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October 2024
by Hope Allen
As we get into the spooky month of October and prepare for Halloween, let’s talk about one of the skin conditions that scares parents the most…Eczema!
What is eczema?
Eczema is a descriptive term. It describes skin that is dry and itchy. There are different categories and causes for eczema. At any point in life we can get nummular eczema, dyshidrotic eczema (on the hands and feet), or medication induced eczema. Most of these eczemas are correlated with environmental triggers and can come and go.
The main category, however; (what we most often think of and refer to as “eczema,”) is a condition called atopic dermatitis or atopic eczema.
What is Atopic Dermatitis?
Atopic Dermatitis is the most common inflammatory skin disease worldwide. It presents as generalized skin dryness, itch, and rash. This form of eczema is also often the first presentation of the atopic triad. The atopic triad refers to Atopic Dermatitis, Asthma, & Allergic Rhinitis (runny nose due to environmental allergies)
Approximately 230 million people around the world have atopic dermatitis. It usually starts in infancy, affecting up to 20% of children. Approximately 80% of children affected develop it before the age of 6 years. All ages can be affected. It can resolve completely and often lessens in severity in late childhood and adolescence. The prevalence in young adults up to 26 years of age is 5–15%.
The main questions we hear about atopic eczema are Why? and What can be done about it?
Why– The answer is complex and still being studied today. We know it is due to several genetic and environmental factors. If one parent has the atopic triad (asthma, allergies, eczema) then there is a greater than 50% chance a child will.
We’ve seen that patients with eczema have some mutations in a gene that affects natural moisturization factor, as well as being deficient in several types of ceramides. (You can think of these ceramides as being the brick and mortar that hold our skin together.
What are some of the major triggers for atopic dermatitis?
Think FADS:
F: fragrances (laundry detergents or perfume), fabrics (wool or polyester), food allergies (wheat, eggs, milk, peanuts)
A: Allergens (pet dander, dust mites)
D: dry environments, detergents
S: stress, smoking, sweating, soaps, showering (too long or too hot)
What can be done about it?
Luckily, there are many things that can be done!
Start by avoiding triggers (FADS) and moisturizing skin daily, ideally within a few minutes of exiting the shower (use bland emollients or petroleum). Spreading out showers and baths and keeping the water temperature low.
We have a lot of different prescription medications that can help. First line treatment for mild disease is low-mid potency topical steroids, and non-steroidal creams. We also recommend non-sedating antihistamines.
– For more severe cases, we have narrow-band UVB (light therapy), and even injections or pills.
What are complications of atopic dermatitis?
Because the skin barrier function is not at 100% in atopic dermatitis there is opportunity for secondary infections from bacteria, fungus, and viruses. This is why treating eczema is important. We are blessed to live in a day and age where there are many safe treatment options for atopic dermatitis as well as most of the secondary infections that can occur.
What is the big take away?
When it comes to children with eczema, I like to end conversations by reminding parents, “this is not caused by anything you are doing wrong.” So many parents of children with eczema carry guilt that they are doing something wrong with their child’s diet or environment that is responsible for their child having eczema. Of course, there are misleading things online or on ticktock that perpetuate this, but there is no evidence based medical data that supports it. So, if you are reading this and your child suffers from eczema, asthma, or seasonal allergies take a second to tell yourself it is not your fault, you are a great parent. Also, be comforted to know there are many treatment options that are safe and effective… and MidState is just a phone call away.
