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Ask Dr. Sears: Eczema Questions

Q  Both of my children have eczema. I have tried everything my doctor recommends, but they still get bad flare-ups. Can it be something in their diet? What else can I do?
A Eczema is a patchy, scaly, intensely itchy skin condition that is either inherited or caused by an allergy. Eczema usually occurs in square-inch patches on the cheeks, arms, inside the elbows, and behind the knees. Because the area itches so much, the child scratches, which causes more irritation, which in turn causes more itching. Over time, this itch-scratch cycle thickens the skin and in some cases the protective layer of outer skin breaks down and becomes infected.

First, try to figure out whether your children's eczema is caused by allergies. The most common eczema-producing allergens are soaps, detergents, fabrics (especially wool), fabric softeners, carpets, and foods such as eggs, dairy, or wheat. Stress may also trigger eczema, so any measures that make your children's environment less stressful should help relieve the eczema.

Next, relieve the itching. Dress your children in cotton clothing and use cotton sheets. Wash new clothes before wearing them. Keep fingernails short to minimize scratching and infection. Keep the skin moist, as moist skin itches less. Avoid excessive use of soap, which dries the skin. If soap is necessary, use creamy, emollient types of soap (Neutrogena, Dove, or Cetaphil). You can also try emollient lotions to help soften the skin. Use a vaporizer or humidifier during the dry months of central heating. Don't let your child soak more than a few minutes in soapy water, which dries the skin. Yet soaking in soap-free lukewarm water allows the water to soak into the skin. Pat the skin dry; don't rub it - that irritates sensitive skin.

During eczema flare-ups give your child an antihistamine recommended by your doctor before bedtime. This not only relieves your children's itching but helps them sleep. Cortisone creams help the inflammation and itching caused by eczema, but it's important that you use them only as directed by a physician, and only when the eczema is severe and not helped by the above home remedies. Use only for the duration of time prescribed by your physician. Using cortisone creams that are too strong for too long can weaken the skin. Your doctor will recommend a mild cortisone cream when the eczema is mild and a stronger cortisone cream when the skin condition is severe. Also, milder cortisone creams are reserved for eczema on sensitive areas such as the face. Stronger cortisone creams can be used on areas such as the arms and legs.

Above is the standard treatment regimen for eczema, yet new insights into this common skin condition suggest that eczema should be treated both from the inside and outside. Here's the inside treatment, which means feeding the skin properly to keep it healthy and lessen the irritation. First, hydrate the skin. Encourage your children to drink at least three extra glasses of water a day. Hydrated skin itches less. Next, healthy skin needs to be rich in healthy oils, and the diets of most children are deficient in omega-3 fats that promote healthy skin. The best skin oils are fish (especially coldwater fish, such as salmon and tuna) and flax oil (available in the refrigerated section of nutrition stores). Over the past few years I have seen dramatic results in my little patients with eczema after prescribing them a tablespoon of flax oil daily added to a smoothie made with fresh fruit and yogurt, in addition to four ounces of salmon or tuna three times a week. Finally, zinc is another skin-friendly nutrient. Give your child a daily multi-mineral supplement that contains 5 to 10 milligrams of zinc. Many cereals are fortified with zinc. Feed your children these skin-friendly foods and you should notice an improvement in their eczema.

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