discuss this issue further with your doctor if you are concerned.

Can I use splints/armbands on my child’s arms to stop him/her from scratching?

Armbands/splints may be required at times to stop your child from scratching. Armbands are better than mittens and allow the skin time to heal and improve. They are useful at night and in the car, or when you cannot supervise your child and when the itch is worse. Armbands should not be used all day long. During the day if you can, distract your child with activities to reduce scratching.

Can I immunise my child?

Your child should continue to have all immunisations unless told otherwise by your doctor. If your child is allergic to eggs there are no contra-indications for your child being immunised for measles, mumps or rubella. Although, if the reaction is severe, it is best to have the immunisation performed by your local doctor or immunisation clinic, and your child should not have the flu or yellow fever immunisation.

Wet Dressings for Eczema

Wet dressings are important for the effective treatment of eczema. Wet dressings are essential when your child is itchy and hot and if they are waking from the itch. Your child may need a wet dressing if they itch and scratch during the night, if there is blood in the sheets in the morning, and if the eczema is still present despite treatment with cortisone ointments, moisturisers and bath oils. You will need to apply wet dressings at night for a few nights to get it under control. Initially they may be required during the daytime but should be changed as soon as they are dry. Early use of wet dressings will reduce the amount of cortisone creams needed to control the eczema substantially. Parents who have used wet dressings, generally express great satisfaction with the technique.

Why do wet dressings help eczema?

1. COOL wet dressings help to reduce the itch.
   The itch is worse when the skin is hot.
2. DAMP wet dressings help with the treatment of infection.
   They help to clean the skin’s surface.
3. The skin is REHYDRATED with the moisturiser under the wet dressing.
4. Wet dressings PROTECT the skin from trauma.

What items do I need for a wet dressing?

• Moisturiser (50% soft and 50% liquid paraffin or sorbolene cream)
• Cortisone or tar cream if prescribed
• Tepid water
• Bowl
• Disposable towels
• Crepe bandages

How to apply a wet dressing

1. Wet disposable towels in a bowl of tepid water and one capful of bath oil.
2. Apply cortisone or tar creams, if they are due to be applied.
3. Apply moisturiser to the body and face.
4. Wrap the wet towels around the affected areas gently,using a few layers.
5. Wrap crepe bandages around the wet towels, firmly but not tightly. Avoid direct contact with the skin.

Wet dressings may be applied as often as required to any area of the body with eczema, for example, the elbow or the knee. The wet dressings will dry, please try not to leave the dressings on dry as dry dressings can irritate the skin by causing it to become hot, dry and itchy. Please note the water used in the wet dressing does not have to be cold. Wet dressings cool the skin by the water evaporating just like sweat.

Can I apply a wet dressing to my child’s head, neck or trunk?

No. It is not advised to wet dress the head, neck or trunk.

What can I use if my child’s face, neck, trunk and scalp are itchy?

Instead of using a wet dressing use cool compressing to areas on the face, head or other areas on the body for immediate relief. Wet cool compresses can be applied to the neck as a scarf (only knot once), and a wet bandana can be applied to the head. The scarf and bandana should be applied only under supervision. For the trunk, it is advised for you to apply a wet T-shirt or singlet over a layer of moisturiser if the trunk is red or itchy. A dry T-shirt can be applied over this.

To Cool Compress

1. Fill a bowl with COOL water
2. Add a capful of bath oil to the water
3. Add disposable towels to the water, and soak until wet
4. Apply moisturiser to the areas, i.e. soft and liquid paraffin to the face or scalp
5. Hold the wet disposable towel to the red, hot or itchy areas for five to ten minutes, repeat every half to one hour until the redness, heat or itch has subsided
6. Reapply moisturiser to the skin once the towel has been removed from the area

Wet dressings and cool compressing should not be used as a last resort treatment, when your child’s eczema is at its worse. Use these helpful techniques as soon as the eczema flares rather than leaving it until the eczema becomes severe and infected. Think of the wet dressing and cool compressing techniques as first line treatments when the eczema flares or becomes itchy.

If your child initially refuses to allow you to apply wet dressings or cool compressing, persist slowly with these techniques to keep your child’s eczema under control. Teach your child the value of wet dressings and encourage them to participate with the application or encourage your child to apply wet dressings to their doll. Rewards are important in encouraging the application and continuation of wet dressings and eventually your child will understand the benefits.

How will I know if my child’s eczema is infected and what should I do if it is?

When eczema is infected it is often crusted, the crusts are normally yellow in colour, there may also be areas of weeping, and this is often a sudden change in the normal eczema. Your child may also be itchier than usual and the skin may be painful to touch, when severe your child may find it difficult to extend their elbows or knees. Children with eczema may often get secondary infections if the eczema is not under control. The eczema becomes infected because children scratch and the skin is then broken. One small area of infection can flare the other areas of eczema.

The cold sore virus can also infect eczema.A sudden onset of clusters of blisters will result from this infection, which requires special treatment. Your child should avoid close contact with people with cold sores and school sores. If you think the eczema is infected you should go to your family doctor and have the infected areas swabbed. If your doctor thinks the eczema is infected he/she will start your child on a course of antibiotics. If there are areas of crusts it is very important to remove them, as if you do not remove the crusts you are not treating the infection properly as antibiotics cannot get to the crusts to treat the infection.

To remove the crusts

1. Fill a bowl with tepid water
2. Soak disposable towels in the water
3. Apply the wet towels to the crusted areas for five to ten minutes, while also trying to gently wipe the crusts away
4. Do this half to one hourly until the crusts have been removed. This usually takes between one to five hours and this may also
   be done at bath time.
5. When the crusts are removed you can start the moisturisers and cortisone creams and wet dressings and cool compressing. If there are areas of weeping simply hold a wet disposable towel to the area for five to ten minutes every half to one hour until the weeping stops, if crusts persist you may need to continue to cool compress more frequently. Do not apply creams over weeping areas. Remember, if the skin is dry, moisturise it, and if it is wet, dry it out with wet towels.

My doctor has prescribed an antiseptic wash for my child, how does this help the eczema?

Antiseptic washes are important in the maintenance and treatment of eczema infections. They help to reduce the bacteria on the skin. When your child scratches and breaks the skin’s barrier the skin may become easily infected. By using an antiseptic wash the numbers of bacteria are reduced this helps to reduce the amount of skin infections. When the skin is infected it can be more difficult to keep under control. On the other hand some antiseptics can irritate the skin so it is important to use these only if directed by your doctor.

My daughter with eczema has behaviour that is to sometimes difficult to control, she often scratches to get my attention or to get what she wants, what should I do to help this situation?

Some children with eczema have learnt that if they scratch they will get what they want or attention from their parents. It is encouraged that parents do not give in to their child’s scratching behaviour. Scratching behaviour is often worse when the child is crying, stressed, upset or having a tantrum to get their own way. Treat the tantrum first and later deal with the eczema. When scratching gets attention the behaviour is more likely to be repeated. Avoid always telling your child to stop scratching or giving in; rather use distraction activities, especially ones using your child’s hands. Distraction is always a good way to stop children scratching by taking their mind off the skin and itch. Positive language should be given as often as possible, never use words such as ”bad skin”. It is common for childrens’ behaviour to deteriorate with the eczema. When the eczema is under control the behaviour usually improves. This can be due to many factors such as itchy, hot skin, and lack of sleep. Seek help and talk to your treating doctor or nurse if your child’s behaviour is worsening.

My child is eight months old and has had eczema since five months of age. He is waking four to six times a night, and has not gained weight for the past six weeks. He is eating and drinking well and has not had any vomiting or diarrhoea, why is this and how can I help?

When eczema is not well controlled, children may wake many times a night. This vicious circle can lead to the eczema and sleep pattern deteriorating more, the eczema becoming secondarily infected, and minimal or no weight gain. Poor weight gain can be attributed to poor sleep and feeding. Short and broken feeds can be associated with itch, this can produce broken feeding patterns. A child needs to sleep and feed well to help them gain weight and grow. To help your child sleep well it is important to keep them cool and apply wet dressings just before bedtime. You will need to apply wet dressings at bedtime until the eczema is under control and your child is sleeping well, the weight will also increase with this improvement. If the eczema is under control and the weight has not increased it is important to visit you family doctor for consultation on this matter.

As you can appreciate, eczema is influenced by many factors. Just as the skin is improving it may become worse again for no clear reason. Unfortunately this tends to happen with eczema. Remember to treat the flare as soon as possible with wet dressings, cool compressing and cortisone creams and maintain it with moisturisers and bath oils. Eczema takes a lot of time and attention to keep it under control, however it is easier to keep it under control than to manage it when it is infected or severe.

Written by Emma King, Dr George Varigos, Dr David Orchard and Dr John Su.
We would like to thank the children and their parents for their participation and time spent in helping
with the production of this booklet, and acknowledge the wonderful care given by the nurses and doctors
to the eczema patients admitted to the Royal Children’s Hospital.
This booklet was made possible by the generous support of Dermatec Laboratories,
manufacturers of Dermaveen Colloidal Oatmeal for eczema.
Illustrations by Jocelyn Bell
Designed by the Educational Resource Centre,
Women’s & Children’s Health Care Network, October 1999, 996082