Eczema: Beneath the skin
Itchy dry skin plagues many people in the winter, but for an estimated ten to twenty percent of the population it is a red itchy daily irritation known as eczema. Eczema is a chronic dry rash that is itchy, and can have redness, swelling, cracking and weeping. It can be found anywhere on the body, commonly on the elbows, back of knees, wrists and hands, but even on eye lids and scalp. Although many adults and adolescent have eczema, it is primarily a condition of infancy and childhood. Sixty five percent of cases develop in their first year of life, ninety percent by the age of five. Of these cases, half will resolve before adulthood, though eighty percent will have persistent dry skin. Urban environment and family history are the biggest risk factors. Two of the biggest concerns for children with eczema are nighttime itching, which can disturb sleep and lichenification, when the skin thickens as a result of scratching and chronic inflammation. Both poor sleep and skin changes can be distressing for the child and parent.
Addressing the underlying cause early in life may help prevent long term inflammation and prevent other disorders. There is a higher incidence of asthma and allergies in children with eczema. Much like allergies and asthma, eczema is a product of an up-regulated, out of balance immune system. Researchers have also found there is a breakdown of the outside later of skin in eczema, which may be from scratching and inflammation.
There is no magic bullet for eczema, and every case is different, however, examining the child’s environment, diet and lifestyle, eczema can be reduced and even put into remission.
The first step is to confirm the diagnosis of eczema. Psorasis, contact dermatitis and many other conditions can look similar to eczema. A licensed physician can diagnosis any skin rashes that might be eczema.
Identifying and removing triggers for the child’s immune reaction is an essential part of treatment. Soaps and detergents should be mild and non-abrasive. Washing skin is important to remove dirt and bacteria which can also be irritating. Respiratory allergies can be tested through a skin test or blood test. Dietary allergens can be determined in a blood test or more definitively with a medically supervised elimination diet. Determining irritants in the child’s environment and diet can be difficult; observing the child’s diet and constitution may facilitate this. One study recently reported an improvement in symptoms when allergens were effectively avoided in the diet or environment.
Researchers have found that skin with chronic eczema has less ability to retain moisture and increased inflammatory markers. Keeping the skin well hydrated with moisturizers and drinking ample amounts of water can help. Also ensuring good nutrition will help skin restore its health, especially Vitamins A, C, D, E and zinc. These should not be supplemented with in a child more than a multivitamin without medical supervision. Adequate levels can often be met with food sources. Healthy fats, including essential fatty acids, and whole foods, especially fruits and vegetables, are all important to focus on in a child’s diet.
Stress and exposure to irritants can exacerbate eczema symptoms and need to be monitored and limited. Drier climates will dry out skin, so keeping humidity up with the dry months with a humidifier and avoiding hot showers will help prevent flare ups.
Skin is one of the best communicators of the internal ecology of a child. Improving eczema symptoms reflects a more balanced immune system, less inflammation, better hydration and overall a happier kid.
Dr. Lauren Young is a naturopathic physician with a family practice in Hartford Hospital Wellness Center in Avon. For more information, contact her at Whole Health Associates, (860)674-0111 or visit www.wholehealthllc.com. See ad on page .