March 14, 2016
Eczema or atopic dermatitis is a skin condition in children and adults that is related to allergic type phenotypes of rhinitis and asthma. It is a patchy, dry, itchy skin rash that can affect any area of skin but often targets the elbows, space behind your knees, face, hands and feet.
It is often the presenting symptom for infants at 3 weeks old who have IgG mediated food sensitivity to the casein protein in cow milk based formula. It also occurs to breastfed infants if the maternal diet has dairy in it.
These infants present with green stools, colicky behavior and reflux/spitting. If left untreated without the removal of dairy, these children will progress to full-blown colitis and bloody stools. Once the offending cow milk is removed from the diet the majority of these children will heal and get healthy.
In some cases the eczema and GI symptoms do not completely clear with hydrolyzed formulas or maternal dairy removal. In these cases it is a good idea to try an amino acid formula or a maternal elimination diet for the major food protein irritants including, soy, egg, wheat, corn, peanut, nut and shellfish. Within three weeks the symptoms should abate.* If they do not, your child may be suffering from FPIES or food protein induced enterocolitis syndrome. This is the point at which your child needs to see a pediatric allergist versed in FPIES. We have a great one in Charlotte, Dr. Maeve O'Connor.
If your child is older and suffering from eczema and allergic rhinitis but no GI symptoms, a trial of the above elimination diet for a few weeks is still warranted although not always successful. Consult with a local nutritionist for meal plan advice to make sure that macro and micronutrient levels are maintained.
If dietary interventions offer no benefit, then it is possible that the eczema is related to a fillagrin gene defect and other allergenic and chemical triggers. It is highly recommended to avoid all fragranced chemicals that come into contact with the skin including clothing cleaning agents. Find hypoallergenic types that are minimal in their chemical composition.
Hydration is key to prevent skin irritation. Moisturizing eczematous skin within 3 minutes of a bath or shower is critical to lock in moisture. Coconut oil, shea butter, cerevae, eucerin, aveeno eczema care cream are some good choices.
Wet wraps are another option for hydration. Taking cotton clothing and making it damp with clean water then wearing it for an hour with warm dry clothing over top is effective. Moisturize immediately after taking the clothing off for the greatest effect.
Inflammation can cause a significant irritating burden to a child. Scratching often exacerbates the issue. Keeping nails filed is a great idea. Calendula and 7 creams are helpful for itching and inflammation. If the eczema continues to be uncontrolled, consult your physician for topical anti-inflammatory creams.
Infection of the skin can be a confounding problem. Red inflamed skin is likely colonized with pathogenic skin bacteria. Topical bleach baths or topical antimicrobials may be necessary to stop progression. Consult your doctor for help at this stage.
Vitamin D, B12, zinc and magnesium status are important in treating skin disorders. Get these levels checked and supplement as needed.
Getting adequate sun exposure is critical for D development. Know your burn threshold and avoid it while getting sun exposure to develop vitamin D from your skin.
Omega 3 fats and DGLA from evening primrose oil have been shown to help quell inflammation. Consider eating cold water oily fish a few times a week or taking fish oil supplements to balance the omega 3/6 ratio for inflammation reduction.
Melatonin at night has been shown to help a child sleep and can reduce eczema severity. Getting adequate sleep is critical for all children, especially those that scratch at night. If sleep is an issue with eczema try melatonin 1 hour before bed time.
Some potentially useful therapies on the horizon include HDC parasite therapy to force the immune system away from attacking self and towards the parasite.
Eczema is a tough condition,
Dr. M
*If your child is put on an amino acid formula and still fails, consider Alimentum ready to feed as it does not contain corn solids as the powder versions all do. It has sucrose which is not an irritant.
