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Eczema – Information for parents from QV

Name

Prepared by: Josh Townley PhD

Introduction

Eczema, also known as atopic eczema or atopic dermatitis, is a chronic skin condition that affects around 15-20% of children.[1] It’s most common between the ages of 2 and 4 years and often disappears with time, but for some people, it can persist into adulthood.[1]

While the exact causes of eczema are unknown, there is a strong genetic factor, and eczema often occurs together with asthma and hay fever.[2] This is called ‘atopic tendency’. Eczema can’t be cured but with the right treatment, it can be effectively managed in most children.

Signs and Symptoms

Eczema commonly appears first on the face of younger children, but as children grow older, it’s the skin around the joints that can become the most problematic.

Infants

Eczema is often widely distributed. Cheeks are usually the first area affected.

Toddlers

Eczema becomes more localised. Outer skin of the joints (wrists, elbows, ankles, knees) are most commonly affected.

School-age

Inner creases of joints most often affected, particularly elbows and knees. May also affect eyelids, earlobes, neck, and scalp.

Commonly affected areas. Eczema can look different depending on the child's age[1]

Redness, inflammation and intense itching are the main symptoms.[1] In severe cases, the skin may begin crusting or weeping, which could be signs of a bacterial infection. Whether the symptoms are mild or severe, however, eczema needs to be diagnosed by a medical professional to ensure you’re getting the right treatment for your child. Discuss the problem first with your GP or paediatrician. If the condition doesn’t respond to the initial management strategy, they may refer you to a dermatologist.

Managing Eczema

Even before thinking about treatment, there are two key strategies that should form the basis of every eczema management routine:

  • Identifying and avoiding triggers
  • Regular use of moisturisers

Eczema triggers

Just as things like dust and pollen can aggravate hay fever, some irritants and conditions are known to trigger or worsen eczema. These aren’t the same for everyone, but can include:[3–5]

Heat, animal dander, dust, sweat, perfumes/fragrances, wool clothing & carpets, soap, stress, food allergens

It’s important to be aware of these triggers and watch for any others that might be affecting your child. One way to do this is to use a symptom diary, where you can record when and where symptoms occur. This can make it easier to spot patterns or triggers in your child’s diet or environment.

The role of moisturisers

Even when the skin appears normal (not red or inflamed), people with eczema have a weakened skin barrier—the part of the skin responsible for keeping water in and irritants out.[6] Just like a bucket with holes in the bottom, eczema-prone skin will lose water more quickly than normal skin and is often bordering dryness and irritation. Similarly, the incessant itch associated with eczema can be made worse by dry skin.[7]

To work effectively, the skin barrier needs to be hydrated all the time, so regular use of moisturisers should form the foundation of any eczema management strategy. This is why all expert guidelines for eczema management recommend regular, liberal use of moisturisers.[8–10]

Topical emollient therapy

A daily routine for managing eczema should include carefully considered products for cleansing and moisturising.

Step 1: Bathe with QV Bath Oil

Add QV Bath Oil to your child’s bath to provide very gentle cleansing without stripping the skin’s natural protective oils. QV Bath Oil also helps to hydrate the skin by forming a light moisturising film on the skin to help seal in water.

*Older children who take showers might prefer using QV Gentle Wash, a mild cleanser that’s pH balanced and free from soap, fragrance, and other common irritants that can irritate eczema-prone skin.

Step 2: Moisturise

Choose an appropriate moisturiser depending on how dry your child’s skin is.

Normal/Dry: Light and readily absorbed, QV Skin Lotion is ideal for slight to moderate dryness

Moderately Dry: QV Cream is a highly concentrated, rich moisturising cream for moderately dry skin

Very/Chronically Dry: For intensive hydration. QV Intensive Ointment is water-free, so it won’t sting when applied to very dry, cracked skin.

The itch-scratch cycle

The natural impulse when an itch arises is to scratch it. This temporarily relieves the itch, but unfortunately, it doesn’t usually stop there. Scratching triggers the release of inflammatory messengers in the skin, which are itch factors, and can stimulate a new itch signal.[11] This, in turn, can lead to further scratching that begins the cycle all over again. It can be very difficult to resist the urge to scratch, especially for children with eczema, but over time this can lead to small cuts on the skin, which open up the possibility of secondary bacterial infections.[11]

Coping as a parent

Eczema doesn’t just affect your child. One study showed that mothers of young children with eczema had significantly higher stress scores than those of children without eczema.[12] Stress scores also tended to increase with increasing eczema severity and were on par with the stress experienced by parents of children with severe disabilities.[12] Acknowledging to yourself that it’s a difficult and stressful condition is important, and where possible, talk about your struggles with your partner, family or friends. There may be a support group in your area or, if not, online forums are a place where you can find others who can relate to the challenges of raising a child with eczema.

Routine can be key to reducing stress. Make sure you apply moisturisers to your child’s skin regularly, or if they’re old enough to do it themselves, that they know how often to use a moisturiser and apply it liberally to their skin. If they have to use other medications or techniques (e.g. wet-wrapping), make sure these are worked into the routine as well. A regular bedtime can also help improve your child’s sleep, and as a result, yours.[13]

Top tips for Home & School

Home

  • Keep fingernails trimmed short – this helps reduce skin damage caused by scratching
  • Develop an eczema management routine with the help of your doctor. Know how much and how often to use moisturisers and establish a soothing bedtime routine
  • Encourage kids to take an active role in managing their eczema – for younger children, use sticker charts or other forms of positive reinforcement; for older children, help them write down or draw the steps in their moisturising routine for them to follow
  • Keep a symptom diary to look for new triggers and patterns. Dedicated apps are also available
  • Make time for self-care. Schedule breaks for yourself where a trusted friend or family member can step in

School

  • Discuss your child’s eczema needs with their teacher
  • Ensure your child has moisturisers in their school bag and the classroom if they need to apply them throughout the day
  • Be aware that some children with eczema may experience bullying or embarrassment because of their condition. Talk to their teacher about ways to help ensure your child is comfortable and supported at school

References

1. Stanway A. Atopic dermatitis | DermNet NZ [Internet]. DermNet NZ2004 [cited 2019 Apr 17];Available from: https://www.dermnetnz.org/topics/atopic-dermatitis/

2. Eczema and Dermatitis. In: Clinical Dermatology. Chichester, UK: John Wiley & Sons, Ltd; 2014. page 76–98.

3. Atopic dermatitis [Internet]. National Eczema Association [cited 2020 Sep 24];Available from: https://nationaleczema.org/eczema/types-of-eczema/atopic-dermatitis/

4. World Allergy Organization. Atopic dermatitis [Internet]. 2018 [cited 2020 Sep 24];Available from: https://www.worldallergy.org/UserFiles/file/WAOAtopicDermatitisInfographic2018.pdf

5. Eczema – British Skin Foundation [Internet]. [cited 2020 Sep 24];Available from: https://knowyourskin.britishskinfoundation.org.uk/condition/eczema/

6. Agrawal R, Woodfolk JA. Skin Barrier Defects in Atopic Dermatitis. Curr Allergy Asthma Rep 2014;14(5):433.

7. Homey B, Steinhoff M, Ruzicka T, Leung DYM. Cytokines and chemokines orchestrate atopic skin inflammation. Journal of Allergy and Clinical Immunology 2006;118(1):178–89.

8. National Institute for Health and Care Excellence. Atopic eczema in under 12s: diagnosis and management [Internet]. 2007 [cited 2019 Mar 12]. Available from: https://www.nice.org.uk/guidance/cg57/resources/atopic-eczema-in-under-12s diagnosis-and-management-pdf-975512529349

9. Bourke J, Coulson, I, English, J. Guidelines for the management of contact dermatitis: an update. British Journal of Dermatology 2009;160:946–954.

10. Holden C, English J, Hoare C, Jordan A, Kownacki S, Turnbull R, et al. Advised best practice for the use of emollients in eczema and other dry skin conditions. J Dermatolog Treat 2002;13(3):103–6.

11. Hong J, Buddenkotte J, Berger TG, Steinhoff M. Management of itch in atopic dermatitis. Semin Cutan Med Surg 2011;30(2):71–86.

12. Faught J, Bierl C, Barton B, Kemp A. Stress in mothers of young children with eczema. Arch Dis Child 2007;92(8):683–6.

13. Buxton OM, Chang A-M, Spilsbury JC, Bos T, Emsellem H, Knutson KL. Sleep in the modern family: protective family routines for child and adolescent sleep. Sleep Health: Journal of the National Sleep Foundation 2015;1(1):15–27.

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