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Skin care: eczema – treatment (part 1) SKIN CARE: ECZEMA – TREATMENT (part 1)
The treatment of any condition, particularly eczema, is related to correction or modification of the abnormalities causing the problem. Since these children have impaired oil gland function, resulting in a dry skin, the first important step is to counteract this. This means infrequent bathing or showering, with the temperature of the water kept cool and with a minimum of soap used. Bath oil may be very useful, as will soap substitutes such as emulsifying ointment. The condition of these children will be worse during the winter when the humidity is lower, and this may be aggravated by central heating which is associated with less humidity in the rooms. Humidifiers can be very helpful in these cases.
Due to impaired sweat gland function, it is advisable to keep these children cool rather than allow them to become overheated, and to avoid rapid temperature changes since their skin will not adequately cope with these, and will become itchy. Due to their lower itch threshold, it is advisable to avoid irritants such as wool or synthetics next to the skin, as these may stimulate
itching. Similarly, it is worthwhile considering cuffs on pyjamas or mittens to restrain such children from sub-consciously scratching while they are asleep, further damaging their already easily-irritated skin.
Expensive skin testing with regard to various potential allergens is quite useless for these individuals. Because of their extremely sensitive skin, due to their increased IgE levels, they will exhibit positive reactions to most substances on which they are tested. Such tests, then, have absolutely no bearing on their eczema whatsoever. This type of testing may be useful in elucidating a cause for asthma or hay fever, but not for eczema. Interestingly these children are certainly more prone to irritant types of contact dermatitis, but no more prone than normal individuals to a true allergic contact dermatitis.
The overall management of atopic eczema requires time to explain the disease to the parents, time to discuss the particular case and the various factors involved in treatment. This requires patience on the part of the doctor as well as the family. In particular, the treatment may involve manipulation of the environment, the application of creams to the skin, the taking of various oral medications and, to a very limited extent, 'allergic' treatment or psychotherapy. The condition does not have one single magical cure but can be most adequately controlled with the cooperation (and this includes the active participation) of the patient and family.
Specific applications which will reduce itching and aid the healing of the skin include various bland emollients such as aqueous cream or emulsifying ointment, and extends to various tar-based creams or ointments, which have a similar effect to some cortisone preparations. It is important to remember that, where possible, the less strong cortisone preparations, such as Hydrocortisone cream, should be used in preference to the stronger fluorinated creams such as Betnovate, Synalar, etc.
Oral medication such as various anti-histamines tends to reduce the intensity of the itch and lessen the tendency to scratch. It also may have a sedative effect, and so be useful at night to help the child sleep better, scratch less, and consequently damage the skin less. Oral cortisone should always be avoided unless absolutely essential.
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