ECZEMA -- MANAGEMENT AND HELPFUL HINTS
Adapted from Royal Children’s Hospital ‘Knowing Your Child’s Eczema’
www.rch.org.au/derm/eczema.cfm?doc_id=4596
There are two important aspects of management of eczema:
(1) Prevention of eczema flare-ups by the avoidance of precipitating and aggravating factors, such as dry skin, heat and irritation.
(2) Treatment of dry skin and eczema using ointments, moisturisers and other treatments.
(1) ENVIRONMENTAL IRRITANTS TO AVOID
HEAT
Turn off heating to the bedroom. Open bedroom window.
Aim for a house temperature or 18 degrees in the day and 15 degrees overnight.
Summer pyjamas all year, eg cool cotton one piece.
No doonas – cotton sheets and one hospital blanket only.
Avoid plastic bed protectors. Use towels under the sheets to protect mattress from wet dressings, and air the mattress regularly.
No sleeping with parents as the child will overheat.
No water beds or electric blankets.
1-2 layers of loose cotton clothing only.
Avoid long car trips. In car, dress in cool clothes and take cool compresses, moisturisers etc with you.
PRICKLE AND OTHER IRRITANTS
Avoid all wool and other prickly garments.
Wear loose cotton clothing. Check for irritating seams, labels. If necessary, turn garment inside out.
Keep hair short or tied back.
Avoid sandpits, dirt, grass.
Avoid soaps, shampoo, bubble bath, detergents.
Citrus fruits and milk on the skin can be irritating.
Dummy sucking can encourage dribbling and eczema of the face.
(Protect the skin around the mouth with Dermeze or QV Kids Balm.)
Teething.
Immunisation.
SWIMMING - don't swim during a flare-up. Apply moisturizer (cream not ointment) prior to swimming. Wash child carefully and apply moisturiser immediately after.
ACTIONS TO DECREASE SCRATCHING
Wet dressings, cool compresses, cool moisturiser.
Short nails.
Splints, mittens.
Use distraction, positive reinforcement for non-scratching behaviour; avoid telling the child to stop scratching.
Ignore scratching aimed at getting attention.
If child's sleep is disturbed, it may be appropriate to use Vallergan/Phenergan at night.
(2) TREATMENT OF DRY SKIN AND ECZEMA
ALL PEOPLE WITH ECZEMA HAVE DRY SKIN AS THEIR MAJOR UNDERLYING SKIN PROBLEM. SUCCESSFUL MANAGEMENT OF DRY SKIN IS CRUCIAL TO KEEPING ECZEMA UNDER CONTROL.
BATH
A daily bath reduces the risk of skin infection, and will not aggravate dryness if the following instructions are followed.
Have a daily cool pleasurable bath (not more than 29 degrees), at least 2 hours prior to bed.
Always put a capful of bath oil in the water (eg. QV, Hamilton's, Dermaveen Bath Oil).
Anti slip mats or adhesives in the bath will help prevent slipping in the oily water.
Do not use soap, shampoo, bubble bath, shower gels or additives like Pinetarsol.
Use sorbolene (eg in a pump pack), emusifying ointment, soap substitutes (eg Cetaphil) or similar to wash dirty areas. Also QV,Hamilton’s Dermaveen soap free washes.
Apply oil to the scalp as needed, and wash hair infrequently with mild shampoo.
Hamilton’s, Dermaveen make a soap free shampoo.
If recurrent infection is a problem, consider using Oilatum Plus antiseptic bath oil.
AFTER BATH
Liberally cover the whole body with moisturiser immediately after patting dry (within 3 minutes).
MOISTURISING
Best done from head to toe 2-5 times daily.
In hot weather, keep in the fridge to give immediate cooling relief.
For daytime use, try QV Cream or Cetaphil Cream (in a jar).
For night use, try QV Kids Balm, Dermeze or Dermaveen Eczema Ointment.
Ointments are best on the face and limbs, and Creams on the trunk.
Ointments are good for dummy rash, thumb sucking rash.
To avoid contaminating the jar, use a clean knife or spatula to take required cream and place on a paper towel before applying with cleaned hands.
If creams sting, try an ointment.
Moisturisers can be applied over steroid or tar creams.
Involve even young children in their own moisturiser routine.
CORTISONE CREAMS
Cortisone is a natural body hormone active in reducing inflammation. If used carefully it is completely safe. Use in reddened, itchy, even broken skin, and reduce usage as redness and inflammation settle.
In dry skin conditions, an ointment or oily base is most effective.
If the eczema is weeping, a cream base may be better.
Examples of steroid creams are:
Weak Hydrocortisone 1% eg Egocort, Sigmacort, Squibb HC.
Useful on the face and around the eyes, and in groin/nappy area.
Strong Elocon, Advantan, Diprosone.
Applied nightly. (Advantan Fatty Ointment is particularly useful)
WET DRESSINGS AND COOL COMPRESSES
Wet dressings and cool compresses reduce heat and itch and greatly improve dryness and inflammation. They also reduce infection by cleansing skin and removing crusts. Use them frequently, even to settle mild flares of eczema. Use to settle the early flushing stage of a flare-up.
They can be used once daily or continuously, depending on severity.
For detailed instructions, Royal Children’s Hospital Website – poster and video.
INFECTION
If you notice weeping, crusted or thickened areas, often associated with general flaring of the eczema, there may be an element of infection.
Antibiotics may be required, so seek a medical opinion.
Infections can be painful, paracetamol may be required.
Regularly remove the crusts by applying a cool wet compress and firmly wiping. Steroid creams and moisturisers can be reapplied once the weeping and crusts have settled.
To reduce incidence of infection, use Oilatum Plus bath oil daily in the bath, (but not in wet dressings.)
TAR CREAMS
If the eczema is particularly thickened from scratching, or is discoid, it may improve with tar cream, eg Hamilton's Eczema Cream. This can be applied once or twice a day, and can be used under the wet dressing. You should apply moisturiser over the top. It should not be applied to the face or the folds, and not used in children under 1 year.
NAPKIN DERMATITIS
Use disposable nappies.
Wash with olive oil on a dry disposable towel.
Apply 10% olive oil in zinc paste.
If required, use 1% hydrocortisone, mixed with Canesten/Clonea if thrush/candida suspected.
DIET
Simple measures include avoidance of artificial colourings, preservatives, shellfish, oranges, tomatoes and eggs as these will non-specifically flare eczema.
Children with persistent eczema despite good general eczema management may require assessment by an allergist and dietician.
HANDY HINTS
All creams, disposable towels, oils, bandages and splints can be purchased at cost price from the EQUIPMENT DISTRIBUTION CENTRE at the Royal Children's Hospital. You can order by phone and pay by credit card, and the goods will be delivered for a delivery fee.
Splints are made from canvas and Velcro, and are designed to allow the young child to move their arms, but not to be able to bend their elbows in order to scratch. They are particularly useful in children under 3 with facial eczema. You need to measure the child from the bottom of the deltoid shoulder muscle to the wrist.
If the creams are STAINING your clothes/linen, try soaking in Sards Soaker, or adding a cup of bicarb to the washing machine.
SUNSCREEN should be applied before moisturisers, or it may not be effective. Recommended brands are Ego Sunsense, and Hamilton's Quadblock.
MOLLUSCUM CONTAGIOSUM
Often occur in children with eczema, and can worsen eczema.
Choose 6 to treat. Apply a small square of Elastoplast to each after the bath. Remove before the next bath and reapply after. Keep going until the molluscum become reddened. If they don't disappear, but return to normal colour, repeat the process.
If resistant, try 5% Benzac gel dabbed onto the molluscum, and then covered with Elastoplast.