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About Eczema8

(The following are directions for young patients with eczema. Use these notes as guidelines only. Please contact your allergist to amend the directions to suit your child's individual needs.)

Diet

  • Evaluation for offending food triggers is important!
  • Foods, especially milk, eggs, wheat, chocolate, oranges, nuts, peanuts and tomatoes are often a factor. In younger children, soy, and corn are also often factors.
  • An allergy elimination diet with a “serial oral re-challenge”-(reintroduction of one offending food at a time for a period of three to four days while carefully monitoring symptoms) may be necessary.
  • Children often outgrow food sensitivities. Be sure to discuss appropriate re-evaluation with your physician in order to avoid over-restricting your child's diet for
    longer than is really necessary.

Skin Care
Clothing

  • New articles of clothing for your child are best washed before worn.
  • Dreft detergent is preferable.
  • No fabric softeners or strong laundry soaps of any kind should be used.
  • Best to avoid dressing your child in wool, tight clothing, “rubberized” or elastic items, and sometimes polyester (especially bare or exposed stitches.)
  • Cotton clothing should be worn next to the skin.
  • Double rinse when doing your child's laundry (two or three rinse cycles).

Bath

  • For children with very dry skin, decrease water exposure to two-three times per week, and limit duration of water exposure to less than ten minutes at any given time.
  • Cetaphil bath substitute may be used (yes, one will smell clean and the skin will also actually be cleansed without the drying effects of water).
  • Best to bathe your child before or after supper, or at least one hour before bedtime. The skin is too warm immediately after a bath to get right into a nice, warm bed. Prurititis would result from doing so.
  • Bath water should not be too hot-this increases histamine release into the skin, and increases pruritis. Bath water should be tepid (room temp) or cool.
  • Do not use commercial alkaline soap. Hypoallergenic soap or sudsing agents (Aveeno- bar, Neutrogena, Basis) are preferable.
  • Avoid deodorant or perfumed soaps; they are very harsh.
  • If necessary, add emulsified oil or oatmeal colloid to the bath water.

Lubricants and Emollients

  • Be certain to make the application of an overall lubricant a routine part of your child's day.
  • The best emollient for any individual is often a trial and error process. Your physician, after examining the skin, will have a better idea of which lubricant might best suit your child's needs.
  • Ointments are used for thicker skins, while creams tend to be most beneficial for the mild-moderate eczema cases. Lotions often are ineffective as the skin “drinks” the lotion immediately, not allowing for maximal efficacy.
  • It is not unusual for a patient to have to change creams (“rotate” creams, much as you would alternate anti-histamines) to allow the skin to respond maximally to the prescribed treatment. Some work for a while, and then a substitute needs to be made.

Scratching

  • DON'T SCRATCH!
  • If your child is “itchy,” pat or slap gently. Do NOT scratch, as it destroys the top layer of the skin, and 1) allows for skin infection and 2) worsens the eczema!
  • You may use ice or cool compresses to relieve itching.
  • Avoid bath brushes.
  • Avoid “reflex” or “habit” scratching.
  • An anti-itch medicine is important if your child tempted to scratch.
  • Children should be given an anti-itch medicine before bedtime. Clean white socks may be affixed to a child's hands (once asleep), and prevents excoriation of the skin that may occur with overnight scratching.

Sunlight

  • In moderation, it may be beneficial.
  • Avoid sunburn!
  • Avoid excessive heat. Perspiration may irritate the eczema.
  • PABA-FREE sun lotions (screens) are recommended. Carefully test sunscreen lotions on a small area of the skin before applying generally.

Swimming

  • Avoid Jacuzzis, hot steam baths, and the sauna-they may worsen the eczema.
  • Swimming is beneficial for select patients. Showering immediately after chlorine
    exposure, and applying a lubricant all over the body immediately afterwards are
    definite musts.

Cosmetics

  • Avoid perfumes.
  • Use non-perfumed lipsticks.
  • Use very simple shampoos-Neutrogena is recommended.
  • Use hypoallergenic deodorants, avoid antibacterial deodorants.
  • Avoid acrylic nails and be very careful what agents are used on nails for manicure.

Medications
Oral medications may be used to help control eczema.

Anti-histamines

  • These are extremely helpful in reducing itching, promoting mild sedation, and perhaps protecting the skin from the action of the histamine.
  • These should NOT be applied in ointments (i.e. Caladryl) on the skin as they may cause allergic reactions.
  • These are particularly important to be used at night when subconscious scratching takes place.

Antibiotics

  • Oral antibiotics are indicated when the eczema becomes infected (often heralded by oozing, dark red or purulent lesions, scratching of scab marks, yellow crusting, painful lesions, and/or malodorous discharge from the affected areas.)
  • Should not be applied topically.

Lubrication

  • Water-washable creams and ointments, Vaseline, vegetable oils and a variety of other ointments may be recommended on an individual basis.
  • Best to avoid lanolin and paraben-containing medications.
  • Read all labels carefully.

Cortisone-like Medication

Topical

  • Used by most physicians as creams or ointments to severely affected areas except the face, mucous membranes and genitals, where special prescribing rules apply.
  • Systemic absorption is variable depending upon multiple factors (the condition of the skin at the time of application, whether the area is occluded after application, whether an emollient is pre-mixed with the steroid, what type of steroid is used, etc.) Systemic absorption can certainly be minimized-speak with your physician regarding specific recommendations which would be appropriate for your child's specific needs.

Oral

  • Occasionally oral steroids may be needed to decrease the inflammation of moderately severe eczema. Usually only a short course is necessary. The appropriate use of steroid by your physician may actually allow for less overall exposure to medication, and may increase subsequent control over the eczema.

FLARE-UPS (EXACERBATION OF ECZEMA) AND CHANGES:

  • Immediately report any severe flare-ups of eczema. Your physician needs to know when there is any significant change from the normal course of events!

Remember! Your physician is not a mind-reader. If the eczema is out of control, it is time to have the specialist re-evaluate to decide on a change of treatment “game plan.” Keep skin cool, calm, and comfortable-eczema is essentially an “itch that rashes”-DON'T SCRATCH!

8 “Treating Eczema”, by Catherine G. Fuller, M.D., Board Certified Asthma and Allergy.