It’s uncomfortable to see your child like that; red and blotchy; unable to understand why her skin commands her to itch when it’s so painful to touch.
Eczema, which the US-based National Eczema Association (NEA) says is the name for a group of conditions that cause the skin to become red, itchy and inflamed, is more common than you’d think. Dr Rania Ayat Hawayek, Specialist Paediatrician at UAE-based Circle Care Clinic, says, “We see cases of eczema on a daily basis, and it is the most common skin condition we find in children here. The incidence ranges from 10 to 20 per cent depending on the age group.”
NEA explains that there are several types of eczema. “Atopic dermatitis, contact dermatitis, dyshidrotic eczema and seborrheic dermatitis, also known as ‘cradle cap’ in infants, are the most common types that affect children. Eczema, especially atopic dermatitis, often appears in the first six months to five years of a child’s life,” it explains.
But what causes eczema?
Dr Hawayek explains that inflammation may be caused by a number of factors, which may be:
- Non-modifiable such as genetic/hereditary
- Modifiable, such as environmental factors including heat, sweating, allergens in the air or surroundings such as dust, pollen, certain textured fabrics, and detergents or other chemicals used in bathing and washing.
“In some cases, certain foods are observed as exacerbating eczema, but these do not cause it directly; they simply give rise to a flare or an increase in the symptoms,” she adds.
What happens during a break-out?
“An individual with eczema is prone to having dryer skin, with a reduction in the production of the natural greasy protective substance, and this increases the occurrence of friction on the surface of the skin, and allows allergens and other substances to enter the skin layers and trigger an inflammatory response, which results in redness, itchiness and spread of the condition,” says Dr Hawayek.
What does eczema look like?
NEA explains that eczema looks and acts differently in infants and toddlers than it does in older children. Here’s what to look for, according to age:
Infants (first 6 months)
Eczema usually appears on the face, cheeks, chin, forehead and scalp. It can also spread to other areas of the body, but not usually in the diaper area, where moisture protects the skin. The skin at this stage also tends to look more red and ‘weepy’.
Babies (6-12 months)
At this stage, eczema often appears on your baby’s elbows and knees — places that are easy to scratch or rub as they’re crawling. If the eczema rash becomes infected, it may form a yellow crust, or very small, ‘pus bumps’ on the skin.
Toddlers (2-5 years)
Around the age of two, your toddler’s eczema is more likely to appear in the creases of the elbows and knees, or on their wrists, ankles and hands. It may also appear on the skin around your toddler’s mouth and the eyelids. Your toddler’s skin may start to look dry and scaly at this stage and become thick with deeper lines — this is called ‘lichenification’.
Children (5 years+)
Eczema usually appears in the folds of the elbows and/or knees. Sometimes, it’s only on a child’s hands — at least 70 per cent of people have had hand eczema at some time in their life. Redness and itchy patches behind your child’s ears, on their feet or scalp, may also be a sign of atopic dermatitis. But these could also be symptoms of another condition, like seborrheic dermatitis, which can exist with eczema.
What can a parent do to alleviate the pain/itch?
Dr Hawayek offers the following advice to parents with kids who suffer from eczema:
- A daily bath is recommended, as water replaces the moisture lost from the skin.
- The use of gentle, eczema-appropriate bath products is essential.
- Once out of the bath, the skin should be pat-dried and not rubbed with high friction.
- A moisturiser should then be applied generously to damp skin to seal the moisture in. This moisturiser should be reapplied regularly throughout the day to reduce the inflammation or itchiness.
If, despite this, these symptoms remain, it is best to have this child reviewed to assess whether or not their eczema has developed a secondary infection, which will need further medical treatment, she suggests.
Is there a way to prevent it?
She adds: “Maintaining a cool environment, low in allergens such as dust, pollen and using eczema-friendly fabrics such as cotton, as well as the regular use of moisturisers and bath products, can help keep eczema at bay. However, if a child has the genetic tendency to develop eczema, it cannot be prevented completely. It can be extremely well-managed though and seldom causes long-term issues once the appropriate regimen and approach is applied.”
‘My kid’s eczema and weeping sores were caused by allergies’
- Sonali Goenka
Dubai-based mum Sonali Goenka says she didn’t think much of her daughter’s eczema since it’s quite common in children and she herself had eczema as a child. Doctors gave her a steroid cream that seemed to quell the inflammation, but every once in a while, there would be a flare-up and it would be worse than the time before. “At the worst point, her skin started to weep when we stopped putting steroids. And she got patches all over. That’s when somebody advised us to look at look at an allergy profile,” she recalls. Her daughter, Anaya, it turns out was allergic or intolerant to all the food she was eating.
The Goenkas have used diet to control the flare-ups, but off and on they’ll come back. “When that happens, and the skin starts weeping I have no option but to put a very, very mild corticosteroid so that the skin closes, and then we heal with home remedies, while managing her triggers.
“I don't give her antihistamines for eczema. Because while they help if the reaction is in the initial stage, by the time it presents on skin, the medicines no longer work,” she says.
What they do is use a mixture of oil – something rich in omega 3 – as a skin shield. “We do a combination of flaxseed oil and avocado oil. So that is something that we keep on hand at any given point of time; we use skin barrier creams, like a vitamin E oil and Borage seed oil … it just kind of seals the skin until it has time to heal. I also do a lot of vitamin E mixed with olive oil a bit. You get a nice thick cover. And then it protects the skin until it has a chance to kind of settle down.”
‘I bathed her with water mixed with oil for relief’
- Susan Varghese
Dubai-based Indian expat Susan Varghese says her daughter’s encounter with eczema began in the neonatal intensive care unit (NICU). As a pre-term baby – she was born a month early – she had jaundice for which she underwent phototherapy. This began to cause little patches that came and went. When Varghese took her baby home, the eczema came along. Her doctor offered some advice, she says. “He told us that when giving her a bath, add two drops of olive oil or coconut oil to the water, and when you take her out, there’ll be this kind of layer that’s formed on the baby. The doctor's advice was a steroid whenever she’d have an outbreak, then it would go and then it would come back after a while. I didn't want to put the steroid on. I read in a lot of Facebook groups that basically all skin problems come because your gut is not healthy. At that time I was still breastfeeding her and giving her formula. I tried a formula that did not have cow’s milk – that helped. Over time, she’s gotten better with lactose [tolerance] and four to five months on, the eczema was gone.”
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