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My daughters hear two words more than any others from my husband and me, more than “I love you” or some form of “no” (we have a very active, mischievous toddler).
Those words are: “stop scratching.”
For those lucky parents who have never dealt with eczema, it’s difficult to explain the sheer helplessness of watching your child literally scratch herself bloody. When the condition flares, we fall into a world of tears, anger, exhaustion and guilt.
The National Institutes of Health estimates 15 million Americans suffer from some form of eczema, including 10 to 20 percent of all infants, 60 percent of whom will show signs of eczema in the first year of life and 85 percent within the first 5 years. Nearly half of these children will see drastic improvement between the ages of five and 15, while the rest continue to struggle with the affliction into adulthood. Symptoms may include red, blistering, scaly, oozing, thickened and exceedingly itchy skin. And the side effects? Unhappy kids.
“We cannot know how much of a child’s behavior is affected by the eczema,” asserts Dr. Linda Ladd, a clinical psychologist and professor at Texas Women’s University. But, “absolutely there is a correlation between the skin and behavior issues.” Ladd speaks from firsthand knowledge, both as a sufferer and parent. She endured eczema well into her teens, and one of her three children inherited the condition. Ladd’s daughter, now in her 30s, still keeps her medicinal cream nearby for flare-ups on her hands, which can quickly become cracked and bloody.
My own daughter, Madeleine, threw intense prolonged tantrums at three. Ladd nods knowingly, “This is about how she feels inside. She cannot understand why. [Eczema] affects not just the child suffering but the entire family.” Indeed, research suggests children with moderate to severe eczema (specifically atopic dermatitis, the most common form) may have twice the level of psychological disturbances as children with mild or no eczema. These difficulties can spill over into school and interpersonal relationships and be exacerbated by stress.
Ladd cautions, however, that there is no definitive study linking behavior and eczema. During my four years of research, I was forced to admit this illness is too personal to generalize behavioral outcomes or “cure” dates. I’ve taken comfort from the statistics of children who outgrow the condition, but Ladd’s daughter didn’t. Mine may not either. Talk about a difficult realization.
The Skin Monster
While no one knows the root cause of eczema, researchers continue to examine eczema-riddled skin. Dr. Frank McGehee is a local practicing pediatric physician. He says normal skin looks like sandbags stacked one atop another while the skin of an eczema sufferer resembles gravel. The random and jumbled bits cannot form a strong barrier to protect against the irritants bombarding the skin. Healthy skin forms a thick, impenetrable dam, but for eczema sufferers, even minor pressure can cause a fissure in the normal barrier, causing leaks. Dr. Stephen Pedro, an area dermatologist, says eczema-prone skin tries to heal itself with defective parts causing a cycle of itching and rash.
We call it the skin monster.
Each time my daughters scratch those tiny bumps, they feed the skin monster, and each time it feeds, it gets hungrier. My older daughter’s feet are a testament to just how far the skin monster will go: On good days, Madeleine’s feet are slightly red. On bad days, they are bloody, and she’ll pull her socks off to scratch more vigorously. The pain is often as intense as the itching, and it is very difficult to explain to a 4-year-old and a toddler that the pain will go away if, please, you’d just stop scratching.
Conventional medicine recommends treating the disease with topical steroids. We keep a large tube on my daughter’s shelf. In addition, organic shea butter, TriCeram, Eucerin, Face of the Wave Eczema Balm and organic coconut oil round out the offerings, all of which offer at least temporary relief.
Because each child’s eczema is as individual as the skin it covers, there is no one antidote for eczema. The triggers and the treatments for an outbreak depend largely on the child’s immune system and genetic make-up.
My daughters’ outbreaks are brought on, in part, by outdoor allergies, another common trait of eczema sufferers (hay fever is a typical companion of atopic dermatitis). We suppress the rash through antihistamines, and I made a big mistake this week; I forgot to give my girls their respective antihistamines. By lunchtime on the second day, both girls had large, red patches on their skin and were unable to stop scratching. Within an hour of taking their medication, the inflammation abated.
This is the No. 1 rule of any eczema regimen: Stop the itching.
Jennifer DeLaCruz’s second child also suffers from the excruciating itchiness. “Our daughter has had eczema since she was 3 months old. A couple months after it began she looked like a burn victim,” the North Texas mom remembers. “She would wake in the morning with bloody sheets from scratching. I still shudder thinking what she went through and how hard it was as a mom feeling so helpless.” DeLaCruz and her husband have tried many techniques from chiropractics and antibiotics to steroid creams and Chinese medicine.
The family finally saw improvement once Pedro explained the flares were caused by what her skin touched. “We changed our laundry detergent, and we had to be careful who held her (because of their detergent and perfume),” says DeLaCruz. She also gave her daughter vitamins and probiotics and bathed her daily in a mixture of water, horticultural cornmeal and special oil before applying creams, one of which contained a mild cortisone. Now at age 2, her daughter’s skin is clear and healthy with only the occasional, mild rash.
Like DeLaCruz, we have experimented with a number of treatments. I’ve eliminated suspect foods and taken the girls for allergy testing and NAET, a form of resonant acupuncture designed to eliminate allergies — all with minimal success. I share DeLaCruz’s unease of steroid creams. I’ve read countless times about the efficacy of such drugs, yet the tube of topical steroids is still sitting, about half-used, on my daughter’s shelf. We only use it when the flares are excessive. That leads to rule No. 2: Know your child’s triggers because, Pedro explains, “Eczema is an itch waiting to happen.”
What causes it?
Dairy is the biggest culprit, according to Dr. Larry Davis, of the Nutritional Wellness Center in Plano. But corn, wheat, eggs, soy and even feathers are other common allergens that may be causing the itchiness. Davis asserts that some foods do not trigger symptoms for up to three or four days, meaning blood and skin scratch tests may not detect a food-related intolerance. He suggests that children tend to develop many of the same allergies as one of their parents. That primary intolerance creates an inflammatory process in the GI tract, which can lead to additional food allergies.
Davis contends that there’s a link between what we eat and how we react, both physically and psychologically. “[Food] allergies are a nervous system irritant,” he says. And, we tend to crave foods that our systems do not tolerate well.
Where the rash appears can often give clues to the type of triggers, notes Davis. For instance, he finds that with a food intolerance or allergy, the rash manifests itself on the back of legs, under the arms and sometimes on the eyelids. For contact dermatitis, which is usually set off by bleaches or detergents and synthetic fibers, the eczema patches will surface where the offending garments touched the skin.
“In eczema, the skin is hyper-reactive,” supports Maurica Contreras, a pediatric nurse practitioner in the dermatology clinic at Children’s Medical Center Dallas. “It can be triggered by many things in the environment, including grasses, pollens, stress, certain foods, infections, skin irritation due to wind, low humidity, heat, sweating, abrupt temperature changes, excessive washing, use of drying products (such as harsh soaps or perfumed products).”
Contreras adds that asthma and allergies are also hyper-reactive diseases and part of what is referred to as the atopic triad, meaning that children with one condition are more susceptible to the others. Even the metal in zippers and snaps or pressure from shoulder pads or shin guards can spark and outbreak, says McGehee.
Stopping the Itch
McGehee and Pedro agree that removing perfumed products is an important step in controlling eczema. That means sticking to dye- and scent-free soap and using only when necessary. We’ve been bathing our daughters in lukewarm water and lightly patting their skin with a washcloth. For their hair, I use a vegetable glycerin-based soap with no additives. And I started making my own laundry detergent a couple of years ago to ensure that chemicals never touch their skin.
Davis also recommends eliminating offending items for a minimum of three weeks and consuming only quality, whole food supplements (without any synthetics). “When eczema is bad, with deep lesions, the tissue needs time to heals and regenerate,” he explains.
Keeping the skin lubricated (rule No. 3), preferably right after bath to lock in the moisture, helps because it is much harder for the irritants to break down moist, healthy skin. I make Madeleine rub Eucerin onto her hands after each hand washing to prevent bloody cracks. For Rylie, I massage lotion behind her knees with each diaper change.
Medical experts strongly recommend scent-free emollients like Eucerin and Aquaphor. Other suggested products, which may or may not work for your child’s skin, include: Lubriderm, Cetaphil, Robathol (a cottonseed oil), dye-free Aloe Vera, Aveeno, petrolatum-based products and even Crisco. Alex Bekker, MD, a holistic practitioner in Dallas, also recommends organic coconut or almond oils, though McGehee cautions that plant-based oils may increase reactions for outdoor allergy sufferers.
Atopiclair, which is made from shea butter extracts, is a promising prescription option for those parents, like me, who are leery of the steroids. However, there are times when steroids, and even antibiotics for secondary infections such as impetigo or scabies, are necessary to clear the skin. McGehee advises parents to use the lowest dose prescription for the shortest time frame possible.
Then, resort to one of the moisturizers mentioned above to keep the skin as healthy as possible.
Other options include the pill Elidel and the prescription gel Hylira. Pedro also mentioned CeraVe and TriCeram, both of which contain barrier repair proteins. Ceramide is a lipid in the outer-most layer of the skin that helps form the skin’s protective barrier. Most traditional moisturizers prevent further water loss through the skin, but a ceramide-based emollient assists in the skin’s rebuilding efforts.
For us, though pricey, TriCeram has been a wonder cream. We can apply it to red, angry skin before bed and by morning, Madeleine’s skin is 90 percent clear. With continued applications, we can usually reduce the redness to just around anklebones and wrists, a vast improvement from scarlet hot rashes from toes to hips and fingers to armpits.
Pet dander, dust mites and other allergens inside the house may be contributing to the disease. Pedro recommends a good vacuum cleaner, preferably with a HEPA filter. If it’s financially feasible, removing carpet and laying down real hardwood floors (that don’t have a lot of chemicals in the protective coating) will eliminate one of the biggest indoor triggers. Keep in mind that eczema may be caused by more than one factor, which means more than one therapy is needed to alleviate the symptoms. “You wouldn’t treat a heart disorder or cancer with just one drug,” says Pedro.
The Healing Journey
Some parents are turning to healing through alternative medicine. Chinese medicine, pediatric chiropractic and holistic medicine are options for parents looking for natural solutions.
Bekker believes eczema is an internal imbalance, and homeopathic medicines stimulate the organism’s vitality to heal itself. He looks at the entire child to discover as much as possible about her constitution or adjustment to the outside environment. Thus, a thin, wiry, social child like my daughter will need a different protocol than a slow, heavy child who isn’t very active. The treatment selected depends largely on the child’s physical condition and answers to such questions as: Where is the eczema located? What time of day is it itchy? Is the itchy skin moist or dry? By understanding the connectivity between the skin, the body’s largest organ, and other internal processes, the immune system itself can be strengthened, which may alleviate many of the eczema symptoms.
Another plus for homeopathic remedies? There are no side effects like those that can occur with drug-based treatments.
Along these lines, McGehee says research has shown a connection between taking a quality probiotic (either in yogurt, Kefir or pill form) and omega-3 fatty acids (derived from certain fish or flax seed oils and available in capsule or liquid form) and a reduction in the rash. My daughters are on both, in addition to a quality multivitamin containing Vitamin E to relieve dry skin.
The key to managing the disorder is catching a flare early. We never travel anywhere without Benadryl (topical and liquid) to stop the itchiness and TriCeram to alleviate any redness. For us, the most important aspect is knowledge about the disease. Knowing your child’s responses makes eczema manageable.
We don’t win every day, but we’re still fighting.
Resources
Want to learn more about eczema?
ABCs of Eczema
The National Eczema Society and the American Academy of Dermatology recognize multiple types of childhood eczema. A clear diagnosis is necessary for correct treatment.
Infantile eczema is characterized by itchy, oozing and possibly crusty rash that mainly occurs on the face, scalp and behind the ears. Because of the itch, infants may rub their heads, cheeks or other itchy places on a hand, pillow or any other easily accessible item. Many children outgrow this form of eczema by age 2.
Infantile seborrhoeic eczema is also known as cradle cap. It usually starts on the scalp or the bottom area and spreads from there. Normally this type of eczema is not itchy or sore and will clear in just a few months with the help of emollients.
Eczema in toddlers and older children is typically found in the creases of the elbows, knees, ankles, wrists, neck, between fingers and the possibly on the face and chest. Patches of eczema may be dry, red to brownish-gray, scaly or thickened. The intense itching usually worsens at night.
Allergic contact dermatitis is typically an allergic reaction that develops over time to a substance such as the metal used in earring or jean closures, rubber or scents. Avoidance is key.
Irritant contact dermatitis is caused by frequent contact with skin-irritating substances like detergents and chemicals and can be prevented by avoiding the irritants and keeping the skin moisturized.
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