A question was raised about eczema; feeling winter’s dry chill this week makes it a good time to discuss this topic.  Eczema(atopic dermatitis)is a chronic skin condition that causes redness, scale, crusting and sometimes blistering(particularly in African Americans).  We often refer to the problem as the “itch-scratch cycle” and ” the itch that rashes” because of the phenomenon of itching LEADING to irritated, dry, flaky skin.  Eczema can involve almost any area of the body.  In babies it often starts on the forehead and cheeks and spreads to trunk and limbs, children commonly have it on inside of elbows and knees and teens on face, neck, and back.  Its course is variable–in some children it gets better with age, in others it can worsen.

Eczema is mainly caused by allergies and is part of the ” atopic triad”–eczema, hay fever, and asthma; effected individuals frequently have a family history of these problems.  It effects 10% of all American children.  9 of 10 cases start before age 5, 65% in the first year of life.  Girl:boy ratio is 2:1.  Many factors may lead to flare ups: allergies to foods, pollen, dust mites, or animals; weather extremes (sudden changes in temperature, humidity); excessive sweating or excessive bathing; skin irritants (cleansers, harsh soaps, perfumed topical products); harsher fabrics(wools and nylons);and even stress.

Eczema has no cure but there are many effective management strategies.  Keep skin clean and nails cut short.  Keep your house clean to avoid dust mites and other indoor pollutants.  Hypoallergenic pillows may be of benefit.  Avoid offending foods if that effects your child.  Use unscented soaps and skin products, have your child wear loose fitting cotton clothing, and it can often be helpful to wash new clothes prior to first wearing.  Liberal use of moisturizing creams (the thicker the better)after bathing can help.  It may be better with certain effected children to avoid sports where intense sweating is expected or participants wear heavy uniforms or equipment.  Rinse skin after swimming.

There are several classes of medicines that are used if the above gives inadequate relief: topical steroids,TCI’s, topical tar preparations, prescription emollients, and oral antihistamines like diphenydramine (benadryl)–better at night as it causes drowsiness.  If your child’s skin does not improve, shows signs of infection(redness, crusting, oozing) or she develops fever or uncontrollable itching you should call me and make an appointment.

Thanks so much for following.  As always, I invite comments or questions.


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