Before I had Thomas, I totally underestimated the impact eczema has on the quality of life. Not only does it cause symptoms on the skin, it has far-reaching effects on the individual and their families. Food allergies are more common in infants with eczema; it is thought that a broken skin barrier could allow food sensitization through the skin. This is why it is important to treat eczema in infants actively and aggressively as this may, in theory, prevent the development of food allergies later.
Here are some important tips:
- Ditch the soap – try to avoid any soap, even if it is labelled ‘gentle, hypo-allergenic’ – most soaps are very alkali and will strip eczema skin of the little oils (the cement we discussed in the previous article) it has. Use emollients or ointments to wash/shower with instead e.g. Aveeno, Aquafor.
- Moisturize, moisturise, moisturise. This is a vital step in caring for eczema skin. (see What causes eczema? ) The lack of oil and important proteins to act as ‘cement’ in between the layers of skin cells mean that moisture evaporates easily from the skin (making it dry) and allergens can penetrate easily, causing symptoms of irritation, itch, rash. If you moisturise well, there should be a visible sheen when you look at the skin. If there is no sheen when you look at the skin, then you need to moisturise! When eczema is active, you should moisturise more often (every 1-2 hours in most cases). As a general rule, thicker, petroleum jelly like ointments (e.g. Aquaphor) is better than the thinner, watered-down lotions.
- Shower/Have a bath EVERY DAY – try to soak in warm water (NOT HOT) for 20 minutes when you bathe, then gently pat dry the skin and moisturise while the skin is still damp. Again, the best is with a thick ointment so that the moisture is sealed in.
- Avoid scratching – easier said than done, I know!! I spent an entire year grabbing Thomas’ hands while he reaches for his skin, and distracting him! It helps to keep fingernails short and use nail brushes to keep fingernails clean. There are special mittens you can buy e.g. scratch sleeves, which are difficult for babies to remove. These are particularly helpful during naps and at night. Wearing breathable fabric like cotton helps, and if your budget allows, there is clothing made of silk which keeps the skin cool and may reduce itchiness e.g. skinnies.
- Treat active eczema actively – moisturise more frequently, and if necessary, don’t be afraid to apply a thin layer of steroid cream or topical immune modulator (e.g. pimecrolimus). Make sure you leave a gap of 10-15 minutes between moisturising and application of steroids otherwise the absorption can be poor. Most patients I looked after under-treated their eczema due to fear of using steroids, but there is evidence to show that if eczema is left active, the broken skin barrier could lead to allergies developing, and persistent inflammation also creates a vicious cycle leading to more scratching and worsening of the skin. (I will talk about eczema treatments in detail in a later post)
- Don’t use too much washing detergent – and put on an extra rinse cycle when doing laundry to ensure clothes don’t irritate the skin. Always wash new clothes before wearing it as many factories use chemicals that can irritate eczema skin.
- If you are allergic to house dust mites this might be a trigger for your eczema. It is impossible to get rid of house dust mites completely but there are ways you can reduce the allergen burden – more on this later.