Childhood Eczema: What Parents Need to Know
Avoiding Triggers: Parents need to consider fabrics, detergents, and personal care products. It’s easy to change clothing fabric (100-percent cotton or an 80-percent cotton blend are good choices), but hard to avoid sweat after running around in the backyard. In this case, after playing, a child should shower as soon as possible and apply moisturizer right away. Stress can also trigger eczema, as can foods. When good treatment regimens aren’t working, a pediatrician or allergist may recommend a food elimination trial. During a trial, one type of food is eliminated from the diet for one to two months, then re-introduced to see if symptoms are affected by the diet change. Care must be taken that a food trial doesn’t deprive a child of essential nutrients or calories. In 90 percent of food-related eczema, the culprit is either milk, egg, soy, fish, or wheat.
Medication: Topical steroids have been the backbone of eczema treatment for over 50 years. When used appropriately, steroid preparations are highly effective and safe. Be aware that the strongest ointments are over 400 times as potent as the weakest, and that proper steroid use involves finding the lowest potency choice that works and using enough of it twice a day for two weeks at a time. Only the mildest preparations should be used on the face and groin area. Stronger ointments can be used on the trunk and limbs. Your doctor can tell you which steroids your child needs for various lesions.
In the past few years, another class of eczema medications has been introduced to the market. Called topical calcineuron inhibitors, these drugs are derived from a very powerful immune suppressor. Like steroids, they reduce inflammation but do not bring relief from flare-ups as quickly and work differently from steroids within the body. Tacrolimus (Protopic) is approved for use in children two to 15 years at a 0.03-percent strength, and pimecrolimus (Elidel) can be used on children older than two years in a one-percent strength. Their role in the treatment of eczema is evolving, though they are not recommended first line for mild cases. These newer agents will probably find their place in combination with steroids and in harder to manage cases. Just as with steroids, these medicines should not be overused.
Other medicines that have a role in eczema management are antibiotics (when lesions have become infected) and antihistamines. The latter don’t help much with itchiness, but their side-effect of sleepiness can lead to a better night’s sleep for itchy kids.
There is no cure for eczema and no sure way to prevent it in eczema-prone children, but diligent skin care and the wise use of medicines can go a long way towards controlling flare-ups and restoring itch-free, healthier skin.
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