Dr Preeya’s First 5: Dermatitis/Eczema

  1. Dermatitis/atopic dermatitis/eczema (all the same condition) is the red itchy rash people develop due to the immune system being heightened. Dermatitis typically occurs in the elbow and knee creases. In children it also commonly involves the face.

 

  1. You are at increased risk of dermatitis if you have a family history of allergic conditions or a personal history. We call it “atopy” in the medical world – the triad of hay fever, asthma and dermatitis are known as atopic conditions. To break it down and give it some context – my husband I both have a history of asthma and hay fever. This makes our daughter extremely high risk for atopic/allergic conditions; she is automatically higher risk for dermatitis and even asthma. So, when you come in with a red itchy rash –taking a good family history is key to diagnosis!

 

  1. Management of dermatitis varies according to the patient and severity of the disease. But these are the simple skin care rules all patients with dermatitis should follow:
    1. DON’T use soap to bathe – this is a big rule lots of people break. Soap is drying to the skin and dry skin is more likely to flare. Soap free washes are crucial and there are many suitable ones available. For kids – bubble bath is a big no no!
    2. DO moisturise skin religiously and regularly – I cannot harp on about this enough. Most of my patients eventually manage their dermatitis with regular moisturising and we end up using fewer steroid creams overall! The KEY to dermatitis management is giving the skin moisturise – I explain to patients that moisturising makes “on edge” dermatitis skin a bit calmer. And on that note – pick the right one. You need high oil, low water moisturisers – Sorbolene cream for instance is high in water and can actually make dry skin and hence, dermatitis worse. There are lots of suitable brands (like QV or Cetaphil – we use both in our house) available in pharmacies. For kids with dermatitis I suggest parents apply moisturiser at every nappy change ideally!
    3. DO NOT vigorously rub the skin after bathing – rather pat it dry to avoid aggravating the skin further
    4. DO NOT scratch – easy to say, hard to do! The more you scratch – the higher the risk of permanent scarring and infection.

 

  1. Steroid creams are commonly used to treat dermatitis flares – we make choices (ointment versus cream, strength of steroid, duration of therapy) based on the severity of the flare and the location (some areas are more sensitive than others). If you take ONE thing from this – steroid creams are for SHORT TERM use; we use the steroid to get the flare under control. The steroid tells the skin to calm down, chill out, relax a little. Once the redness and itchiness have settled we STOP the steroid and manage the skin with the stuff in point 3 (no soap, moisturising like a crazy person etc). Long term steroid cream use has significant consequences – it can thin the skin and superficial blood vessels near the skin surface can become more prominent. So never self-treat with steroids, never use them for longer than advised! For patients with severe dermatitis there are other immune therapies available; we involve a dermatologist for these.

 

  1. Can you prevent your child developing dermatitis if they are high risk? (ie. You or your partner have one or many of the 3 of the allergic conditions I mentioned earlier). The answer is YES! There is evidence that in kids who are high risk of dermatitis due to family history daily application of the right moisturiser (as I mentioned above) as soon as possible after birth may reduce the risk of dermatitis developing or delay its onset. This is something we have done with our daughter from day 1 – and so far, so good (I say this with fingers and toes crossed!).