the 'undervalued' impact of childhood eczema
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treating eczema often requires the use of creams, lotions, and other products that reduce inflammation and reintroduce much-needed moisture into the skin.
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roughly 15 to 20 per cent of canadians have some type of eczema. the condition is common in children under the age of five, with 10 to 15 per cent of all canadian children affected. many will grow out of it by the time they reach the age of two, but for the 40 per cent that don’t, dealing with the flare-ups of symptoms can be challenging and uncomfortable, especially as the seasons change.
dr. annie liu, a dermatologist with dermcafe, a virtual clinic geared toward offering reduced wait times for dermatological care for canadians, understands how difficult it can be to live with eczema at any age. but as an infant experiencing the telltale symptoms of itching, swelling, and cracked skin, the entire family suffers.
“it has an impact on the whole family because when a baby’s skin is uncomfortable, itchy, scratchy, rashy, even bleeding with infections, no one in the family sleeps,” she said.
the overarching impact of childhood eczema
dr. liu notes that the “impact is undervalued” when it comes to eczema that starts in infancy or childhood. it’s not simply about the painful and irritating symptoms experienced during a flare-up, which indicates active disease, but also how it can affect other areas of health, including growth and development.
recent studies have shown that having eczema as an infant or child is associated with shorter stature, as well as a higher bmi and lower weight in early childhood.
“certainly, their general wellbeing (is affected) because if you’re uncomfortable in your own skin, you won’t eat as you should,” said dr. liu. “you may not grow as you should, so definitely a lot of impact beyond just the child’s immediate days or weeks dealing with eczema.”
the symptoms can also interfere with getting adequate sleep, concentration, self-confidence, and mood in children and adolescents, all of which can affect a child’s life.
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for example, children with eczema are found to have higher rates of depression and anxiety, as well as other mental health problems.
up to 83 per cent of children experience sleep disturbances during eczema flare-ups as well, leading to:
- increased sensitivity to pain
- increased risk of infection
- cognitive impairment
- behavioural issues
“it really can have a significant impact, not only on the child’s life, not only during childhood but a lasting impact ongoing for many years into their adulthood,” said dr. liu.
eczema is also different in children based on its presentation. according to dr. liu, the classic areas typically affected are the elbows and the back of the knees. however, in children, it can present “all over the body.”
infants, especially, are also more at risk for developing impetiginized eczema, which occurs when bacteria infect the area, leading to an immune response that worsens symptoms.
prompt medical care is vital when a child develops impetiginized eczema because, according to dr. liu, the “bacterial infection can really spread and get deeper into the skin.”
“there are so many other potential complications. one of the biggest and most common ones is what’s called post-inflammatory hyperpigmentation,” she said. “that’s just a medical word, which means soft of leftover discolouration on the skin. so, even when the rash settles down, eventually there will be these discoloured patches, either dark coloured or light coloured, that persists sometimes for over six months and can be very alarming to parents and patients.”
she notes that it does fade over time but is entirely avoidable with the proper treatment.
weather-driven flare-ups
eczema is considered chronic, meaning that it will come and go. people living with eczema can experience periods without symptoms, and they will naturally return, called a flare-up. many things can drive eczema flare-ups in children, including:
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- irritants
- allergies
- skin infections
- scratching
- environmental changes, including air pollution and less biodiversity
weather and temperature changes also highly contribute to eczema flare-ups, with some research calling the disease “environmental” in nature.
“environmental conditions are a major trigger and cause of eczema,” said dr. liu. “you always hear about, ‘oh, is it food that’s causing it?’ not anywhere to the extent that it’s triggered or associated or caused by environmental conditions.”
dr. liu goes on to note that harsh environmental conditions, such as cold and dry weather, are incredibly irritating to the skin and can lead to painful and irritating flare-ups.
“as canadians, lucky canadians, we do see a lot more eczema around certain seasons. i would say beginning in even september all the way until april and may, basically when the months are colder, and the weather is harsher and drier,” she said.
the weather has a strong hold on eczema flare-ups because it can dry out the skin. when the skin doesn’t have enough moisture, it becomes a perfect breeding ground for eczema symptoms.
treating eczema in children
treating eczema often requires the use of creams, lotions, and other products that reduce inflammation and reintroduce much-needed moisture into the skin.
fortunately, as dr. liu puts it, “we’re in a really exciting time in eczema therapy.”
“there’s a lot of new medications on the horizon … that will really change the game.”
typically, topical steroids are the first-line therapy for eczema because they effectively reduce inflammation and symptoms. however, they come with various long-term side effects if used too often, including:
- skin thinning
- stretch marks
- easy bruising
- dilated blood vessels
- increased hair growth
- acne-like rashes, if used on the face
- rebound symptoms
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steroid withdrawal can also be an issue, which causes painful and burning skin to develop, alongside other symptoms, including a detachment of skin layers that show up as flaking, shedding, or peeling skin and redness.
while dr. liu notes that steroids are the mainstay because they “have a beneficial role to play,” the precautions people have to take may no longer be necessary with other forms of treatment.
“there’s a lot of what’s called steroid-sparing topicals … that have a similar ability to decrease inflammation in the skin,” she said, continuing, “but they work in different mechanisms to calm skin inflammation down, and they don’t have any of the same concerns of, like, skin thinning.”
she also notes that maintaining the skin barrier between flares is paramount, and alternative therapies can help.
“everyone with eczema, whether baby, child, or adult, should have a good skincare routine, which definitely includes a good moisturizer with soothing ingredients and a gentle cleanser,” she said. “those are a must because the moisturizer will literally help to repair the skin barrier.”
choosing the right type is crucial, too, because with eczema, the skin can be more sensitive to added ingredients in moisturizers.
“one product that i do use on my own baby is dove, just because their ingredients are tailored so well,” said dr. liu.
there are a lot of good products on the market geared toward infant and childhood eczema, but as dr. liu notes, it’s about the ingredients first and foremost. she advises parents to choose products that are “gentle and more natural, such as colloidal oatmeal,” because they help to decrease inflammation and provide hydration to the skin.
parents can also help their children with eczema by avoiding exfoliants, using a humidifier in their rooms, and seeking appropriate care from a dermatologist as soon as possible.
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“we’re experts in skin, and we’re here to help,” she said.
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