Control Your Child’s Eczema Before It Controls You: A Guide to Eczema Management
From sleep disruption and poor productivity to emotional and mental stress, eczema causes a range of negative effects on both the child and the parents’ health and function. Implementing proper eczema management is important to maintain a good quality of life despite having this skin condition.
Eczema brings a whole lot of inconvenience that can affect many areas of your child’s life. According to an article in the Journal of Dermatological Treatment, the symptoms of eczema cause a range of negative effect on a child’s health and function such as sleep disruption, skin infection and discomfort, emotional and mental stress, low self-esteem, behavioural deficits, impaired peer relationships, restricted physical activities, dependency, and fearfulness.
On the other hand, parents of affected children may also suffer from
- Sleep disruption
- Emotional and financial stress
- Work disruption
- Limited leisure activities
- Strained spousal relationship
If you and your child are going through the challenges mentioned above, know that you are not alone in this battle. Many children and parents around the world have been dealing with the same difficulties caused by eczema. Based on the Guidelines for the Management of Atopic Dermatitis in Singapore, atopic eczema affects 20.8% of school children and teenagers aged 7 to 16 years in Singapore. In some countries, the prevalence of atopic eczema can also be as high as 20%, as per the Clinical Practice Guidelines for the Management of Atopic Eczema published by Ministry of Health Malaysia. This percentage continues to rise, affecting both developed and developing low-income countries.
To treat and manage eczema properly, it is important to understand what this skin disorder is all about. Atopic eczema, also known as atopic dermatitis, is a chronic, recurrent inflammatory skin disorder which results from skin barrier defects, immune dysfunction and environmental factors. A flawed skin barrier causes transepidermal water loss, which makes the skin dry and allows penetration of irritants, allergens and pathogens.
While dry and itchy skin is a common symptom of eczema, you can’t just conclude that your child has the condition based solely on pruritus. According to the U.K. Working Party’s Diagnostic Criteria for Atopic Dermatitis, to confirm the diagnosis of eczema, patients must have an itchy skin condition that is accompanied by three or more of the following:
- History of involvement of the skin creases such as folds of elbows, behind the knees, fronts of ankles or around the neck (including cheeks in children under 10 years old)
- A personal history of asthma or hay fever (or history of atopic disease in a first-degree relative in children under four years old)
- A history of a general dry skin in the last year
- Visible flexural eczema (or eczema involving the cheeks/forehead and outer limbs in children under four years old)
- Onset under the age of two (not used if the child is under four years old)
Eczema is a skin disease of flares and remission. Treatment varies depending on the phase and the severity of the condition.
Eczema flare-up refers to a period when your child’s symptoms worsen. During this time, you may use a ceramide-dominant, cream-based emollient therapy to optimally rebuild defective skin barrier. Ceradan® Skin Barrier Repair Cream has high physiological lipid content in 3:1:1 optimal lipid ratio for skin barrier repair. To control the flares, you may consider combining the emollient therapy with anti-inflammatory or calcineurin inhibitor topical cream. If there is an infection, applying an antimicrobial cream is advisable. Likewise, it is advisable to consult a doctor for further evaluation.
The flare-up is usually followed by a period of remission where your child’s skin either gets better or completely clears up. During this time, keep your child’s skin hydrated by applying ceramide-dominant moisturiser like Ceradan® Hydra Moisturiser, a step-down maintenance therapy after successfully treating eczema flare. It is a hydrating moisturiser enriched with ceramide and sodium hyaluronate. As per the guidelines developed by the Dermatological Society of Singapore, sufficient moisturiser must be liberally applied on the skin, at least twice a day or as frequently as required.
Likewise, it is important to bathe daily using a gentle, non-soap wash that does not strip away the skin’s natural oil. An example of a non-soap wash is Ceradan® Moisturising Wash. This fragrance-free, paraben-free and SLS-free body wash is pH-balanced and nourishes the skin with ceramides.
However, for severe cases of eczema, it is best to consult a doctor for further evaluation. According to Clinical Practice Guidelines for Management of Atopic Eczema, some of the treatments that may be recommended for severe cases are phototherapy and systemic therapy. Phototherapy is a therapeutic option for patients who do not respond or develop side effects to conventional treatment. On the other hand, systematic therapy includes adjunctive treatment like antihistamines and systemic antibiotics, as well as specific treatment like immunomodulating agents and biologics.
One of the secrets to keeping a happy life despite having eczema is learning how to relieve the itch in a quick and effective manner. Reducing the itch can save your child from the many unpleasant effects of scratching. You may use a topical treatment like Ceradan® Soothing Gel, which is specially formulated to provide optimal itch relief in just 5 minutes without the unpleasant smell and stinging sensation.
In eczema management, identifying and avoiding the potential aggravating factors which can worsen flares are important. Based on the Clinical Practice Guidelines for Management of Atopic Eczema, potential triggering factors include the following:
- Aeroallergen like house dust and unfamiliar pets
- Physical irritants like nylon or wool clothing, soaps, detergents, disinfectants, shampoo, sweat
- Environmental factors like climate, air pollution, sun exposures
- Food like milk, egg and peanuts
- Microbial colonisation/infection
- Patient factors like pregnancy
According to the guidelines developed by the Dermatological Society of Singapore, food allergy may worsen symptoms in infants and young children below 3 years with extensive, recalcitrant atopic eczema. Avoiding common food allergies including cow’s milk, egg, wheat and soy may help improve skin condition. However, eczema in older children and adults is unlikely to be aggravated by food allergy.
Though it surely won’t be easy to handle, eczema shouldn’t get the best of you and your child. Bear in mind that there are ways to maintain a good quality of life despite having eczema. Being informed about proper eczema management is just the first step to breaking free from the undesirable effects of this skin condition. Consistently implementing your eczema management plan is your next goal.
Guidelines for the Management of Atopic Dermatitis in Singapore
Clinical Practice Guidelines for Management of Atopic Eczema
Addressing treatment challenges in atopic dermatitis with novel topical therapies – Journal of Dermatological Treatment
Treatment of Childhood Atopic Dermatitis and Economic Burden of Illness in Asia Pacific Countries