Tuesday 24 October 2017

Eczema affects babies more now – but there are treatments

Up to 20pc of children suffer from skin affliction whose cause is unknown

Eczema is affecting more babies and young children
Eczema is affecting more babies and young children

Dr Nina Byrnes

Those of you who listen to Ryan Tubridy in the mornings as well as reading these columns are probably aware that I am due to give birth soon.

I am fully immersed in all things baby at the moment and so have decided this week to focus on an affliction suffered by babies and young children – eczema.

Eczema, or atopic dermatitis as it is medically known, is thought to affect 10 to 20pc of children and 1 to 3pc adults. It occurs in people of all skin colours. Nine out of 10 of those affected will develop it before their fifth birthday. It is seldom present at birth but may develop in the first few weeks of life.

Eczema is becoming more common but the exact cause remains unknown. It does tend to run in families, particularly in those that also have a tendency towards hay fever and asthma.

In fact, these three conditions are closely linked and often referred to as the atopic triad. Some of the factors thought to be involved in the increase in the incidence of eczema are higher air pollution, less exposure to infection (the "hygiene hypothesis"), better housing insulation (less circulating air), more pets and a broader range of foods.

Living in a developed country or a cold climate also makes the condition more likely. Females are slightly more likely to be affected than males and it is more common in higher socioeconomic classes. Children born to older mothers also appear to have an increased risk.

Food allergies get a lot of bad press when it comes to eczema. There is no proof that any particular food causes eczema but certain foods do seem to cause flares in some children and blood tests can help identify allergies to dairy, nuts, eggs and shellfish.

One of the best and simplest ways to identify a food trigger is to keep a food diary observing the condition of the skin after certain foods. If there is a flare, cut this food out and see if the skin improves; the food could then be reintroduced at a later date and if a flare reoccurs, this food may well be the trigger.

This doesn't mean excluding a whole food group because we do know that a healthy balanced diet is essential to a child's health. In many cases no food allergy will be identified. Other common triggers include extreme heat or cold, clothing fibres (such as polyester or wool), perfumes or additives, pets, teething, or infection.

Eczema typically causes skin to become dry red, scaling and itchy. It may become infected, leading to bubbles that can ooze fluid and the skin can become broken from scratching. Over time skin can ultimately become thickened and chronically inflamed.

In babies the first area affected is usually the face and as they start to crawl it often spreads to the front surface of the legs and outer elbows. In older children, it usually settles in the skin folds such as inside elbows and behind the knees.

As dryness is the main problem in eczema, daily moisturising skin is core to the effective management of the condition. There is a huge range of eczema products on the market and all of these can be beneficial.

Soaps, bubble baths and anything with perfume or fragrance should be avoided. Moisturiser should be reapplied frequently and generously.

There are two schools of thought here. I recommend daily baths with the correct products improving moisture in the skin. The baths should not be too hot nor last longer than five to 10 minutes. Sprinkling bread soda or oatmeal in the water can be soothing and beneficial to the skin. Skin should be patted dry after and a good moisturiser applied while still damp.

When a flare occurs steroids are usually required. Ideally the weakest steroid necessary should be used for the shortest time possible as long-term use of these can cause thinning of the skin. However, the inverse is also true and underuse of the correct steroid can lead to a prolonged flare.

Treatment with steroids should only be used when prescribed and supervised by a doctor. If the skin has become infected an antibiotic may be included in a cream or occasionally taken orally.

An antihistamine given at night can ease the itch and allow comfortable sleep. Rooms should be kept cool and bed clothes changed frequently. It is important to keep nails short to avoid breaking down the skin.

Studies haven't really proven the benefit of herbal remedies and it is important to remember that herbal doesn't mean harmless.

Many herbal creams were found to contain large doses of strong steroids which can actually damage the skin if used for prolonged periods. Cases of severe allergic reaction to products containing chamomile have also been reported.

Although there is currently no cure for eczema, the outlook is overall good. It is not a contagious condition and you cannot pass it on. In 50pc of children it will clear by adulthood and in the other 50pc it is likely to become milder with age. If good skin care habits are formed early on, permanent skin damage is unlikely.

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