As many as 10 per cent of all infants born in Singapore suffer from eczema, a chronic skin disorder. While the exact cause of this condition is unknown and it varies in severity, it is generally characterised as an itchy, red rash on dry and inflamed skin.
“There are many types of eczema of which atopic dermatitis [AD] is more common in young children,” explains Dr Lynette Low, a Raffles Hospital dermatologist. “It is part of a group of conditions where the person has an increased sensitivity to allergens.”
She adds, “Although atopic dermatitis can affect people of all age groups, it commonly presents in children under 5 years of age, especially in those under 1.” In fact, about 65 per cent will develop AD symptoms within the first 12 months of life. In infants, these symptoms commonly appear when they are between six and 12 weeks of age. Other atopic conditions include allergic rhinitis (also known as hay fever), asthma and allergic conjunctivitis (eye inflammation).
The good news ― eczema is treatable and not contagious. The bad news? There’s no cure, you’ll never know when it might flare up and what might trigger it. The best thing you can do, according to Dr Low, is to avoid triggers, establish good lifestyle habits and take medication when needed.
If this condition hits close to home for you, here are six more things to know about eczema.
While dry skin is a sign of eczema, it can also appear as circular patches often misdiagnosed as fungal infections.
1. Different types of eczema show up differently
While dry skin is a sign of eczema, it can also appear as circular patches often misdiagnosed as fungal infections, says Dr Low. “Discoid eczema presents as round juicy thick rashes, while infected eczema can appear as blisters or vesicles [blister-like elevations in the skin surface that contain tissue fluid] and may look different from the usual itchy red rash.”
Also, eczema caused by allergens may look like mosquito bite-like wheals (itchy white or red lumps) or sheets of red rashes. Dr Low adds, “Children with chronic uncontrolled eczema have thick, rough patches of rashes which are a result of persistent scratching and rubbing,”
Where the skin lesions appear also depends on your child’s age. In infants, eczema is usually found on the scalp, diaper area, face and folds of the arms and legs. The wounds also tend to ooze the fluid that has escaped from blood vessels because of the inflammation. In older kids, you will often find lesions on the wrist, ankles, back of the neck and knees and the elbow area. The scabs will also be thicker and harder as a result of long-term scratching or rubbing.
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2. Soap, detergent or baby wipes could trigger eczema
Contact dermatitis ― also part of the eczema family ― is caused by direct contact with substances such as perfumes and detergents, plus materials such as latex. “If a person has developed a sensitivity to a certain substance, coming into direct contact with it can irritate the skin and trigger a flare-up. Harsh soaps and washing detergents can also dry out the skin, just like cold and dry weather,” Dr Low says.
Jerry Lim, 40, who has a daughter, 1, and a son, 6, found out that the baby wipes they were using were triggering his then 3-year-old son’s eczema. “We had been using the same wipes since the day he was born and one day, three years later, we bought a different brand because our usual one was out of stock,” says Lim. “His eczema didn’t flare up while we were using it, and when we switched back to the old brand it did ― we had finally found the culprit!”
So if bub shows signs of eczema, try using different brands of soaps, body lotion, wipes and detergent to see if these make a difference.
If a person has developed a sensitivity to a certain substance, coming into direct contact with it can irritate the skin and trigger a flare-up.
3. Steroid creams have scary side-effects, so use these wisely
If the condition is getting out of hand, doctors usually recommend using steroid creams and ointments, which have been proven to be effective. Steroids come in many strengths and medication is usually prescribed to suit the patient’s needs, where the lesions are located and the severity of the condition.
“Occasionally, combination creams with topical antibiotics will also be prescribed,” explains Dr Low. “The recommended dosing is usually a thin layer applied to the affected area once or twice daily till the rash improves, after which, the topical steroid can be stopped.”
However, parents tend to fear medical prescriptions ― especially when they hear the word steroids ― and avoid applying medication altogether, even when it’s been prescribed by their doctor. This is probably because they’ve heard that prolonged and inappropriate use of topical steroids can lead to side effects such as thinning and bruising of the skin, increased hair growth, stretch marks and the skin’s dependency on it, Dr Low notes.
Lim says, “They started my son on cortisone cream when he was a few months old because the rashes were getting out of hand. We were told to strictly use it for only four to seven days, max ― it helped greatly to manage the situation.”
Adds Dr Low, “It is important to know that a little goes a long way and can help a baby’s troubled skin return to normal safely when [medication is] applied as recommended.” She notes that topical medications are also used as a maintenance dose for patients with chronically affected areas as a preventative measure.
The most important thing is to not let rashes get out of control. If you are still worried about exposing your little one to steroids, there are treatments like Tacrolimus ointment. Ideal for kids over the age of 2, it is as effective as steroid creams, just without the side effects.
Three more truths about eczema coming right up!
4. Genetics has a part to play, too
Dr Low notes, “The cause of eczema is multifactorial with both the environment and genes playing a role. There is an interplay between the skin barrier and immune system, both of which are controlled by multiple genes.”
If a child is born to a parent with any form of AD, he has a 60 per cent chance of developing the disorder. If both his parents have it, the risk rises to a whopping 80 percent, according to the Encyclopaedia of Children’s Health.
Scientists have also found a link between AD and Filaggrin deficiency, which is caused by a genetic mutation. Filaggrin is a protein found in the outermost layer of your skin. “The loss of this skin protein increases the risk of the development of atopic dermatitis,” Dr Low explains. The presence of this gene defect can also increase the chances of your kewpie developing food allergies. And although doctors are unable to explain why, she adds that they’ve also seen an increased risk of eczema in children born to older mums.
5. Children with eczema are at higher risk for food allergies and asthma.
Since AD occurs frequently with allergic rhinitis such as hay fever or inflammation in the nasal passages, it can also lead to other allergic conditions.
So, having eczema can be an early cue that your little one may develop other common allergies and asthma. Studies show that 50 to 70 per cent of children with severe AD go on to develop asthma. The combination of asthma, eczema and allergies is commonly referred to as an “atopic march” in the medical world. It refers to a series of immune disorders that pop up one after the other. Over a period of time an individual may develop one, two or all three conditions.
“The relationship between food allergies and eczema is yet to be ascertained,” says Dr Low. “It is important to remember that while eczema is not an allergic reaction, food allergies may produce rashes upon exposure to the allergen.”
The most common food allergies that kids battle are cow’s milk, egg and peanuts. In breastfed babies, the allergen may come from food the mother consumes, especially if you include nightshades, such as tomatoes, potatoes, peppers and eggplant, in your diet as babies with food sensitivities can react to them. A skin-prick or blood test is an easy way to confirm allergies.
“Keeping baby’s skin well moisturised is paramount. Also, ensure that your newborn is dressed comfortably and keep their nails short.”
6. Broken skin can make a child ill and socially withdrawn
When you let rashes get out of control, the never-ending itch-scratch cycle can cause skin to break, making it an entry point for bacterial and viral infections. This will only aggravate the condition, making it harder to treat, and may cause the child to feel unwell.
When the itch is severe, it can often interrupt sleep. Newborns may even rub against bedding or other items to relieve their itch. Lim recalls, “Both my son and daughter have eczema and as infants, they would scratch till they bled. I would see blood stains on their bed sheets very often in the mornings. I think it also contributed to their extra fussiness and crankiness because they slept badly and were uncomfortable.”
Another important factor to note is that a child growing up with chronic eczema may also shy away from making friends or attending social events because they are self-conscious of their thick and rough skin. This can affect their social ability in the long run, especially if the eczema never clears up.
This is why Dr Low can’t stress enough the importance of managing the situation well from the get-go, so that it doesn’t spiral out of control. “Keeping baby’s skin well moisturised is paramount. Also, ensure that your newborn is dressed comfortably and keep their nails short,” she adds.
Dr Lynette Low is a specialist in dermatology & consultant at Raffles Skin & Aesthetics, Raffles Hospital.
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