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Eczema

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1.  PREPARE TO PREVENT

An eczema flare up can occur at any time but through a combination of close observation and using the right treatment, it can be possible to keep the number to a minimum.2,4 Keep a diary of your child’s eczema, noting when and where flare ups occur.5 Look for patterns in what your child has been doing and where he or she has been, to try and work out the triggers for eczema flare ups.6 Prevention is always better than cure; identifying and avoiding situations that trigger flares is a key step in helping to minimise the impact that eczema has on your child’s life. The following may be helpful in better understanding your child’s triggers; does your child’s eczema get worse when they have been playing with a particular friend (perhaps the friend’s family has pets)? Does the eczema get worse after swimming or after sports at school? Does eating certain food trigger a flare up?6 It may be useful to share your eczema diary with your child’s doctor or nurse in order to discuss prevention strategies and/or treatments.
It should be noted, however, that not all flare ups have identify able triggers.6 It is only too easy for parents to blame themselves when they see their child suffering with a flare up but it is important to remember that eczema is not the parent’s fault.3 Try to maintain a balance between giving your child the best possible care for his or her eczema and avoiding letting the condition dominate family life.
 

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2.  GET THE TEACHER ON YOUR SIDE

Telling a school or nursery teacher about your child’s eczema, and the steps you are taking to avoid flare ups, can be very important as this allows the teacher to help.7 Give the teacher a list of any substances or activities that your child should avoid and explain the purpose of any moisturisers or special hand washes you have given to your child to use at school. You could also ask the teacher to share this information with other staff members.7 You may also wish to discuss ways in which you and the teacher can avoid making your child feel excluded and different from the rest of the class, such as arranging for your child to join in with another class when his or her own class is doing something best avoided.7 You may also want to explain to the teacher that your child will sometimes be tired and less able to concentrate during class due to disturbed sleep.7 For older children with eczema, it may be helpful to discuss how to help them to manage moisturising and scratching during exams and tests.7 Eczema is a common condition1,2 and it is likely that your child’s teacher already has some knowledge of it.

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3.  DRESS FOR SUCCESS

Your child’s clothes are in contact with his or her skin for many hours a day, so choosing the right fabrics is very important. It is best to avoid tight-fitting, rough or scratchy clothing. Wool and some synthetics are especially likely to cause the skin to itch and cotton/cottonblends are better choices.
Loose-fitting clothing can help prevent overheating (which may increase itching).
In warm rooms, remember to remove coats and jumpers to prevent sweating.
Labels inside clothes are rough and can be a cause of itching and should be removed where possible. Some biological washing powders may also irritate the skin.6

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 4.  GET YOUR CHILD INVOLVED

As your child gets older, it will become more important for them to take control of managing their eczema. Knowledge is power, so help them to do this by teaching them how they can take steps to prevent flare ups and reminding them of these steps regularly. Educating your child about how to manage eczema can help him or her to participate in as many normal childhood activities as possible. If they know, for example, that they must always take a cool shower and moisturise after swimming or sports to reduce the risk of flares, they may be more likely to be able to go on enjoying these activities. Teaching a child how to handle the urge to scratch is also important. Remember that it can be hard for a child to understand why he or she must keep using moisturisers and taking preventative treatments, even when they feel well. Explaining this to them carefully can help them to understand how important these things are.7

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5.  KEEP SCRATCHING UNDER CONTROL

Keeping your child’s finger- and toenails short will help to minimise damage to the skin from scratching.8 This is important all of the time, not just during a flare up, so make regular nail trimming part of your normal routine. If your child particularly dislikes having their nails cut, make a treat, such as an extra story before bedtime, part of the nail
cutting routine. If scratching at night is a particular problem, consider getting some cotton gloves for the child to wear in bed.8 Placing a cold object on the itchy area can also help to minimise the urge to scratch for example a cold, damp wash cloth or an ice pack wrapped in a soft towel.8 Keeping the skin well moisturised will help to prevent eczema flare ups and itch, so be sure to apply your child’s emollients daily.8 Discuss scratching and ways to limit damage to the skin with your child’s doctor or nurse if it continues to be a problem.

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6.  THINK SEASONAL

The different seasons can bring different challenges for children with eczema. Air conditioning in the summer can dry the skin, as can central heating in the winter, so it is important to maintain a careful moisturising routine throughout the year.8
Extremes of temperature can also cause damage to the skin. Making sure your child is not too warmly dressed in winter, as being too warm may trigger flare ups. In winter, it is important that your child’s bedroom is not too warm.4,9 Your child’s doctor can also advise on whether an antihistamine will help to reduce itch symptoms at night.4

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7.  MOISTURISE, MOISTURISE, MOISTURISE

Regular use of moisturisers can help prevent dry skin and skin cracking.10 Moisturisers come in a variety of different forms, from creams to gels and ointments, so if one does not meet your needs it is worth trying others until you find one that suits.11 It is important to choose fragrance-free moisturisers that don’t contain any substances that could irritate the skin. Avoid moisturisers that contain sodium lauryl sulphate (SLS) – it has been proven that SLS irritates the skin.11 Moisturisers should be applied at least twice a day. Every child is different – some may need to apply
moisturisers four or more times a day while others may need to avoid moisturising for 2 hours before applying an active treatment.11
Make sure that your child has a small pot or tube of moisturiser to take to school so that they can apply it whenever their skin starts to feel dry, and after activities such as swimming.2 Your doctor may also recommend special moisturising products to use in the bath.10 Talk to your child’s doctor or nurse about different types of moisturisers available (called emollients by medical staff) and which one is likely to be best for your child e.g. SBR® Repair and SBR® Lipocream are specially developed for patients with dry skin, eczema, psoriasis and other dry skin disorders.12

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8.  BE FOOD AWARE

In about 10 % of children, certain foods can trigger eczema.13 Milk, eggs, citrus fruit, chocolate, peanuts and some colourings are the most common ‘problem foods’. If you think that a particular food is causing your child’s eczema to flare up, discuss this with your doctor. He or she will be able to order appropriate testing and, if necessary, give you advice on maintaining a healthy, balanced diet for your child while excluding ‘trigger foods’.13

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9.  MAKE BATH TIME MATTER

Daily bathing with special moisturising products, is often recommended for children with eczema.10 If this is the case for your child, ensure that you follow the doctor’s or nurse’s instructions. The bath water should be lukewarm and the bathroom not too hot, as extremes of temperature can irritate the skin.6,13 Soap and products containing soap such as bubble baths and shower gels, can be very drying to the skin and should be avoided.6,14 Any products used should be fragrance-free, dye-free and have a low pH (less than 5).14 When helping your child to dry, use the towel very softly and avoid rubbing.14 Apply a moisturiser after bathing.14

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10.  GETTING THE RIGHT TREATMENT

Eczema is a complicated condition and there is no cure for it at the moment (although a huge amount of research is being conducted in this area).
These days, however, there are a range of effective treatments that can help your child live life to the full.2,6 Some of these treatments are designed to be used regularly to prevent flare ups from happening, while others are used for a shorter period of time to treat a flare up and help the skin to heal.6 Every child is different and finding the right treatment or combination of treatments for your child may take some time. It is important that you work closely with your child’s doctor and nurses to monitor how effectively each treatment is working and to ensure that all treatments are used exactly as recommended. When your child starts a new treatment, make sure that you know exactly when and how it should be applied and in what quantities. Don’t be afraid to ask questions if you aren’t sure about something and consider taking a note book along to your child’s appointments to jot down any important points. As well as treatments provided by your doctor, educational programmes and support sessions can be very valuable in helping your child to learn to live life to the full.

Medical References

  1. Carroll CL, Balkrishnan R, Feldman SR, et al. The burden of atopic dermatitis: impact on the patient, family, and society. Pediatric Dermatology 2005;22(3):192–199. 
  2. Caring for children and young people with atopic eczema – a guide for nurses. RoyalCollege of Nursing, London, 2013.
  3. Faught J, Bierl C, Barton B, et al. Stress in mothers of young children with eczema. Arch Dis Child 2007;92:683–686. doi: 10.1136/adc.2006.112268. 
  4. National Institute of Arthritis and Musculoskeletal and Skin Diseases. Atopic Dermatitis [online] July 2016 [cited] 28 August 2019; Available from URL: https://www.niams.nih.gov/Health_Info/Atopic_Dermatitis/default.asp.
  5. The Eczema Society of Canada. Trigger chart [online] 2019 [cited 28 August 2019]; Available from URL: https://
    eczemahelp.ca/wp-content/uploads/2019/02/ESC-Trigger-Chart-Feb-2019-EN.pdf.
  6. Atopic Eczema. [online] [cited] 28 August 2019; Available from URL: http://www.patient.info/health/atopic-eczema.
  7. National Eczema Association. Eczema: Tools for School. [online] [cited 28 August 2019]; Available from URL: http://www.https://nationaleczema.org/wp-content/docs/TFS_Parents_web.pdf.
  8. Greenlaw E. Children With Eczema: How to Stop the Scratching. WebMD [online] 2017 January [cited 28 August 2019]; Available from URL:
    http://www.webmd.com/skin-problems-and-treatments/eczema/features/child-scratching#1.
  9. National Eczema Association. Eczema Basics for Children [online] [cited 28 August 2019]; Available from URL: https://nationaleczema.org/wp-content/uploads/2016/10/EczemaBasicsKids.pdf.
  10. Bath emollients for atopic eczema: Why use them? Drugs and Therapeutics Bulletin 2007:45(10):73–75.
  11. National Eczema Society. Emollient Fact Sheet [online] 2016 January [cited 28 August 2019]; Available from URL: http://www.eczema.
    org/emollients.
  12. SBR® Patient Information Lea et (SBRPat02/ 30 Jan 2014); May 2015. Astellas Pharma (Pty) Ltd.
  13. Holden C. Eczema in children: 7 tips to stop the itch. Supplied by NHS Choices [online] [cited 28 August 2019]; Available from URL: https://www.your.md/condition/allergies-stopthescratching/.
  14. National Eczema Association. Caring for Eczema. Easy as 1,2,3 [online] 2017 [cited 28 August 2019]; Available from URL: https://nationaleczema.org/wp-content/uploads/2018/03/FactSheet_Skincare_FINAL.pdf.

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