Parenting a child with a chronic skin condition like eczema is no cakewalk. Fortunately, there are things you can do to help your child feel more comfortable and happy in his or her skin. Dr. Robert Sidbury answered questions about the latest treatments and offered skincare tips for children of all ages in a recent NEA webinar. Please note that portions of this Q&A have been edited for clarity and brevity.
My son has been diagnosed with eczema on his hands. They are red, raw, rough, cracked and bleeding, but no itching. Does eczema always itch or could it be something else?
The absence of itch would make me entertain other possibilities. But you can have certain areas that are such thick skin areas; they may not itch as much, and yet it may still be part of an eczematous process. If they are washing their hands frequently at school, I would want them to moisturize afterwards or else it’s going to drive the eczematous process no matter what it is. Vaseline under cotton gloves at night can help drive that moisture in.
You mentioned redness as a sign of inflammation and irritation, but for children with darker skin tones, it may not be as easy to see that. Do you have recommendations for what to look for in those cases?
We don’t think of inflammation as a color, do we? We think of inflammation as a state. It is redness. But it’s also swelling. It’s also warmth. And in the case of eczema, it’s also itch. One of the important variants of atopic dermatitis that we’ll often see in patients with darker skin types is a so-called follicular eczema, which has the look of perma-goosebumps. The skin looks like the hairs are standing on end, but that’s actually inflammation—and that’s eczema. So I would look for that follicular pattern to be a clue.
Will swimming in the ocean or saltwater pools make eczema better or worse?
In some cases, yes. In others, no. When I will actually use it is when I have a child whose skin is so open and so broken down that they can’t get into the bath because it stings. Sometimes you can put a little salt into the bath, mix it around and get it nice and dilute. Then the water actually stings less. So in that sense, it is beneficial to use salt. Epsom salts are fine. Table salts will do. See how a tablespoon of salt feels and work your way up. But to say whether saltwater is inherently good or bad for eczema is no more appropriate than to say whether a bath is inherently good or bad.
Can or should you apply moisturizer after a baby has been drooling or after a child is hot, sweaty and dirty from playing in the park?
Starting with the drooling baby, you can take a little coat of Vaseline and moisturize the area before the meal, and it can act as a barrier. Then at the end of the meal, you clean them up and apply another coat of Vaseline, and they’re good to go. If an 8-year-old comes off the playground covered in dirt, do you want to slather them in moisturizer? No, you don’t. But once they clean up, you absolutely do. And if they’re going to come in for a little bit, clean up and go back out, you probably wouldn’t want them rolling around in the dirt covered in Vaseline and having that stick to their skin.
On the topic of food sensitivities, what are some things parents can and should be looking at to help keep their child’s eczema under control?
Eczema is the ultimate feeling of lack of control for the sufferer because you itch and you don’t know why. It’s the ultimate feeling of lack of control for the parent because it breaks your heart to see them suffer and not be able to fix it. There’s a certain element of acceptance of the inability to control all aspects of eczema. That said, you want to do everything in your power to make things better. From a food standpoint, if there seems to be a relevant food trigger, eliminate it or have it assessed by an allergist. If the child wants to have more control by putting on their own moisturizer, let them do it. It’s important to pick your battles and act accordingly as long as they are safe, simple things that might help.
Dr. Robert Sidbury is associate professor in the department of pediatrics and chief of the division of dermatology at the University of Washington School of Medicine. He also is co-chair of NEA’s Scientific Advisory Board.