How to cope with eczema

Operations manager Fatisyah Yahaya’s youngest child is three years old but he still keeps her up at night. Sleepless nights are quite the norm in their family because all three of Fatisyah’s children have eczema which disturbs their rest.

“My youngest son sleeps with me. In the middle of the night, he would wake me up and say ‘itchy’ and ‘garu’ (scratch). He had an attack last week and I had to keep rubbing lotion on his body throughout the night,” says Fatisyah, 35.

Like the youngest child, her two older children who are five and six have also had eczema from birth.

“My eldest has eczema at the back of his ears and sometimes, he scratches till they bleed. His friends at school have started asking him, ‘What is that? What’s that weird thing on your ears?’ He would come home crying and ask me what it is. All I can tell him is ‘It’s OK. We are treating it’,” says Fatisyah who has had to quit work to take care of her children when they have bad flare-ups.

One in five children under the age of five in Malaysia have atopic dermatitis, or atopic eczema – an itchy, chronic inflammation of the skin. Diagnosis is primarily based on appearance of skin and on personal and family history.

In urban areas, eczema has become two to three times more common in recent decades. It has been said that urbanisation and an improvement of general hygiene standards may have caused an immature immune system in children due to a lack of exposure to potential allergens.

Fortunately, in more than two-thirds of these children, the condition resolves itself before adolescence.

Fatisyah’s children’s eczema flare-ups can often get very bad, which result in dry, red and intolerably itchy patches on her children’s cheeks, creases of their elbows and knees, and behind their ears. When they experience eczema attacks, they can be so severe they cause inflammation and bleeding.

While there is no exact cause for eczema, doctors believe it is linked to a combination of genetic and environmental factors.

Children with a family history of asthma, rhinitis and hay fever have a higher chance of developing eczema. This, coupled with the use of harsh cleansers, the hot and humid weather, emotional stress, and the itch-scratch cycle, add to the factors that can aggravate eczema.

Fatisyah has asthma, which she says is most likely the main cause for her children’s eczema.

According to Hospital Kuala Lumpur’s (HKL) consultant paediatric dermatologist Dr Leong Kin Fon, food allergens only play a small role in aggravating eczema. He says eczema in infants is often inaccurately diagnosed as milk rash, which is caused by intolerance to cow’s milk.

“A lot of parents choose to believe that eczema is due to one single cause. As a result, they are willing to spend hundreds or thousands of ringgit to go through all sorts of allergy testing, from patch tests to blood tests. They are hoping that once you identify the cause, you can remove it and the eczema can be cured. But there’s no such thing,” says Leong during the recent launch of My Eczema Action Plan: Your Step-by-Step Guide to Managing Eczema, a national guidebook that aims to help families better manage the chronic disease.

Leong says eczema patients from different parts of the world require different “recipes” to combat the situation, hence the necessity for a Malaysian guidebook. At HKL, there is an Eczema Kidz Club that offers support for families coping with eczema.

Written for children and parents, the guidebook introduces a helpful “traffic light” system that tells readers what to do during the different stages of eczema. Essentially, it’s about how to maintain your skin when it is in the healthy “green” zone, what to do with flare-ups in the “yellow” zone and how to identify “red” zones which needs immediate medical attention.

Following doctor’s orders

Eczema sufferers have skin that can’t retain moisture very well. This means they need to moisturise twice as often as a normal individual, so choosing the right skincare product matters.

Fatisyah has tried countless skincare brands in her search for a miracle cream for her children. She says organic products only provide temporary relief before the itchy patches come back, angrier than ever.

She has even tried steroid creams, which many are wary of using, especially on children.

“When I took my children to see the GP, I was prescribed a steroid cream.

“At that time, I didn’t know I was only supposed to use it over a short time. I kept thinking I was managing it well,” she says.

Now, her daughter and youngest son have discoloured patches on their cheeks, where the steroid cream was applied continuously for two weeks.

According to Leong, steroid medicine isn’t always the “bad guy” it is made out to be. “The key word here is ‘excessive use’. Too much of anything is never a good thing,” he says.

When the skin becomes inflamed, a course of steroids is normally required to manage the flare ups. Steroids are safe for children, but must be discontinued once the situation improves, usually between three to seven days. Leong advises parents to start children on the lowest-strength topical steroid and only move on to a stronger one when there is no improvement.

Leona Lim, 31, is not averse to using steroid creams on her one-and-a-half-year old son. Earlier this year, the boy suffered a massive eczema attack on his back but recovered swiftly with the help of a mild topical steroid.

“I just had to use a light steroid. Within five days it got much better,” says Lim, a product manager.

Not all parents are as open as Lim and Fatisyah when it comes to steroid use.

Lim dismisses this “fear of steroids” and a preference for alternative remedies as groundless.

“In Malaysia, I notice a lot of parents are trying all sorts of remedies, but they are not helping their children. I joined several mother groups and a breastfeeding network on Facebook. Sometimes, I’d see a picture of a baby with weeping eczema and the mother would say she’s putting breast milk on him and that she doesn’t know what else to do,” Lim shares.

To keep the itch at bay, Lim makes it a point to moisturise her sons skin several times a day.

While eczema isn’t contagious, weeping eczema is a different case altogether. When the skin is weeping a clear or yellow fluid, it is a sign that it is infected and may be contagious through skin contact. Antibiotics are required to clear the infection.

Fatisyah now has an eczema “rescue kit” with her at all times. The pouch contains a clean towel, wet wipes, a topical steroid and a controller cream. Unlike a normal moisturiser, the controller cream repairs the skin while it moisturises and helps take care of irritations. When her son was diagnosed with eczema at just three months old, Lim panicked and ended up spending thousands of ringgit on organic skincare products.

There is no cure for eczema but there are ways to control flare-ups. But can eczema be prevented from even happening in the first place?

Leong reveals that a few studies done within the Scandinavian region have pinpointed probiotics as a form of prevention against eczema.

“Some studies have shown that if mothers take a particular strain of probiotics –the lactobacillus GG – four weeks before, and six months after a child is delivered, it actually helps reduce the risk of eczema up to 50%,” he says.

But the studies have not been conclusive.

Nevertheless, Leong says there’s no harm in trying this since probiotics are generally safe.

He adds that newborns who are at higher risk of having eczema should use a regular moisturiser and the right cleanser in their first year of life.

“It’s important to protect the skin from allergens by using the right skincare while the immune system is still maturing,” he says.

Preventing daytime scratching

Eczema flare-ups can happen when it’s hot and humid. Here are some tips to help get your child through the day.

Eczema sufferers need to moisturise twice as often as a normal individual.

1. Wipe off sweat before moisturising.

2. Have a small container of moisturiser handy and bring it with you everywhere.

3. Most kids start scratching when their hands are idle. Make sure your children always have something fun to occupy their hands with, like playing cards or doing crafts.

4. Let your child wear long sleeves and pants. This is to prevent habitual scratching during activities like watching TV.

5. When his skin gets itchy, ask your child to take a deep breath and start counting to 10. This will distract him from scratching.

6. Do the 10-second blow. Pat or blow gently on your child’s skin for 10 seconds, then ask him to engage in a new activity. For example, draw a picture, go for a walk or play the piano.

7. Use a cold compress on the affected areas and count to 10. This wil help relieve the itch. Repeat as needed. Alternatively. you can wash skin under cold running water for a few minutes.

8. If your child’s skin hurts, don’t rub but gently dab with controller cream. Allow time for the controller cream to work.

Battling night time itch

Eczema is often called ‘the itch you can’t scratch’, because scratching would only make it worse.

Eczema is known to cause sleepless nights. Here are some things you can do to pacify the night time itchiness.

1. Apply moisturiser at least 20 minutes before bedtime to allow it to soak in.

2. Dress your child in baggy pajamas with long sleeves and long pants. During flare up periods, put on cotton gloves and socks for him.

3. Follow the doctor’s orders and give your child the medication he requires so that he can have a good night’s rest.

4. If your child feels a burning sensation when taking a bath, try adding one cup (237 ml) of table salt to one big pail (22.7l) of warm bathwater.

5. Give your child a naptime massage. Try applying a bit of moisturiser on your index fingers and massage your child’s face, back and legs.

6. Keep the bedroom cool and use cotton sheets or a light, natural-fibre comforter.

7. Apply wet wraps before bedtime. Moisten clean gauze bandages with water and wrap the affected skin. Cover the wet bandages with a dry bandage or towel.

Traffic light zone
Symptoms: Skin looks normal with very mild irritation. Can still work and play.
Recommendation: Continue use of moisturiser and controller cream.

Yellow zone: Caution!
Symptoms: Skin starts to itch more intensely and red scaly rashes appear. There is difficulty in functioning normally.
Recommendation: Follow your doctor’s orders and start applying medicine, like a topical steroid, on the affected area until it improves.

Red zone: Danger!
Symptoms: Yellowish fluid appears on skin. There is fever and pain in the affected areas. The itch is so intense that you can’t sleep at night.
Recommendation: Seek immediate medical attention. – Star2.com

Category: Education, Top Story