What We Learned About Managing Eczema

When we got back from the NEA conference, we wanted to put together what we learned to help in managing Jarrett’s eczema. Here are the main points we found useful for us, along with the things we have started to do differently to manage Jarrett’s eczema. We just want to share some of what we learned at the conference in the hope that someone else will find this helpful!

Three physical problems have to be combated to manage eczema:

1. Dryness

• It is believed that many eczema patients have low levels of filaggrin, a protein that holds cells in the epidermis together. Without a functioning skin barrier, the skin cannot hold onto water and allergens are easily absorbed into the skin.
• It’s important to keep the skin moisturized since moisturizers help to create a healthy skin barrier by keeping water in and allergens out. Of course, if the skin is exposed to allergens, putting a moisturizer on top will lock them in, exacerbating the itch.
• Ceramides and other fats/lipids appear to be helpful in rebuilding the skin barrier. Jarrett’s skin responds better to ointments after his baths, but we do use lotions during the day. He likes it so long as the lotion goes on his skin when he is not already itchy. When he’s itchy any lotion makes it worse unless we start all over, sticking him in the tub or at least washing him off with a cloth first.
• In addition to Jarrett’s baths, we have been using allergen-free wipes to clean and dampen his skin before applying lotion during the day, especially when he is hot/sweaty or around grass and other allergens. This seems to cut down on his itchiness during the day.
• When possible, we also have Jarrett take a bath during the day, especially if he has just been playing outside, sitting on carpet, or near cigarette smoke. Apparently there are high amounts of pet dander in carpets at public places (i.e., malls and airports), and being around cigarette smoke makes the skin more sensitive to allergens in the environment.

  2. Inflammation

• When skin is inflamed, filaggrin production is reduced. Barrier support then becomes even more important.
• Anti-inflammatory oils, such as sunflower seed oil or extra virgin coconut oil, applied to the skin after baths and before the ointment, provide better absorption. Jarrett’s skin gets noticeably softer and smoother after consistent applications.

   3. Infection

• Even if Jarrett is not getting infections, eliminating bacteria will help the eczema.
• Bleach baths are highly recommended by doctors to help eliminate bacteria. After the bath, skin should be rinsed off to remove the bleach.
• Some people think apple cider vinegar might have the same effect without the harshness of bleach. We started with the apple cider vinegar (we didn’t have the pure bleach), and we bought bleach a few days ago to have that ready for him.

Psychological aspects also need to be managed.

Jennifer LeBovidge, Ph.D., a psychologist at Boston Children’s Hospital who specializes in Pediatric Psychology, talked about the importance of children developing coping and self-regulation strategies. This will become more and more important for Jarrett as he gets older, since he will not always have people around to distract him from his itchiness. Based on the ideas and strategies Dr. LeBovidge shared, we have started to explain to Jarrett why his skin gets itchy and why it’s important for him to take care of his skin. he’s been asking a lot of questions and seems to understand why he needs to rinse/soak and moisturize his skin.

Dr. LeBovidge suggested teaching guided imagery techniques that kids can use when they feel stressed, tired, anxious, etc. We tried this on the plane home when he started scratching. We’re not sure how effective it will be for him at this age, but he played along and it became a sort of game.

Dr. LeBovidge suggested we come up with a secret signal that Jarrett can use with his school teacher, so he doesn’t have to call attention to himself if he needs to go to the nurse’s office because he feels an intense scratch attack coming or he wants to relax his body or use his wipes and moisturize. The teacher can also use the signal with Jarrett if s/he sees that he’s getting really itchy. Since Jarrett is the type who will keep saying he’s okay until the itch is unbearable, this might be a particularly good approach to use while he’s at school.

Rethink the role of food and environmental allergies

There was a lot of talk about food and environmental allergies. To sum it all up into one sentence, food allergies do not cause eczema. The hives that food allergies do cause are generally itchy and the increased itchiness often makes it appear that certain foods cause flare-ups. We are told these are two distinct conditions. One does not cause the other. In other words, eliminating certain foods will not make the eczema go away.

Allergy tests are not reliable when it comes to positive results (these results are just 50% accurate), but these can be helpful in eliminating allergies (negative results are more reliable).