Getting under their skin

Living with eczema is hard work – for all members of the family

CANCER IS the only thing worse than eczema, according to children who were asked to grade their illness in terms of how it affected their everyday lives.

The study of children’s perceptions of heart disease, epilepsy, diabetes and other health problems is a stark reminder to non-sufferers of skin conditions how distressing life can be if you have red or scaly patches of skin throughout your body that can flare up and itch at any time day or night.

“Up to 15 per cent of Irish children suffer from eczema [also known as atopic dermatitis] and 90 per cent of these will have it by the age of five,” says Prof Alan Irvine of the dermatology clinic in Our Lady’s Hospital for Sick Children, Crumlin, Dublin.

Although not life-threatening in itself, the condition is associated with asthma, hay fever and food allergies throughout life. “It can have a big effect on family dynamics when children are scratching all the time and their sleep is disturbed,” says Irvine.

And although eczema will disappear in two out of three children by the age of seven, it can be re-activated by stress or infection later in life.

Due to the increase in numbers of identified sufferers of skin conditions, food allergies and asthma, these conditions are often dubbed the diseases of the 21st century. And with this comes a lot of discussion and debate about what causes them.

“There is a view that they are caused by urbanisation and then there is the hygiene hypothesis which I believe is over-simplistic,” says Irvine. Specific foods are the main trigger of eczema in about 10 per cent of cases.

Irvine says that eczema is caused by a multiple number of genetic and environmental factors and while there are ongoing international genetic studies into the particular genes responsible for the condition, the issue that concerns parents most is how best to manage it and, in doing so, help reduce the burden it brings to everyday family life.

Cathal (8) and Ciarán (6) Galvin have suffered from a severe form of eczema since they were babies. Their parents, Róisín and Micheál Galvin, have struggled to manage the condition as best they can while continuing work and family life with their three other children.

“People don’t understand the condition. They say that the children will grow out of it, but a child with severe eczema can rule the family. Sport is difficult and holidays are stressful because you can’t go to the seaside or swimming pools because we can’t expose them to salt, sand and sun,” says Róisín.

Although eczema is not contagious, its red, patchy look can result in children with the condition being bullied or side-lined socially. This can then affect their self- confidence and performance in class and requires sensitive classroom and yard management in schools.

Róisín describes in detail the daily management required for the condition. This includes regular moisturising of the boys’ skin and specific treatment creams (there is a range of steroid and atopic creams available) during flare-ups.

Antibiotics are required when the skin becomes infected, as is often the case for Cathal. The boys also have daily moisturising baths, wear cotton clothing and sleep in well-ventilated cool bedrooms.

Micheál is particularly keen to try out new treatment approaches and the Galvins recently travelled to a mineral water spa in France which specifically treats skin conditions.

While there, the boys received daily mineral water baths and showers as well as facial and scalp showers over a three-week period. They were also monitored by a dermatologist and given instructions on the correct use of moisturising and treatment creams.

Although the boys’ condition hasn’t been cured by the mineral water treatment, they benefited from the dedicated residential treatment regime.

“It was a lovely respite for us and the whole environment is very therapeutic,” says Róisín.

One of about 100 such hydrotherapy centres in France, Avène Les Bains is one of only two dedicated to skin conditions and the French government reimburse patients having treatment there. “It would be great to see a centre like that developed in Ireland,” says Micheál.

Some parents also opt for alternative or complementary treatments such as nutritional therapy (eg essential fatty acid supplements and probiotics), homeopathy or herbal medicine. However, the Irish Eczema Society advises parents to use only registered practitioners and to carefully check ingredients in any creams used.

Irvine says that each family with a child with eczema benefits from an individually tailored programme. “Most children respond well to treatment and the condition can be contained and the children can get back to normal life,” he says.

Some, however, will have a longer, more stressful journey than others. “There is no magic bullet. We have to sit down with each family and go through every aspect of care and then try specific things. Assessing each family’s needs is the art of medicine and that is required just as much as the objective view on the severity of the condition,” says Irvine.

SKIN DEEP: TIPS ON MANAGING ECZEMA:

• A good daily care regime is the key to managing eczema. This includes moisturising baths, application of moisturiser, treatment creams and ointments when required.

• Use cotton clothing and bed clothes.

• Use soap-free products for bathing and hair-washing.

• Keep skin cool and keep all rooms (particularly bedrooms) well ventilated.

• Use a non-biological washing powder and don't use fabric conditioners.

• Avoid the use of perfumes, cosmetics, heavy cleaning agents or chemical sprays and plug-ins in the home.

• Avoid processed foods.

• Consider adjusting your daily routines to avoid long car journeys or reduce the number of activities in the day, so that there is adequate time to relax and unwind.

The Irish Eczema Society has fact sheets on eczema with specific advice on different types of treatment creams and how to use them correctly. E-mail info@eczemaireland.org Tel: 01-8321250.