Having sensitive skin can be a real challenge. It often means forgoing certain types of soaps, buying products without fragrances and dealing with unexpected rashes from everyday exposures. While skin care is tough at any age, skin care at the beginning of life can be a particularly difficult challenge, which is why I wanted to talk about a question Lanie put to me through Facebook this week.
Eczema is a fascinating skin condition that carries with it many misconceptions. Before getting directly to Lanie’s question, I want to take a moment to touch on what we know about eczema.
What is eczema?
Eczema is a skin inflammation disease commonly known in the medical community as atopic dermatitis. This skin inflammation appears to be triggered by the environment, but it’s unclear why some are affected and others are not.
There are two hypotheses about what causes eczema. In the first, the skin is disrupted in some way that weakens the barrier it provides against the outside world. That weakened barrier allows compounds in the environment to penetrate the skin and irritate it, leading to inflammation. Research is ongoing as to what causes that disruption, but both genetic and environmental factors seem to play a role.
The second hypothesis is the older of the two and says that inflammation results from the immune system responding to environmental compounds that it shouldn’t normally respond to. The difference from the first hypothesis is that environmental triggers hit the skin all the time, but the immune system has learned not to pay attention to those compounds. In eczema, this tolerance doesn’t develop and the immune system attacks these compounds with inflammation.
Eczema is a disease mostly found in children. The vast majority of people are diagnosed before age 5 and the eczema often resolves or becomes milder as a person ages. In some cases, though, eczema can continue to be a problem well into adulthood.
What does eczema look like?
Eczema shows up as itchy skin areas often found in body creases like the elbows, knees, neck, ankles and areas around the eyes. These irritated areas tend to happen in the context of generally dry skin elsewhere on the body. The inflamed areas may be red from scratching, but otherwise just look dry with fine scaling. The dry areas may appear darker than the surrounding skin since the constant scratching causes the skin to increase pigmentation and thicken. Bumps are also often present in the affected areas.
How do we treat eczema?
The general approach to eczema treatment is similar for adults and children. The core goal is to maintain skin hydration and support the skin’s protective barrier. Creams are best for this since they supply some water and also are protective (or thick and rich) to seal in water that already exists in the skin. Ingredients like colloidal oatmeal may help with soothing some symptoms of eczema. Ointments, which are oily and don’t contain any water, can also be used to help seal in moisture and reduce symptoms. Lotions often don’t provide enough support (or hydration and care) for eczema-prone skin, and products that are fragranced should not be used because they can cause rash flares in those who have eczema. Instead, I recommend using a fragrance-free cream with oatmeal that’s specially formulated for people with eczema.
Antihistamines can be used to reduce the itching. These can come in both pill form and forms that children and infants can take. In some cases, steroid creams might need to be used to ease itching and inflammation. Other creams with anti-inflammatory properties are also often given to ease the skin irritation, although some can’t be used in children. Finally, efforts can be made to avoid conditions that can dry the skin and trigger the reaction. Heat and dry air are common triggers.
Unfortunately, alternative treatments like probiotics, dietary supplements and herbal medicines haven’t been found to work any better than a placebo. The advertising may be flashy, but you should stick to the tried-and-true methods for soothing the skin.
Also keep an eye out for skin infections. When the skin is dry, damaged and irritated, skin infections are more common. These will show up as a patch of warm, red skin that may be painful and that doesn’t necessarily stay within the areas of dryness.
What about allergies?
I saved this for the end because it’s the most common question I hear. Research indicates that allergies may play a role in some cases of eczema, especially in severe cases. These allergies may be to food or to factors in the environment, like dust mites for example.
However, deciding to cut food out of your child’s diet should only be done with the help of a physician and allergy specialist, even if you think you know the culprit. No single food is associated with eczema and cutting out nutritious parts of the diet can lead to vitamin, mineral and nutrient deficiency in children who desperately need these things. If you’re concerned about your child, see a doctor and figure out the next best step.