Tag Archives: eczema

Eczema: A Parent’s Guide (Pedcast)


Transcript:

Welcome to this edition of DocSmo.com. Hope you are having a great day. Thanks for joining me today. I am your host, Dr Paul Smolen, a general pediatrician with 30 years of experience caring for both sick and well children. I’ve learned a few things during that time and I want to share that knowledge with you.  As I like to say, from the crib to the country club, from the bassinette to the board room and everything in between… that’s what we talk about on DocSmo.com. Today’s cast very important because we are going to learn about a common skin condition, in fact, the most common skin condition in children-eczema. In today’s pedcast, I hope to give you a fundamental understanding of what is going on in the skin of a child with eczema. We have all heard that word, eczema, but do you understand what exactly it is?  I hope after listening today, that you will.  Before we get started today, let me remind my listeners, that I am probably not your child’s doctor and what you hear on this podcast is intended to supplement your child’s regular healthcare.  For specific advise about your child’s health, visit the wonderful person you call your pediatrician.

 

 

You remember from biology class that your skin is made of two layers, the deep part called dermis and surface called epidermis. You may recall that the surface epidermal layer is made mostly of dead cells, which serve to protect the deeper part of our skin, the dermis.   The dermis is where we find the working part of our skin, the sweat and oil glands, the hair follicles, as well as the nerves in our skin.  Babies have two layers as well but their epidermis is thinner and more fragile when they are young. That’s probably why their skin is soooo soft! Soft is great but your babies skin is supposed to be a barrier to the outside world and when it is broken, there are bound to be problems. Thin epidermis can mean easily damaged and cracked.  Bad. Think of your child’s epidermal skin as the shingles on your roof.  If the shingles are cracked or loose, the roof is going to leak. The same is true with your child’s skin; if the epidermal barrier isn’t intact it is not going to work well.  Without an intact barrier (shingles so to speak) your child’s skin will let in irritants that it was not meant to touch and the deeper parts of your child’s skin doesn’t like touching the outside world and will react by turning red and angry…. Itchy red angry skin means the dermis isn’t happy.  In  a  nutshell,  that  is  what  we  call  eczema.

 

 

 

Now that you know what is happening in the skin in a child with eczema, let’s talk about the essential dos and don’ts in skin care for a child with this condition. First the don’ts

Try not to remove oil from their skin by:

Don’t over bathe: Limit bathing.  I suggest twice weekly for young babies.

Don’t use hot water: Try not using hot water when bathing as this may remove oils your baby’s skin really needs.

Don’t use much soap-Try using very little soap for the same reason.  When you do use soap, don’t put the soap in the bath water. Just use a little on the washcloth and only use it on the areas that need it.

If your child is infection prone, many dermatologists recommend using “Clorox” in the bath to kill some of the nasty skin bacteria that can infect the broken skin of eczema. Many experts recommend ½ cup per full bathtub no more than twice weekly. Check out the references in the Smo notes if you don’t believe me or ask your child’s pediatrician but…. take care to follow the directions carefully.

 

I also want you to limit your child’s exposure to irritants:

Limit Laundry products- I do not recommend you use dryer sheets or softeners. Now, I don’t do much laundry but I hear that baking soda in the wash cycle is a good softener.

Make sure the detergent you choose is perfume and dye free.

Avoid irritating fabrics like wool from touching your child’s skin.

Remember that if you wear perfume or wool clothing, your baby is probably going to get a good dose of it when you carry them around so be careful to keep a cloth on your shoulder when this is going on.

Avoid vigorous rubbing during bathing.  Only use a soft cloth.

Avoid alloy metals- snaps, earrings, jewelry

Avoid skin products with chemicals, especially perfumes

Avoid touching grass or other things that  you find trigger trouble

If you find a food that starts the whole inflamed skin process, avoid it!

 

 

If you do have a child with sensitive skin, here are some of the things that you want to do to help keep their skin in good condition. Hydrate the skin. Moisturize quickly after bath as well as at other times.  Use the thickest moisturizer you can that has no perfumes.  Petroleum jelly may work for your child.

Try reminding yourself to moisturize by associating the moisturizing with other activities such as diapering and bathing.  The more the better.  We are talking at least 4 times a day.  Remember, those shingles are cracked and need repair. Suppress eczema that is inflamed. Watch for signs of infection

Pustules, blisters, oozing mean it’s time to seek help from your child’s doctor.

 

6.

-Let me sum up today’s podcast with one of those DocSmo pearls that I love: “Modern children’s skin probably needs less exposure to modern life.”  Let me repeat that;  “Modern children’s skin probably needs less exposure to modern life.”

Less bathing!

Less soap!

Less hot water bathing!

Less exposure to chemicals and perfumes of all sorts!

7.

 

That wraps up another edition of DocSmo.com

I told you were going to be smarter after this podcast.

If you enjoyed today’s talk, go ahead and check out the extensive DocSmo library of pediatric topics

Share any thoughts you have with us by sending a comment to our blog at www.DocSmo.com.  We would love to hear from you.

This is your resident pediatrician, Dr. Paul Smolen, broadcasting from studio 1E in Charlotte, NC hoping you have all the facts about your child’s skin cracks

 

Until next time

 

Smo Notes:

 

  1. Doc Smo podcast with Dr Primmer on Eczema: https://www.docsmo.com/wp-admin/post.php?post=1018&action=edit

 

  1. Clorox formula for bathing :

 

http://aapgrandrounds.aappublications.org/content/21/1/3.full.pdf

http://www.mayoclinic.com/health/eczema-bleach-bath/AN02003

 

 

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Probiotics Update with Dr. Sheila Kilbane (Pedcast)

The “Let’s Talk Kids” podcast is fortunate to have as our returning guest, Dr. Shelia Kilbane who is an expert in integrative medicine.  She focuses her expertise in this Pedcast on teaching us about the role of  microbial life in maintaining your children’s good health.  You don’t want to miss her perspective on the topic of probiotics. As always, Dr Kilbane is informative, practical, and up to date.  Join us won’t you.

 

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SmoNotes:

1.    Weizman Z, et al.  Pediatrics (2005)115:5-9.

2.    Isolauri E, Arvola T, Sutas Y, et al.  Probiotics in the management of atopic eczema.  Clin Exp Allergy (2000);30:1604-10.

3.     Isolauri E, Juntunen M, Rautanen T, Sillanaukee P,Koivula T.  A human Lactobacillus strain (Lactobacillus casei sp strain GG) promotes recovery from acute diarrhea in children. (1991) Pediatrics 88:90-7.

4.     Kalliomaki M, Salminen S, Arvilommi H, et al.  Probiotics in primary prevention of atopic disease:  A randomized placebo-controlled trial.  Lancet (2001)357:1076-9

5.     Vanderhoof J, Young R.  Probiotics in Pediatrics.  Pediatrics (2002)109;5:956-8.

6.      Szajewska H, Mrukowicz J.  Probiotics in the Treatment and Prevention of Acute Infectious Diarrhea in Infants and Children:  A Systematic Review of Published Randomized, Double-Blind, Placebo-Controlled Trials.  J of Ped Gastroenerology and Nutrition (2001)33:S17-S25.

 
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From the desk of Doc Smo: Swimmer’s Ear Prevention 101 (Article)

If you have ever had it, you know Swimmer’s Ear hurts like crazy. However, most people have no idea what Swimmer’s Ear is and what causes it. Well, lets fix that right now. To understand the cause, we need to start by gaining an understanding of the architecture of the ear and how it is different than other places in the body. The ear canal is a dark tunnel lined with skin that is often very damp, especially in warmer weather. Water frequently gets in but gets trapped by the shape of the ear canal. Well, what happens to water anywhere it sits around without movement, especially when it’s at body temperature? You know it, yuk grows in it! This is especially true in your ear canal when you are in and out of water all day. Once the water enables fungus and bacteria to grow in the ear canal, it is easy to see how these microbes can infect the surrounding skin. Swelling occurs to the point that the ear canal can literally be shut, making things much worse. Oh man, that can hurt!
All of this leads to a tender ear, aching down the side of the neck, and a very miserable child. The children most prone to having bouts of Swimmer’s Ear are: those with eczema (lots of cracks in their skin), those who frequently use Q-tips, those who are in and out of water frequently (especially lake or ocean water), and those who go to bed with wet hair (yes, your mother was right on that one).

Once an outer ear infection gets started, it can be very difficult to control; prevention is the only game in town. Here is a simple way to prevent Swimmer’s Ear in your child, especially as they go off to camp and swim in lakes and rivers. First, buy a bottle of rubbing alcohol and pour half of it out. Fill the bottle back up with either white vinegar or apple vinegar. If you can get a bottle with a dropper on it, great. At the end of EVERY summer day, when no more water is going to get into your child’s ear (usually bedtime), put a few drops of the alcohol/vinegar mixture in their ears and rub it around. Dry the excess with a towel. The combination of the alcohol and acidic vinegar make a very hostile place for germs, and they simply don’t grow. Without the bacteria and fungus in abundance, the cracks don’t get infected. Make sure their hair is dry, and put those little puppies to bed. If you are religious about this, most children won’t be suffering from Swimmer’s Ear this summer. Miss a day or two and all bets are off. If they go to camp, figure out how to make this happen there. It is worth the effort.

What is the “Fever” in Hay Fever? Q and A with “Simon” (Laura Nelle Parnell) (Pedcast)

It’s finally spring time and the earth is exploding with life. With all of the flowers, lush vegetation, and beautiful weather, however, comes something unpleasant — hay fever. In this pedcast, Doc Smo tries to improve your understanding of the concept of hay fever and allergies. Joined by his guest Simon (aka Laura-Nelle Parnell), Doc Smo answers questions about allergies and how your children’s bodies interact with their environment.

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What’s Up with all the Children with Allergies? (Pedcast)

The news is full of articles about allergy in children.  What is happening?  Is allergy more common today and why? In today’s pedcast, Dr. Smolen gives you some of his and other physician’s thoughts on the increasing frequency of allergy in today’s world.

 

:

 

To my new listeners, thank you.

To my seasoned listeners, welcome back.

 

I was reading the Wall Street Journal of all place and having coffee with the Mrs..

I came across a report about an article in New England Medical Journal, which points out that farm life exposes children to far more microbes and this early exposure significantly reduces a child’s chance of asthma or eczema.

This observation is a big help to researchers since they are struggling to explain the obvious increase incidence of all allergic disorders, especially in children.

The subject of allergy is a hot, hot issue in medicine and one of the important questions when it comes to children’s health: why so much allergic disease???

I am not an allergist but I am someone who deals with matters of children’s health on a daily basis and I have the perspective of time to observe changes.

I therefore feel that I may have something to contribute to the discussion.

I thought it is important to make parents aware of some research that might have practical implications to their day-to-day lives.

So, lets get started with a our discussion of allergy. Let’s review some research I found interesting, and give you The DocSmo view of the allergy epidemic of the 20th and 21st centuries in the western world.

 

Somehow our bodies know what is us, and what is foreign.

Somehow our bodies figure out how to sort out what foreign things to react to and which to ignore.

Reacting to germs is an essential part of that process.  Particularly important for children.

A strong immune system is paramount to a child’s existence.  Their very survival depends on a functioning immune response.

From the beginning of mankind, the children who survived were those who could mount a targeted, brisk immune response to invasion.  A strong and targeted immune function was essential to survival.

Fast forward to modern times, when immunizations, clean water and food etc. have eliminated most of these threats to survival.

Today most children grow up in a very clean world, very different from his or her parents just a few generations ago.

Just because the germs are mostly gone doesn’t mean their bodies have forgotten what to do!  Could the kid’s immune system simply be bored?

Maybe since children don’t have to defend against as many microbes, they are having responses to more minor irritants.

 

What we call allergy is an inappropriate immune responses to things that children should be tolerant!

These immune responses are so critical to a child’s survival 200 years ago, but are now targeting nonsense threats like peanuts and grass pollen.

 

With that as background, let’s look at the numbers when it comes to allergic diseases…food allergy,. Asthma, eczema, and allergic rhinitis (hay fever)  ESTIMATES vary widely.

Food allergy… up 400%

 

Asthma… up 1000%

Eczema ….up 300%

Hay fever …up 200 %

 

I was taught that these disorders are genetic, Either you get them or you don’t.

Certainly our genes haven’t changed radically in the past 100 years.

What is up?  Why is this happening?

Here are a few recent research studies that might shed some light on this question.

 

 

Lets go back in time a few decades when the Berlin wall in Germany was built.

One side Germans living the Western lifestyle, modern, wealthy, clean, artificial ventilation for both heat and cold, and all the other stuff that we enjoy today.

On the communist side were Germans living the lifestyle that existed in the late 19th century: dirty industry, primitive heating systems such as burning coal or wood, dirty air and water, and fairly ubiquitous poverty.

Fast-forward until the year 1989.  The wall comes down Mr. Gorbachov, tear this wall down.  Well, the people on both sides did just that.

Perfect natural experiment to look at the affect of environment on people.   Same genetic populations, living side-by-side…totally different environments.

What did researches find?  Rates of allergic disease (asthma, hay fever, eczema) were much higher on the clean side of the wall rather than the dirty.  The OPPOSITE of what you would have expected!  Maybe the West Germans were TOO clean.

 

Lets get back to that NEJM article this week. Children who are exposed to barns at an earlier age and more frequently have a significantly LOWER incidence of Asthma and eczema.

What’s going on in a barn: dirt, animal wastes and a lot of pollen, especially grass pollen.

Being exposed to dirt and germs , especially at a young age, seems to be protective when it comes to allergies.

The opposite of what was expected.

Again, maybe the city kids are too clean?

 

These observations and many others have led to what is called the Hygiene Hypothesis. A child’s immune responses and tolerance to the world are altered negatively by lack of exposure to dirt and germs early in life.

Could it be that western children are growing up in a world that is TOO clean and this is causing the rather precipitous rise in allergic disease seen especially in the past 50 years.

Maybe we are creating the problem of allergy by staying inside with artificial heat and cold so much, eating super clean water and food, sleeping on clean artificial bedding , constantly scrubbing dirt off as fast as it touches our children, our obsession with clean hands, not living with animals, and changing the natural grasses, trees and other vegetation in our constant quest to change the natural order around us.

Makes sense to me that if allergy shots can alter immune response and make us tolerant. So could natural exposure.

The answers are not in yet but we are beginning to get an understanding of the complexity of our immune system .

Stay tuned!

Question coming in;

 

Question:  Doc Smo, This is your friend Her Dieter from Germany. I have a question.  If I am hearing you right, you are saying that my little venarschnitzels are too clean, and that they need more time getting exposed to microbes, especially the kind found outside.  Is that right?

 

You got it.  Lot less allergic disease in those children who slop them pigs, shuck some corn, and spend time on the old farm.  The same is probably true for any child who spends a lot of time outside.

 

Question:  How do the experts feel about dogs and cats in the house.  Do they help or hurt allergic children?

 

Good question.  From my reading the answer is both.  Exposure to furry creatures like dogs and cats in the house in the first year of life seems to diminish the chance that a child will develop asthma.  On the other hand, exposure to animals such as dogs and cats in older, already allergic children often makes their allergic symptoms much worse.   I know that answer is as clear as mud but that’s the best I have.

 

Question:  Is the same thing true for food allergy?  I thought early exposure was bad! Is there a way to keep my little snitzels from being allergic to certain food?

 

That is a subject for an entirely different Pedcast but let’s just say that avoiding early exposure to very allergenic foods have not reduce the incidence of food allergy.

The truth is, We just don’t know the best age to introduce allergenic foods

We do know that breastfeeding reduces allergic disease especially eczema

(In fact, in another natural experiment with peanut exposure…conclusion was early exposure is preferable!)

 

Summary- “When it comes to Allergy”

Early experiences change the way our immune system develops.

New research indicates that early exposure to a variety and high quantity of germs lessens the chance of allergic disease, if the exposure is done early!

-Growing up in a too clean environment may harm a child’s health.

Her are some steps parents can take that might help reduce allergic disease in their children.

Breastfeeding as long as possible.

Get your children outside as often as you can.

Turn of the A/C and heat whenever possible and open those windows.

Hand hygiene is really important when your children are spending lots of indoor time with other kids but not when they are at the park. Outdoor dirt won’t hurt.  Calm down about outside dirt.

When it comes to allergy, furry pets in the house seem to be harmful to older already allergic children but may, and I emphasis may actually be of benefit to very young non-allergic children.

Allergies are probably similar to other biologic phenomena—a complex interaction of genetics and environment.  Back to that nature /nuture question-again

 

Hope you enjoyed that discussion

Please feel free to make comments on iTunes or Face book are welcome

Invite your friends to subscribe.

If you are a medical professional and would like to send comments-highlight on blog

More reading can be found in SmoNotes

 

Dr Paul Smolen, broadcasting from studio 1 E, Queen City, Charlotte, NC

Hoping your children get just the right amount of dirt on their toes and pollen in their nose

 

 

Until next time.

SmoNotes:

1.

NICOLAI, T.. “Epidemiology of Pollution-induced Airway Disease: Urban/rural Differences in East and West Germany.”
Allergy : European Journal of Allergy and Clinical Immunology 52.38 (1997): 26-29. Web. 10 Mar. 2011.
<http://onlinelibrary.wiley.com/doi/10.1111/j.1398-9995.1997.tb04866.x/abstract>.

2.

Ring, J. et al “Environmental Risk Factors for Respiratory and Skin Atopy: Results from Epidemiological Studies in Former East and West Germany.” International Archives of Allergy and Immunology 118.2-4 (1999): 403-407. Web. 10 Mar. 2011. <

3.

Bacharier, Leonard B., and Robert C. Strunk “Pets and Childhood Asthma—How Should the Pediatrician Respond to New Information That Pets May Prevent Asthma?” Official Journal of the American Academy of Pediatrics 112.4 (2003): 974-976. Web. 10 Mar. 2011. <http://pediatrics.aappublications.org/cgi/content/full/112/4/974>.

4.

Wang, Shirley S. “Greater Germ Exposure Cuts Asthma Risk.” Wall Street Journal 23 Feb. 2011: 1A. Web. 10 Mar. 2011 <

5.

Greer, Frank R., Scott H. Sicherer, and Wesley Burks “Effects of Early Nutritional Interventions on the Development of Atopic Disease in Infants and Children: The Role of Maternal Dietary Restriction, Breastfeeding, Timing of Introduction of Complementary Foods, and Hydrolyzed Formulas.” American Academy of Pediatrics 121.1 (2008): 183-191. Web. 10 Mar. 2011. <

6.

Toit, G. et al “Different Prevalence of Peanut Allergy in Children in Israel and UK Is Not due to Differences in Atopy.” Allergy and Clinical Immunology 117.2 (2006): S33. Web. 10 Mar. 2011. <http://www.jacionline.org/article/S0091-6749(05)02857-5/fulltext>.

7.

Ege, Markus J. et al “Exposure to Environmental Microorganisms and Childhood Asthma.” New England Journal of Medicine364.1 (2011): 701-709. Web. 10 Mar. 2011. <http://www.nejm.org/doi/full/10.1056/NEJMoa1007302>.

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Dermatologist Dr Susan Primmer answers must know questions about Eczema in children (Pedcast)

Dr Susan Primmer returns to answer questions about a very common childhood skin condition known as eczema.  Get the latest information from a doctor who is both a pediatrician and a dermatologist.  How cool is that!

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