Eczema Questions Answered
Eczema is a chronic, non-contagious, skin condition. You may see it coming if your baby never quite has “baby soft skin” or it could suddenly appear out of nowhere. Our son first showed signs of eczema when he was around 6 months old. At the time, we didn’t know that this was an indication he was more likely to develop food allergies and didn’t take it seriously enough.
Since we’ve had to learn a lot about the topic, let’s dig into some of the easy questions around eczema, like...
What Does Eczema Look Like?
Atopic dermatitis (AD) is sometimes used interchangeably with eczema, but it is actually the most common form of eczema. It appears as dry, red, itchy patches of skin. AD comes and goes over a child’s life, with periods of normal looking and feeling skin, and other periods of “flare-ups.” The frequency and total area of affected areas varies from person to person.
A new flare, or acute eczema, usually appears with red itchy skin. Scratching the itchy patches, or not treating the areas can cause cracked, thickened, or rougher skin. Scratching also increases the chances of the skin becoming infected by the bacteria that live on everyone’s skin. Infected areas can weep fluid or form thick yellow crusts.
At What Age Does Eczema Typically Appear?
Eczema usually first shows up when a baby is between 3 and 6 months old. In babies, it mainly appears on cheeks and the outer areas of arms and legs. It can also be on the back or belly, but this is less common. As a child ages, the insides of the elbows, back of knees, and neck are most affected. Cradle cap may be an early sign but does not mean a child will develop eczema. Many children with eczema will outgrow it, with chances increasing 5, 10, and 20 years from onset.
Can you Prevent Eczema?
When it comes to eczema there doesn’t seem to be much you can do to prevent it. Exclusive breastfeeding has many benefits but has not been shown to prevent eczema. There is weak evidence that probiotics (live bacteria supplements) help and as such the World Allergy Organization offers “limited support for the use of probiotics in pregnant women who are in their final trimester, breastfeeding women, and infants. This recommendation is for the prevention of eczema in children who have a genetic predisposition.” Prebiotics, on the other hand, do not have evidence to suggest their use. Furthermore, a meta-analysis of dietary supplements including fish oil, zinc, selenium, vitamin D, vitamin E, B6, buckthorn oil, hempseed oil, and sunflower oil show no convincing evidence that they can reduce the risk of eczema.
What Causes Eczema?
There are a two main causes of eczema. The first is an inflammatory response in the skin to an allergen exposure (such as a specific food, pollen, other) or chemical (contact dermatitis). The outermost layers of the skin become damaged by this inflammation response and become dry and itchy. 30-40% of eczema is thought to be allergic and is often linked with hay fever and asthma though doctors don’t know why. The second major cause of eczema is that a person’s body doesn’t produce enough of the protein filaggrin, which it needs to produce the outer layer of skin, making the skin dry and itchy. Research has pointed to certain mutations which may cause this. There is a genetic component to both allergic and non-allergic eczema because children with a parent or sibling with eczema have a high risk of developing it themselves. Triggers in non-allergic eczema may be chemical irritants, stress, hot/ cold temperatures, sweating, infections, and hormones. So pretty much living life.
How Do I Know if My Child Has Eczema?
A pediatrician can assess baby’s skin and the history of flares determine if it is in fact eczema. An allergist can further help test for eczema caused by allergies with a skin prick or blood test for IgE antibodies. Both tests are good at ruling out causes. However positive results are hard to interpret because they just point to a sensitization, not an actual allergy.
Also, it is not recommended to “test for everything” because you may end up with a lot of false signals. Because allergic eczema is a response to an allergen, eliminating that food can help reduce flares. Blanket elimination diets of things like gluten, or eggs, when there is no allergy to those foods has not been shown to help.
Now to the hard part: What to expect when your child has eczema.
Living with Eczema:
If you baby is diagnosed with eczema, the game is:
1. Knowing and avoiding triggers to prevent flares
2. Managing and reducing itch to prevent changes to the skin from scratching, and
3. Continuously reducing the chances for dry skin to help with both 1 & 2
Managing flares and continuously preventing dry skin comes down to the use of emollients (high lipid content spreads) such as ointments or creams. Two times a day. Every. Day.
Emollients help lock in moisture after a bath and seem to help manage itching. Acute flares should be dealt with using recommendations from your doctor on a combination of corticosteroids, non-steroidal medications and anti-histamines to help with the itchiness.
If your baby has eczema keeping baby’s nails trim or using gloves at night or long sleeve clothing can also help reduce damage from scratching.
Managing eczema can be tough, especially when a child is young, and you don’t fully understand the triggers. But working with your pediatrician, you can find a routine that works for your child’s skin and limits the damage from this condition until they hopefully outgrow it.