Eczema: tips for soothing itchy skin

If itchy eczema is a problem for your little one, find relief in the experience and wisdom of our experts.

Eczema is one of those troublesome childhood afflictions that is all too common. Red, dry, itchy patches appear on the skin and you may need to work like a forensic investigator to get to the root cause of the problem. To help you in your efforts to ditch the itch, we've pooled the knowledge of four experts - from a paediatric dermatologist, to a nutritionist, a naturopath and a mum. All have slightly different takes on the causes and best treatments but all agree there's no one-size-fits-all cure. So if one idea doesn't work for you, move on and try another.    

IN THE WORDS OF A ... MOTHER
Nicola Wilkie, mum of three
Teal and India both had eczema when they were little. It started around three months - environmental eczema, they call it. Their skin was irritated, red, raw. We stopped using soap products straight away. My husband Nathan had had eczema so we knew what to do. We bathed them much less and used almond oil.

We went to the doctor when we couldn't get on top of it - probably when Teal was around nine months old, and then the same for India. They had it intensely down the backs of their legs, their elbows, under their arms - all those sweaty spots that don't get a lot of air. The doctor gave us hydrocortisone and aqueous cream. Oh, and we used Pinetarsol. It might've worked if we had done it properly - we would use it only to the point where the skin was recovering as I was nervous about the chemicals in the products.

It's difficult. When they're crawling around in dirt and dust, who wants to keep them cooped up in long white cotton? Anyway, a bit of sun is good for them so I'd just let them go outside.  I didn't use much sunblock but don't tell anyone that. I guess I could've got hippy stuff but I couldn't have afforded it back then.

Over time, Teal's eczema has come right. From about age six, he's got progressively better every year. India had grown out of hers by the time she was five. Leni, our youngest, never had it.

There's this other thing the kids had, called molluscum contagiosum. It's a virus that looks like lots of raised whiteheads that can last up to two years. I read that kids with eczema are more susceptible to that, but most people wouldn't pick up on it. I was mortified when they got it. It's a savage thing if it's really let loose. I shouldn't have Googled it, though.

My advice to other people with kids with eczema would be get to it while you can, actively do what you can but don't be too precious and forgive yourself if you don't get round to putting on the cream for the fourth time every day. It seems like environmental eczema is way more common than it used to be. So short of moving to Bali, just relax, read about it and do what you can.

IN THE WORDS OF A … PAEDIATRIC DERMATOLOGIST
Dr Diana Purvis, Starship  Children's Hospital
Eczema affects 15% of New Zealand children. Most children have mild eczema, which responds readily to treatment. However some have more severe eczema that can be challenging to manage. Eczema can have considerable effects on the quality of life of a child and his family due to infection, itch, lost sleep and time-consuming treatments. Fortunately for most children eczema improves or resolves as they get older. However, for some, eczema remains a problem throughout life.

Eczema is a complex condition. Studies show that many people with eczema are born with an abnormal skin structure which means the skin doesn't work as a barrier as well as it should, allowing irritants to "leak" through the skin and cause inflammation. The skin of people with eczema also produces less of its natural defence against infection, and so bacterial and viral infections are more frequent.

People with eczema are more likely to have allergies to foods and environmental factors, although experts now think that this may be a consequence of having eczema and "leaky" skin, rather than being the cause of the eczema. Most children will have many triggers for their eczema, which means it is virtually impossible to identify and avoid them all.

There is no one treatment that will cure eczema, and children with eczema need an individualised treatment plan to bring it under control. The main focus of this should be good skincare. Skincare involves minimising exposure to irritants, supporting the skin's barrier function and treating inflammation and infection.

The most common irritant is soap, and this should be avoided. Moisturisers soothe and support the skin barrier. In mild cases this may be all the treatment that is needed. However where there is persistent inflammation steroid creams have an important role - to break the itch-scratch cycle, allow the skin to heal and restore normal barrier function. The choice of steroid cream will depend on the child's age, the site on the body, severity and which treatments have been used before. Reassuringly, there is no evidence of side effects from appropriate use of steroid creams on children.

Exposure to known allergens (eg, dust mites, pets) should be minimised. Removing foods for treating eczema requires careful consideration. This should not be done indiscriminately or without supervision by a paediatrician as food exclusion can have significant effects on a child's nutrition and even promote the development of life-threatening anaphylactic reactions.

Recognising and treating infection is important. If your child's skin suddenly gets worse with redness, weeping and crusting it is important that you see a doctor promptly for treatment.

Although eczema is common, for some children it can severely impair their enjoyment of life. If your child's eczema is not responding to treatment from your family doctor - particularly if he is sleeping poorly, missing school, having recurrent skin infections or severe facial eczema - you can ask for referral to a dermatologist who can offer other treatments to help children with troublesome eczema.

IN THE WORDS OF A … NATUROPATH
Natasha Berman, Qbaby
Eczema was once a rare condition, these days it is so common that, in my clinic, it is the number one presenting complaint. While I know that every person is different, there are definitely some common underlying causes, and therefore some common effective treatments. Obviously, what works for children can also work for adults with the condition, but it can also be more complex in adults, who often have stress as a trigger for their skin reactions.

Eczema is also known as dermatitis (literally meaning inflammation of the skin), or atopic dermatitis (AD). "Atopic" simply means "allergic" and often eczema that develops before six months may be the first sign of an allergy.

Eczema is "an itch that rashes" in contrast to contact dermatitis, where the rash appears before the itch and so is "a rash that itches". The itching leads to scratching which can result in changes to the skin barrier.

Infants with eczema often have a history of nappy rash. There is usually a family history of eczema, food allergy and/or asthma. There is a controversial concept that vaccination may promote the development of atopic diseases such as eczema. The bacteria staphylococcus aureaus is also a feature of eczema.

Food allergies and intolerances account for much of the increase in eczema. I continually work with this in my clinic. Hair testing for allergies shows that the main foods that seem to be a problem in eczema-sufferers are one of (or a combination of) the following:

Dairy, kiwifruit, citrus, tomato, potato, wheat, yeast, soy, sugar, preservatives and additives. These intolerances can come via breast milk. There is also often an underlying lack of good gut bacteria. Environmental irritants such as dust mites and detergents can also play a part. 

Once problem foods and substances have been eliminated and the correct treatment protocol has been followed, I see a huge improvement in the condition of the skin very quickly.

So much of our immune defence is located in our gut, and this is especially true for babies and children. Promoting good gut health, through fibre in the diet, low-sugar diets and promoting beneficial gut bacteria following antibiotic use, is essential for immunity. Similarly, if a child has been born by Caesarean section, he will need more intensive gut support such as extra probiotics, as he will not have the normal bacterial colonisation.

My first recommendation is an Allergenics Allergy Test through allergenicstesting.com. While there are some common foods that trigger eczema, it is always better (and often easier) to do an allergy test to be sure that all the reactive foods are identified. While awaiting the test results, I recommend starting children on the following supplements:
1. Flaxseed oil: The omega-3 fatty acids present in both flax and  fish oils help to reduce the inflammatory/ allergic response.
2. Eczema Shield Probiotics: A clinical trial showed that when taken by mothers during pregnancy and breastfeeding, lactobacillus rhamnosus GG strain may reduce the incidence of children developing eczema as well as reducing the itching and sleeplessness caused.

I also recommend my own Quintessence Eczema Cream for topical application which contains herbs such as albizzia which is an anti-allergic herb and chickweed which helps to reduce the itching, also zinc for skin healing and rosehip to reduce redness and scarring.

Quintessence Eczema Drops contain a formula that may help to reduce allergy by opening up all the other channels of elimination, reducing eczema overall.

Other useful treatments include adding calendula oil to the bath or for massage. Calendula oil is naturally anti-inflammatory and high in beta carotene, which is healing for the skin. A great old-fashioned treatment is an oat bath - put some oatmeal in an old stocking, tie off the end and run the tap water through it until the water turns milky. Something else that's very helpful is using only products that are natural and contain no harsh detergents, petrochemicals, artificial fragrances or parabens. Natural products are ideal for all skin types, in particular children with sensitive skin or eczema. Also take a look at any washing detergents you use and consider changing to a natural range that contains no harsh products.

IN THE WORDS OF A … NUTRITIONIST
Leanne Cooper, Cadence Health 
In recent years, there's been a change of thinking over the effect diet has on eczema. There is now a load of evidence showing healthy bowel flora from an early age in life helps reduce the risk of allergies and eczema. Studies have shown our modern diets have left us with an imbalance in fats, in particular the ratio between omega-6 oils (such as those from nuts and vegie oils) and omega-3 oils (specifically the essential ones from fish). This is why fish oils have had such a surge in popularity - they help increase the ratio of omega-3. Increasing maternal omega-3 has been shown to exert a protective effect on infants, particularly breastfed ones.

It was once thought that dairy products increased allergic reactions such as eczema but studies now are showing the opposite, with some results stunning people in regards to how much earlier such foods can be introduced to infants. Some years ago the guidelines on introducing solids were set at six months in the hope of reducing the risk of food reactions. However, it appears it has made things worse and increasingly studies are showing that earlier (but not before 16 weeks) introduction of solids including fish before nine months and even eggs, in fact reduces issues such as eczema.

So what else should you be eating? Well, you need to ensure a diet high in omega-3, and the best way to do that is through fish. Good old flaxseed oil does have omega-3 but it doesn't appear to be as well absorbed by the body, with one study showing only an 8% uptake of the fatty acids.

Probiotics such as acidophilus appear to exert a protective effect but many so-called yoghurts really don't do what they should, with little or no detectable bacteria at the time of opening, or too little added (which in itself is a problem as yoghurt should be made from bacteria), or ineffective strains. You need a good natural yoghurt made the old-fashioned way  - cultured from a good strain. Watch out for the thickened dairy products with lots of sugar and a bit of probiotics thrown in at the end.

If you're pregnant or a nursing mum you need to ensure you're eating a diet rich in omega-3 and probiotics. It's not recommended that mums should alter their diet but if you want to try it, do it the slow way, by eliminating one food at a time. Start with the top allergy foods - wheat, dairy, nuts - but make sure you don't reduce the variety or nutritional value of your intake. It's probably better to focus on adding omega-3 and probiotics to the diet.

If your child is formula-fed be aware that formulas differ widely and it can be hard to find one to suit. Partially hydrolysed hypo-allergenic (HA) formulas are better tolerated by babies who react to foods. Babies who have a full-blown cows' milk protein allergy are often popped onto a fully hydrolysed formula but these are available only on prescription. Cow or goat's milk is neither here nor there as they are similar and soy is fine for babies with a lactose issue but no better nutritionally than a cow's milk-based formula. I would recommend the newer generation formulas that contain omega-3, probiotics and an altered protein ratio (such as Nestlé Nan HA Gold) which are generally best tolerated all around.

The current thinking is not to delay the introduction of solids, but rather look out for signs of readiness and then offer baby a wide array of healthy foods over time, ensuring that fish and natural yoghurt get a start between five and seven months. If you're in any doubt ask your Plunket nurse.