Q: I have an 18-month-old with eczema all over his face and body. He was tested at 12 months for allergies, and was found to be allergic to eggs, soy, milk and wheat, and also to dog dander. I continue to nurse him for now. I have tired many creams and none seems to help to relieve the eczema completely, though some days it’s not as bad. What else can I do to get ride for the eczema?
Dr. Watson: While we do not have a cure, the better news is that eczema usually settles so that it’s less of a problem as a child gets older. You mentioned a number of foods that your son tested positive to, along with animals. Children with eczema have a lot of IgE (the allergic protein) and sometimes false positive reactions can occur.
Has elimination of these foods made any difference in the frequency and severity of the eczema flares? Have you spoken to your doctor about reintroducing any foods to see if the eczema changes at all? Do you have a dog in the home and, if so, is it an option to remove the dog to see if that makes a difference?
A skin-care plan for eczema includes both general care and the use of anti-inflammatory topical medications. In my clinic, we recommend regular bathing with luke-warm water for 10 minutes to hydrate the skin. No soap is used unless necessary for cleaning. Then we suggest patting the skin dry but leaving some moisture. If the skin is really dry, we do advise not toweling off at all. An anti-inflammatory ointment should be applied to affected skin, either a low-potency corticosteroid or non-steroidal medication that affects inflammatory cells. A good moisturizer is then applied.
I have had very good success with using plain petroleum jelly on damp skin after applying the anti-inflammatory ointment. Moisturizers have also been developed that contain ceramides to help replenish moisture and build up the skin barrier function. As well, there is some evidence that mild bleach baths (1/4 cup of bleach in half a tub of water) can decrease a skin bacteria that aggravates eczema.
If your child is very itchy, I would suggest a sedating antihistamine such as hydroxycine. Once the skin settles, there is good evidence that using the anti-inflammatory medication twice weekly will help to reduce the skin flares. If the skin looks infected, I would use oral antibiotics to reduce the bacteria counts, and potentially also the eczema.
I hope these sights prove helpful. But if such regular treatments are ineffective, your doctor will want to do further assessment.
Dr. Wade Watson is a pediatric allergist and Professor of Pediatrics at Dalhousie University. He is also the head of the Division of Allergy at the IWK Health Centre in Halifax.