Mission Eczema Control

Eczema (Atopic dermatitis) affects approximately 5 to 20 percent of children worldwide. The prevalence of eczema in the United States is around 17 percent.

The incidence of eczema appears to be increasing. It may occur in any race or geographic location, although there appears to be a higher incidence in urban areas and developed countries, especially western societies.

The vast majority of eczema has an onset before age five years, and data from kids show a slightly increased risk in girls compared to boys (1.3 to 1).

What is the underlying factor behind eczema?

Eczema appears to involve a genetic defect in the proteins supporting the epidermal barrier of the skin. Disruption of the barrier results in inflammation of the skin. Eczema is also characterized by decreased ceramides (a subset of fats in the skin layer that helps to bind water), leading to decreased water binding.

Anything that can be done to prevent the onset of eczema?

Exclusive breastfeeding for the first few months of life may provide protection against the development of eczema in infancy. Some studies have found that partially hydrolyzed formulas aka pHFs (e.g.: Nestle Good Start®, Enfamil Gentlease®) as well as extensively hydrolyzed formulas aka eHFs(Alimentum®, Nutramigen®, and Pregestimil®), compared to conventional cow’s milk formulas, have the potential to reduce the risk of eczema in high risk infants*, when used as a supplement or substitute to breast milk during the first four months of life. Some studies show a slight benefit of eHFs compared with pHFs, although the evidence is not conclusive. Soy formula has not been shown to prevent or delay onset of eczema. Amino acid-based formulas have not yet been studied in the primary prevention of allergy.

Recent research has shown promising evidence to support probiotics in the primary prevention of pediatric eczema, while evidence for the treatment of established eczema was equivocal. The majority of trials chose Lactobacillus rhamnosus GG as their probiotic strain of study. There is a recent surge in formulas with prebiotic or probiotic supplements, that came into the market based on this evidence; eg: Enfamil’s Nutramigen lipil w/ Enflora (Lactobacillus GG ),Similac Advance Earlyshield®, NESTLÉ® Good Start® Protect Plus® with Bifidobacterium lactis.

Note: * An infant is defined as “high risk” for developing allergic disease if there is at least one first degree relative (parent or sibling) with a documented allergic condition (food allergy, asthma, or moderate to severe eczema).

What all things can be done to prevent flare up of eczema?

Exacerbating factors in eczema that disrupt an abnormal epidermal barrier include excessive bathing, low humidity environments, emotional stress, dry skin, overheating of skin, and exposure to solvents and detergents. So, try to avoid these situations as much as you can.

Following are just a few things you can do to help:

• Give your tot lukewarm/cold baths that last about 20 minutes. This will help relieve itching and also give the skin some time to absorb the moisture.

• Do not use any harsh soaps or body washes. Avoid those with fragrance or alcohol content. Use a fragrance free soap, sparingly in areas that get particularly sweaty, oily, or dirty, such as behind the ears, in the neck folds, in the creases of the groin, and in the diaper area.

• Pat the skin dry. Do not rub.

• Keep the skin moist by using an all over- body ointment or cream immediately after every bath.

• Choose loose-fitting, soft, cotton clothes. Avoid clothes that use elastic in the waist.

• Trim fingernails often. This will help limit the amount of damage scratching does to the skin.

• Try to avoid sweating and exposure to heat.

• Try to keep your tot active during the day to distract from itching. If itching is uncontrollable, use antihistamines (the sedating antihistamines like Benadryl® is more effective than their non-sedating counterparts.

Which is preferable: Shower or bath?

Some controversy exists concerning whether showering or bathing is preferable in patients with eczema. Most authorities recommend a hydrating bath followed by immediate emollient application, but others recommend a shower of short duration. Whether bath or shower, rapid application of emollients or prescribed topical preparations is important.

How to take care of the skin when not having a flare up?

Skin hydration is a key component. The rule to use is: match the thicker ointments to the driest, flakiest skin. Lotions, which have a high water and low oil content, can worsen eczema via evaporation and trigger a flare of the disease. In contrast, thick creams (eg, Eucerin®, Cetaphil®, Nutraderm®), which have a low water content, or ointments (eg, petroleum jelly, Aquaphor®, Petrolatum), which have zero water content, better protect against xerosis. Two prescription strength moisturizers have been introduced recently, named Atopiclair® and Mimyx®, which both relieves symptoms of flare and manages recurring flares.

How to take care of the skin during a flare up?

A low potency steroid cream or ointment (eg, 1 or 2.5 percent Hydrocortisone) is effective for a mild flare up. A medium potency steroid ointment may be needed for more severe flare up. Higher potency steroids can be used for up to 10 days in some patients with acute flares, and then replaced with lower potency preparations until the lesions resolve. Topical steroids can be used one or more times daily, although no clear benefit has been demonstrated with more than once daily application.

The topical calcineurin inhibitors (like Elidel®) appear to be effective for the treatment of eczema, and, unlike topical steroids, do not cause thinning of skin with prolonged use. For this reason they may be particularly useful on the face, neck, and in skin folds. They’re approved by FDA for use in children over the age of two. However, concerns have been raised about a possible link to cancers.

Wet dressings help soothe the skin, reduce itching and redness, debride crusts, and limit access to the skin by the kids for itching. Dampened cotton garments are worn over the affected area and covered with a dry garment. You can keep these dressings overnight or change them every eight hours during the day. Talk to your child’s doc prior to resorting to this technique, though.

How likely is that a baby will develop eczema in future?

Eczema occurs in the first year of life in 60 percent of cases, and by the age of 5 years in nearly 85 percent of cases. So, an almost definite answer to whether or not your baby will get to keep her glowing skin can be had within the first 5 years.

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