Dear Readers,

Jordanna, from Hope Pastures, Kingston, is the mother of a five-year-old boy, who suffers with severe atopic dermatitis (eczema). Jordanna said he has suffered with eczema since he was a baby. At times his face, back, hands and feet are covered with rashes, which itch a lot.

Jordanna said that she has used a lot of steroid creams and antihistamine syrups over the years, but the condition frequently recurs. She asked Lifeline to suggest any further remedies to treat the eczema.

The itchy rashes make her son miserable, which in turn make home life unbearable.

Atopic dermatitis (AD, eczema) is a chronic inflammatory skin disorder which affects a significant number of babies, children and adults. In 45 per cent of children, AD first occurs before six months and by age five, 85 per cent of affected children will have manifested symptoms of this disorder.

Dry itchy skin

Only 17 per cent of affected persons actually have onset of AD after adolescence. Infants usually present with papules (bumps to the forehead, cheeks and scalp which itch). Older children have papules and plagues over the hands and feet, ankles, elbows and behind the knees. The back and neck are also often affected. Along with the papules comes dry, scaly skin.

There is a genetic link between eczema and other allergic conditions such as asthma. Other factors leading to the development or prevention of AD are:

Breast feeding. The incidence of AD is found to be reduced in groups of children who have been breastfed for at least four months.

Environmental factors also play a part in the development of AD. Allergies such as house dust, mites, pollens and animal dander which can travel in the wind affect the skin, and increase the risk of AD. Molds and weeds can also cause AD.

Allergies from food such as cow's milk, eggs, wheat and peanuts also increase the incidence of AD.

Severe AD in infancy will continue into adulthood.

In children and adults, stressful situations can trigger episodes of AD.

When AD is suspected, it should be carefully differentiated from other types of eczema due to skin contact with allergies or irritant (allergic and contact dermatitis). Psoriasis of the palm, feet and fungal skin infections can also be sometimes confused with AD.

Skin care is very important in AD. The skin should not be allowed to become dry and special emollients and moisturisers should be used. Any identified triggers should be avoided and skin irritants such as synthetic or woolen clothing should be avoided. Soaps and hot water also irritate AD. Use soap substitutes and warm water at bath time.

Use moisterisers

A number of topical treatments are used to keep the skin moist and help ease the itching and inflammation. Moisturisers should be used at all times.

Topical steroids are important in treating flare-ups and recent studies indicate that applying topical steroids twice weekly when the skin is stable may prevent flare-ups of AD.

Elidel and protopic are two modern (and more expensive) preparations which allow for steroid-free topical, anti-inflammatory treatment of AD.

Topical antibiotics are also used in addition to topical steroids as skin bacteria can worsen the dermatitis. Antihistamine preparations can lessen itching. Jordanna will have to accept that AD is a chronic skin disorder and to manage it, continuous effort will have to be made to control exposure to food and environmental allergies and to keep the skin prepped with moisturisers even when the rash is well controlled.

The twice weekly application of anti inflammatory creams is also useful in maintaining the stable, eczema-free skin. It is not enough to treat the dermatitis when an outbreak occurs.

Write to:

Lifeline

PO Box 1731

Kingston 8.