Eczema is a stressful and difficult illness, both for the person, and for the family. The child can be irritable, and unable to concentrate on play or learning tasks, because they are distracted by constant itch, and families are stressed and tired because of the child’s poor sleep.
I have noticed over the years that many families are fobbed off many health professionals, and are told that their babies “only have eczema”. They are encouraged to use small amounts of steroid creams and ointments for a short time, and are not told anything about the factors leading to, or the triggers and drivers of their child’s ongoing eczema.
What the health professionals miss is that the appropriate early treatment of eczema can change the course of a child’s life, because managing eczema well can decrease the chances of developing food allergies, which can be life-long.
The management of eczema is a balance between skin creams and medications, and identifying factors which continue to produce irritation of the skin. I liken it to driving a car; trigger factors are the “foot on the accelerator” and the skin creams and other medications are the “foot on the brake pedal”.
In order to manage eczema, or “stop the car”, it is important to both take the foot off the accelerator (remove the triggers), and to apply the brakes (use the skin creams) until the car has completely stopped. The main way the skin will worsen then is if the trigger factors have not been properly identified and managed.
Common triggers for ongoing eczema include:
- exposure to house dust mite
- exposure to things the person is allergic to
- the use of soaps, including bubble baths (“anything that bubbles is trouble”)
- scratchy textures on the skin, such as wool and nylon
- perfumed products
- playing in sand and in sandpits
The skin is not only abnormal in the patches of eczema you can see, but also where it looks fairly normal, where the barrier function is decreased by dryness amongst other factors.
You need to use steroid creams generously and all over the skin, not just on the affected patches, and they need to be used until the skin looks and feels normal, or as your dermatologist instructs. If you stop using the treatment creams too early, the skin will quickly become inflamed again, and you are right back to the beginning again.
Once the skin is back to normal, moisturisers help to maintain and protect the skin.