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June 18, 2013

Readers' Questions: Battling Eczema

Eczema, also known as the "itch that rashes," is an extremely common skin condition among children and adults. The fancy medical term for eczema is atopic dermatitis, and both terms refer to chronic inflammation of the skin that causes a red, scaly, itchy rash and can be a real nuisance! Eczema can affect anywhere on the skin, but is most commonly seen in the elbows, behind the knees, and on the face. It can affect people of all ages, but frequently shows up in childhood. Some children do outgrow it with time, while others may continue to experience flares intermittently. Unfortunately there's not a "cure" for eczema, but rather tons of different management strategies - both for calming down those itchy flares as well as preventing them from happening in the first place!

Preventing Eczema Flares

The #1 rule when it comes to eczema management (and preventing eczema flares) is MOISTURIZE, MOISTURIZE, MOISTURIZE! Seriously, you can't moisturize too frequently (and honestly, most people probably don't moisturize enough). You may hear different opinions on how often to bathe children with eczema, but a bath every day actually helps soften the skin and provide some hydration. Make baths short and use warm (but not hot) water. Also be sure to use an unscented soap (like Dove) or hypoallergenic soap (like Aveeno). I love to suggest the "backwards bath," where you let them play in plain water at first and then soap them up and rinse them off quickly before getting them out of the tub (keeps them from sitting in the soapy water). Once they're out of the tub, just pat them dry with a towel to keep the skin damp, then apply any medicated ointment your doctor has recommended followed by a thick coat of your moisturizer of choice.

Most kids with eczema have dry skin at baseline, and the more it becomes irritated and inflamed, the worse their skin gets. Grease those little monkeys up at least two to three times per day, especially after bath! The best moisturizers are ointments or creams (lotions may cause more irritation).

• Ointments are thick and help hold retain moisture in the skin. These will make the skin a little greasy and may be best used in the winter or at night before bed to avoid extra irritation from heat outside. Best ointments? Plain old unscented Vaseline or Aquaphor
• Creams are not quite as greasy as ointments, though be aware that sometimes there are preservatives in creams that can cause additional skin irritation. Choose a thick cream - my favorites are Eucerin, Vanicream, CeraVe, and Aveeno Eczema Therapy Moisturizing Cream.
• Check out the National Eczema Association's website for extensive lists on recommended bathing and moisturizing products!

Other things to keep in mind when trying to prevent eczema flares is avoiding environmental irritants that may cause skin reactions. Most commonly, these are detergents or even perfumes/air fresheners/smoke/fabrics, etc. Avoid using scented detergents to wash clothes (best options are ALL Free and Clear or Dreft) and keep other scented products out of the house. We know that eczema is associated with allergies and asthma, and anything that triggers allergies/asthma can trigger eczema as well.

Treating Eczema Flares

Once that skin gets red and scaly, it likely needs treatment with a topical steroid cream or ointment to help get the flare calmed down a bit. It's usually reasonable to try an over the counter hydrocortisone cream first, but since steroids come in various different strengths, it's important to discuss this with your pediatrician for their recommendation on what to use. In general, however, it's important to know that topical steroid treatments are safe (and aren't going to cause any of the scary side effects that you may associate with the word "steroid") and are an extremely important therapeutic part of treating an eczema flare.

For those cases of eczema that seem resistant to the usual treatments above, some doctors may recommend other measures to help clear up the itchy flares. I'd recommend discussing these with your doctor prior to trying, but some options may be:

• Wet wraps involve wrapping wet bandages around particularly bad areas of eczema flares and leaving them on at bedtime. See AAP directions on how to do this.
• Bleach Baths may be helpful for children who tend to get secondary infections from scratching their eczema (usually staph infections). It's similar to taking your child to the swimming pool, as long as you follow directions to appropriately dilute the bath (Use 1 teaspoon of bleach per 1 gallon of water or 1/4 cup per full bathtub). Giving bleach baths several times weekly for 1-2 weeks may prove to be helpful.
• Consider using an antihistamine like Benadryl for particularly itchy days.

Check out the National Eczema Association for tons of information regarding eczema treatment and product recommendations. And as always, talk with your doctor before you start trying to treat eczema or with any questions that come up!