The eczema enigma

Kylie Carberry reports that Australia has one of the highest incidences of eczema worldwide, and managing eczema to prevent contstant flare ups can cost up to $2,000 a year. But because eczema is not considered to be life threatening it is easy to overlook its severity and its impact on families. 

When seven-year-old Blake’s classmates gather on the carpeted floor for morning news time or sit outside on the grassy playground, he spreads out his little cotton mat to sit on. Contact with either could trigger a painful eczema flare. His olive-toned complexion is currently quite clear, masking what he has endured in his short life.

His mother Rachel explains: ‘His skin was perfect when he was born, you would have had no idea what was to come. At first it was just little flare ups here and there, but at around three it escalated.’  At its worst, Rachel says she was treating Blake’s skin every hour. ‘It was constant – the creams and wet dressings. At one stage he couldn’t even walk; his skin was tight, dry and weeping. It broke my heart when he said to me, ‘Why did God give me this skin, I wish I could just die’.

In my skin

Eczema is a general term encompassing various inflamed skin conditions. The type Blake and many other children suffer from is known as atopic eczema or atopic dermatitis. It is the most common form, with approximately 10 – 20 percent of the world population affected by atopic eczema at some point during childhood. There are no guarantees that a child will grow out of it. However, research has shown that 60 – 70 per cent of children are virtually clear of the condition by the time they reach their mid-teens.

Eczema causes skin to become red, dry, itchy or scaly and may weep, bleed and crust over. It may look unpleasant at times, however, it is not contagious. Commonly, it affects the face, hands and creases of the elbow and knees, but can spread over the entire body.

It varies from child to child what will trigger the symptoms of eczema. ‘Most commonly it is contact with grasses, pollens, sand, dust, chemicals and certain foods,’ says Cheryl Talent, President of the Eczema Association of Australasia Inc (EAA).

When eczema is triggered, the skin becomes itchy, then red and sore. This is called a ‘flare’.  Ms Talent, a long-term eczema sufferer herself, describes the feeling: ‘Imagine a mosquito bite – unbearably itchy, you scratch and scratch until it bleeds – then not itchy, but sore.’

Why me?

The ‘atopic’ in atopic eczema refers to a tendency to develop allergic conditions. Associated atopic conditions include asthma and hayfever. Ms Talent, says if you have an atopic condition, your children have a 50 per cent chance of developing eczema.

Earlier this year researchers at Scotland’s Dundee University discovered that people with atopic eczema don’t have the gene that produces a protein called filaggrin which is normally found in large quantities in the outermost layers of the skin. A reduction or complete absence of this important protein leads to impaired formation of the skin barrier.

‘This means their skin is more porous and prone to drying out more easily because water can evaporate through it. It also means their skin can let foreign proteins get inside that usually wouldn’t, so they get irritation from just normal things in contact with the skin,’ says Associate Professor Dedee Murrell, Head of Dermatology at St George Hospital, University of NSW, Sydney.

The Eczema Impact

Eczema not only causes troublesome physical symptoms, but research published last year in the international publication Pediatric Dermatology showed children with eczema are distressed by the stigma associated with its visibility – they often feel frustrated, embarrassed and angry about their appearance. This can make them vulnerable to behavioural problems such as increased dependency, fearfulness and insomnia, as well as affecting social and intellectual development.

The research also revealed caring for a child with moderate to severe eczema is more stressful than caring for a child with insulin-dependent diabetes. One of the reasons was the 2 – 3 hour chunk of the day taken up caring for a child with eczema.

‘The extra work – oil baths, applying emollients and/or bandaging, can be very exhausting,’ says Ms Talent. In addition, these products can be costly and special dietery needs of many children with eczema adds to the financial stress. A study conducted through Melbourne’s St Vincent’s Hospital in 2002 found people could spend up to $2,000 each year battling eczema.

The War on Eczema

To ease the eczema load, the EAA last year launched the ‘Eczema Control Plan’. It shows you how to identify the three stages of eczema and advises treating the eczma at the first sign of an itch and redness, as this can prevent most of the flares.

‘We used to tell people to wait until the skin was really bad, and then treat it with a steroid cream,’ says Professor Murrell. ‘Now, because of a steroid-free prescription cream called Elidel, which is safe to use much more frequently, you can use it at the first sign of a flare.’ She says Elidel can cut the number of your child’s flares by half.

Professor Murrell summarises a typical plan:

Stage 1. Clear skin

Try to use baths with a bath oil (not bubble bath/soap!) rather than showers, so as to allow time for the water to soak into the skin. Moisturise your child’s skin at least twice a day. This helps improve the skin barrier. Use hypoallergenic products and avoid anything perfumed.

Stage 2. First itch

The first sign of a flare is your child scratching and perhaps a little redness. At this point, in addition to moisturising, you should use Elidel on the areas that are itchy or red. 

Stage 3. Redness and full flare

If the skin continues to flare up, you  should stop using Elidel and start using a steroid cream, prescribed by your doctor, twice a day. Usually, you only need to do that for a few days before the flare improves. Then you go back to Elidel twice a day until the flare has gone.

Professor Murrell says some parents worry about the skin thinning associated with steroids creams. However, the reporting of this has been due to the use of potent steroid preparations over a long period of time and if steroid creams are used as your doctor prescribes, the likelihood of side effects is rare.

Eczma Artillery

Sometimes skin can get particularly nasty during a flare and to help it heal, wet bandaging may be needed. They are usually applied in hospital but can be done at home. Skin infections sometimes occur too and need swift treatment with a course of antibiotics.

Because the triggers of eczema are so varied, Ms Talent says allergy testing can help eliminate allergens and give you another tool to help manage your child’s eczema. She adds that some people find alternative therapies are effective. These include Chinese herbs, naturopathic and homeopathic treatments.

And while a GP will most likely be your first point of contact, Ms Talent says: ‘If your child’s eczema is proving difficult to clear by about three months, it is a good idea to visit a dermatologist who has the latest information for their skin condition.’

Ms Talent encourages families to join advocacy groups such as theirs (phone 1300 300 182 or go to Eczema Association of Australasia) as they can provide psychological support as well as a gamut of eczema-related information.

Particularly useful for pre-school and school-age children is the EAA’s ‘Eczema School Pack’. The pack aims to educate teachers and fellow students about what life is like in the skin of an eczema sufferer.

Lifestyle management of flares:

• Keep your child’s fingernails short to prevent their scratching from breaking the skin
• Dress them in 100 per cent cotton clothing to reduce sweating, which can be an irritant. After purchasing new clothing, wash it first to make it softer and remove any tags to avoid irritating the skin
• Avoid wool and other coarse or rough-textured clothing or blankets and if possible, remove wool carpets. If you are wearing woollen clothing, put a cotton diaper over your shoulder when holding your child
• Keep your child’s room at an even temperature
• Use a humidifier in dry or heated rooms to keep the air moist
• If your child is allergic to dust or dust mites, use protective coverings for pillows and mattresses and wash bedclothes frequently in hot water
• Keep pets off beds and other furniture, or outside
• If night-time itching is a problem, use a cold, damp washcloth to soothe your child’s skin, followed by a moisturiser and a sedating antihistamine, under the guidance of your doctor.

By Kylie Carberry

Resources

The National Eczema Society          

The Eczema Association of Australasia  - offers lifestyle management tips

The information provided in this article is intended as a guide only. Always consult your doctor if you or your child is suffering any medical complaint. Any websites referred to by Australian Family contain information moderated by government and medical institutions or organisations.

This article was first published in Australian Family Magazine, November 2006. Updated July 2009.