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How To Manage Atopic Eczema – An Itchy, Scaly Children’s Rash

Atopic eczema (atopic dermatitis) is the most common form of eczema, a condition that causes the skin to become itchy, red, dry and cracked.

Atopic eczema is more common in children, often developing before their first birthday. 

However, it may also develop for the first time in adults. It’s usually a long-term (chronic) condition, although it can improve significantly, or even clear completely, in some children as they get older.

Symptoms of atopic eczema

Atopic eczema causes the skin to become itchy, dry, cracked, sore and red. Some people only have small patches of dry skin, but others may experience widespread red, inflamed skin all over the body.

Although atopic eczema can affect any part of the body, it most often affects the hands, insides of the elbows, backs of the knees and the face and scalp in children.

People with atopic eczema usually have periods when symptoms are less noticeable, as well as periods when symptoms become more severe (flare-ups).

Read about the symptoms of atopic eczema

When to seek medical advice

See your GP (*physician) if you have symptoms of atopic eczema. They’ll usually be able to diagnose atopic eczema by looking at your skin and asking questions such as:

  • whether the rash is itchy and where it appears
  • when the symptoms first began
  • whether it comes and goes over time
  • whether there’s a history of atopic eczema in your family
  • whether you have any other conditions, such as allergies or asthma
  • whether something in your diet or lifestyle may be contributing to your symptoms

Typically, to be diagnosed with atopic eczema you should have had an itchy skin condition in the last 12 months and three or more of the following:

  • visibly irritated red skin in the creases of your skin – such as the insides of your elbows or behind your knees (or on the cheeks, outsides of elbows, or fronts of the knees in children aged 18 months or under) at the time of examination by a health professional
  • a history of skin irritation occurring in the same areas mentioned above
  • generally dry skin in the last 12 months
  • a history of asthma or hay fever – children under four must have an immediate relative, such as a parent, brother or sister, who has one of these conditions
  • the condition started before the age of two (this does not apply to children under the age of four)

Causes of atopic eczema

The exact cause of atopic eczema is unknown, but it’s clear it is not down to one single thing. Atopic eczema often occurs in people who get allergies – “atopic” means sensitivity to allergens.

It can run in families, and often develops alongside other conditions, such as asthma and hay fever.

The symptoms of atopic eczema often have certain triggers, such as soaps, detergents, stress and the weather. Sometimes food allergies can play a part, especially in young children with severe eczema.

You may be asked to keep a food diary to try to determine whether a specific food makes your symptoms worse. Allergy tests aren’t usually needed, although they’re sometimes helpful in identifying whether a food allergy may be triggering symptoms.

Read about the causes of atopic eczema.

Treating atopic eczema

Treatment for atopic eczema can help to relieve the symptoms and many cases improve over time.

However, there’s currently no cure and severe eczema often has a significant impact on daily life, which may be difficult to cope with physically and mentally. There’s also an increased risk of skin infections.

Many different treatments can be used to control symptoms and manage eczema, including:

  • self care techniques, such as reducing scratching and avoiding triggers
  • emollients (moisturising treatments) – used on a daily basis for dry skin
  • topical corticosteroids – used to reduce swelling, redness and itching during flare-ups

Read about treating atopic eczema and complications of atopic eczema.

Other types of eczema

Eczema is the name for a group of skin conditions that cause dry, irritated skin. Other types of eczema include:

  • discoid eczema – a type of eczema that occurs in circular or oval patches on the skin
  • contact dermatitis – a type of eczema that occurs when the body comes into contact with a particular substance
  • varicose eczema – a type of eczema that most often affects the lower legs and is caused by problems with the flow of blood through the leg veins
  • seborrhoeic eczema – a type of eczema where red, scaly patches develop on the sides of the nose, eyebrows, ears and scalp
  • dyshidrotic eczema (pompholyx) – a type of eczema that causes tiny blisters to erupt across the palms of the hands

Editor’s Note:  

* Clarification Provided for our U.S. Readers

NHS Choices logo


From www.nhs.uk





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Study: Bath Oils for Childhood Eczema Provide No Medical Benefit

“Bath oils used to help treat eczema in children offer no meaningful benefit as part of their care, a trial has found,” reports BBC News.

Childhood eczema, also known as atopic eczema, is a common condition that causes redness and soreness of the skin. Treatments include using moisturisers (emollients), which have been shown to work, and using emollients as soap substitutes in the bath or shower.

However, until now, there has been little evidence for a third type of treatment: adding emollient additives to baths.

In the first big study of its kind, researchers found commonly prescribed emollient bath additives – designed to be added to bathwater and leave a thin layer over the skin – made little difference to children’s eczema symptoms.

The study, carried out in England and Wales, involved 483 children aged 1 to 11 years. Half were randomly assigned to use bath additives regularly for a year – in addition to their usual treatments, including standard leave-on emollients – while the other half did not use them.

The results showed that bath additives made too small a difference to symptoms to be considered clinically important.

Find out more about treating childhood eczema.

Where did the story come from?

The study was commissioned by the UK National Institute for Health Research as part of a programme to investigate which treatments are effective and provide value for money, and carried out by researchers from Cardiff University, the University of Bristol, the University of Southampton and the University of Nottingham.

It was published in the peer-reviewed British Medical Journal and is free to read online.

The UK media reports were generally accurate and balanced.

What kind of research was this?

This was a randomised controlled trial, which is often the best way to investigate whether a treatment works.

To make results more accurate, many trials like this use a dummy treatment (placebo) so that patients don’t know if they are receiving the real treatment. However, in this case, the researchers decided they could not make a convincing placebo for emollient bath additives so did not include one in the study.

What did the research involve?

Researchers used records from 96 general practices in Wales, south England and west England to identify children diagnosed with eczema. The children’s parents or carers were then contacted and invited to take part.

After screening, half the children were prescribed bath emollient additives for a year and the other half were asked not to use them. Most of the experimental group were prescribed Oilatum, Balneum or Aveeno bath products.

All children continued their usual eczema treatments, which included using emollients as creams and soap substitutes, and using steroid creams where needed.

Parents or carers recorded children’s eczema symptoms – weekly for the first 16 weeks and then monthly for a year – using the standard patient oriented eczema measure (POEM). In children, this is usually assessed on how severe parents or guardians think a child’s eczema is.

POEM gives a score of 0 to 28, with 0 to 7 being no or mild eczema, 8 to 16 moderate eczema and 17 to 28 severe eczema. A drop of 3 points on the scale is considered enough to represent a clinically meaningful improvement in symptoms.

The parents or carers also recorded how often the children bathed and how often they used the bath emollient additives.

The researchers compared symptom scores for the 2 groups, adjusting for eczema severity at the start of the study, use of steroid creams and soap substitutes, and ethnic group.

What were the basic results?

The average symptom score at the start of the study was 9.5 in the bath-additives group and 10.1 in the no-bath-additives group, meaning most children had moderate eczema.

Over 16 weeks, the average symptom score was:

  • 7.5 in the bath-additives group
  • 8.4 in the no-bath-additives group

After controlling for confounding factors, such as use of other eczema medication, the average symptom score was 0.41 points lower in the bath-additives group (95% confidence interval [CI]-2.7 to +1.10). This was not a statistically significant difference and was well below the 3-point difference considered to be clinically important.

The researchers also looked at subgroups to see if any particular group of children were more likely to benefit from the bath additives. While they did find some effect for children under 5 years old, it still did not reach the 3-point threshold.

They did find a possibly clinically meaningful benefit for children who bathed 5 times or more a week (2.27-point improvement, 95% CI 0.63 to 3.91), but this analysis was based on fewer children, making it less reliable.

How did the researchers interpret the results?

The researchers said the trial “provides strong evidence that emollient bath additives provide minimal or no additional benefit beyond standard eczema care in the management of eczema in children”.

Conclusion

The study shows that bath emollient additives may not be a useful part of eczema care for children.

But it’s important to be clear this does not apply to the use of leave-on emollient creams and lotions, or to the use of emollients instead of soap. There’s evidence that leave-on emollient creams work, and doctors agree using emollients instead of soap is helpful.

This study’s results only apply to emollient products added to the bathwater. If you’re not sure of the difference, speak to a pharmacist or your GP.

If your child has been prescribed bath emollient additives and is happy with them, there’s no reason to stop using them. The study found no increased risk of side effects – such as slipping in the bath, soreness or redness – among children who used them.

However, they may not make much difference to your child’s eczema, and it’s possible the NHS may decide to recommend that doctors stop prescribing these products in future.

The study was well conducted but had a few limitations, the main one being that, unusually for research of this type, there was no placebo. Placebos are normally included to control for the placebo effect – where people tend to feel better if they are taking a treatment because they expect it to work.

However, in this case, people that did receive the bath additives did not report symptoms significantly different from those not using the additives, which suggests the placebo effect did not have much influence in this study.

The study looked at lots of subgroups among the 483 children to see if any showed different results. However, this increases the likelihood that some of the results are due to chance.

We therefore cannot put too much stock in the finding that children bathing 5 times or more a week may get some benefit from emollient bath additives, as this analysis included just 143 children.

If your child isn’t responding well to a particular treatment for eczema, there are other treatments that may be more effective. Find out more about treating childhood eczema.

Analysis by Bazian
Edited by NHS Choices

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From www.nhs.uk

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Kids Need Vitamin D – Can It Be Gotten Safely From Sunlight

Vitamin D is essential for healthy bones, and in the UK from around late March/early April to the end of September we get most of our vitamin D from sunlight exposure**. Find out how to get enough without risking sun damage.

We need vitamin D to help the body absorb calcium and phosphate from our diet. These minerals are important for healthy bones, teeth and muscles.

A lack of vitamin D – known as vitamin D deficiency – can cause bones to become soft and weak, which can lead to bone deformities. In children, for example, a lack of vitamin D can lead to rickets. In adults, it can lead to osteomalacia, which causes bone pain and tenderness.

How do we get vitamin D?

Our body creates vitamin D from direct sunlight on our skin when we are outdoors. From about late March/early April to the end of September, most people should be able to get all the vitamin D we need from sunlight.

We also get some vitamin D from a small number of foods, including oily fish such as salmon, mackerel, herring and sardines, as well as red meat and eggs.

Vitamin D is also added to all infant formula milk, as well as some breakfast cereals, fat spreads and non-dairy milk alternatives.

The amounts added to these products can vary and may only be added in small amounts. Manufacturers must by law add vitamin D to infant formula milk.

Another source of vitamin D is dietary supplements.

How long should we spend in the sun?

Most people (in the UK**) can make enough vitamin D from being out in the sun daily for short periods with their forearms, hands or lower legs uncovered and without sunscreen from late March or early April to the end of September, especially from 11am to 3pm.

It’s not known exactly how much time is needed in the sun to make enough vitamin D to meet the body’s requirements. This is because there are a number of factors that can affect how vitamin D is made, such as your skin colour or how much skin you have exposed. But you should be careful not to burn in the sun, so take care to cover up, or protect your skin with sunscreen, before your skin starts to turn red or burn.

People with dark skin, such as those of African, African-Caribbean or south Asian origin, will need to spend longer in the sun to produce the same amount of vitamin D as someone with lighter skin.

How long it takes for your skin to go red or burn varies from person to person. Cancer Research UK has a useful tool where you can find out your skin type, to see when you might be at risk of burning.

Your body can’t make vitamin D if you are sitting indoors by a sunny window because ultraviolet B (UVB) rays (the ones your body needs to make vitamin D) can’t get through the glass.

The longer you stay in the sun, especially for prolonged periods without sun protection, the greater your risk of skin cancer.

If you plan to be out in the sun for long, cover up with suitable clothing, wrap-around sunglasses, seeking shade and applying at least SPF15 sunscreen.

Winter sunlight

In the UK, sunlight doesn’t contain enough UVB radiation in winter (October to early March) for our skin to be able to make vitamin D.

During these months, we rely on getting our vitamin D from food sources (including fortified foods) and supplements.

Using sunbeds is not a recommended way of making vitamin D.

Babies and children

Children aged under six months should be kept out of direct strong sunlight.

From March to October in the UK**, children should:

  • cover up with suitable clothing, including wearing a hat and wearing wrap-around sunglasses
  • spend time in the shade (particularly from 11am to 3pm)
  • wear at least SPF15 sunscreen

To ensure they get enough vitamin D, babies and children aged under five years should be given vitamin D supplements even if they do get out in the sun. Find out about vitamin D supplements for children.

Who should take Vitamin D supplements?

Some groups of the population are at greater risk of not getting enough vitamin D, and the Department of Health recommends that these people should take daily vitamin D supplements, to make sure they get enough.

These groups are**:

  • all babies from birth to one year of age (including breastfed babies and formula fed babies who have less than 500ml a day of infant formula)
  • all children aged one to four years old
  • people who are not often exposed to the sun – for example, people who are frail or housebound, or are in an institution such as a care home, or if they usually wear clothes that cover up most of their skin when outdoors

For the rest of the population, everyone over the age of five years (including pregnant and breastfeeding women) is advised to consider taking a daily supplement containing 10 micrograms (μg) of vitamin D.

But the majority of people aged five years and above will probably get enough vitamin D from sunlight in the summer (late March/early April to the end of September), so you might choose not to take a vitamin D supplement during these months.

Find out more about who should take vitamin D supplements and how much to take.

You can get vitamin supplements containing vitamin D free of charge if you are pregnant or breastfeeding, or have a child under four years of age and qualify for the Healthy Start scheme.

You can also buy single vitamin supplements or vitamin drops containing vitamin D for babies and young children at most pharmacies and larger supermarkets.

Speak to your pharmacist, GP or health visitor if you are unsure whether you need to take a vitamin D supplement or don’t know what supplements to take.

Can you have too much vitamin D?

If you choose to take vitamin D supplements, 10μg a day will be enough for most people.

People who take supplements are advised not to take more than 100μg of vitamin D a day, as it could be harmful (100 micrograms is equal to 0.1 milligrams). This applies to adults, including pregnant and breastfeeding women and the elderly, and children aged 11-17 years.

Children aged one to 10 years should not have more than 50μg a day. Babies under 12 months should not have more than 25μg a day.

Some people have medical conditions that mean they may not be able to take as much vitamin D safely. If in doubt, you should talk to your doctor. If your doctor has recommended you take a different amount of vitamin D, you should follow their advice.

The amount of vitamin D contained in supplements is sometimes expressed in international units (IU) where 40 IU is equal to one microgram (1µg) of vitamin D.

There is no risk of your body making too much vitamin D from sun exposure, but always remember to cover up or protect your skin before the time it takes you to start turning red or burn.

Editor’s Note:

** U.S. Resources:

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From www.nhs.uk

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How To Prevent and Treat Teen Smelly Feet

Smelly feet aren’t fun for anyone, but there is an effective, simple and cheap treatment that you can use at home which will banish foot odour within a week.

Medically known as bromodosis, stinky feet are a common year-round problem.

The main cause is sweaty feet combined with wearing the same shoes every day.

Why feet sweat

Anyone can get sweaty feet, regardless of the temperature or time of year. But teenagers and pregnant women are especially prone because hormonal changes make them sweat more.

You’re also more likely to have foot perspiration if you’re on your feet all day, if you’re under a lot of stress or if you have a medical condition called hyperhidrosis, which makes you sweat more than usual. Fungal infections, such as athlete’s foot, can also lead to bad foot odour.

According to podiatrist, Lorraine Jones, feet become smelly if sweat soaks into shoes and they don’t dry before you wear them again.

Bacteria on the skin break down sweat as it comes from the pores. A cheesy odour is released as the sweat decomposes.

“Your feet sweat into your shoes all day so they get damp and bacteria start to grow. The bacteria continue to breed once you’ve taken your shoes off, especially if you put them in a dark cupboard. Then, when you put your shoes back on the next day, even if you’ve just had a shower, putting your feet into still damp shoes creates the perfect conditions for the bacteria to thrive – warm, dark and moist.”

How to treat smelly feet

The good news is that there’s a simple, quick, sure-fire solution to smelly feet.

  • Wash your feet with an anti-bacterial soap called Hibiscrub. There are lots of over-the-counter foot hygiene products at your local chemist, but Hibiscrub is the best one.
  • Leave on the Hibiscrub for a couple of minutes, then wash it off.

According to Lorraine, “if you do this twice a day, you’ll definitely banish smelly feet within a week.”

She adds that you shouldn’t use Hibiscrub on your feet if you have broken skin, such as eczema.

Preventing smelly feet

Keeping feet fresh and sweet smelling is all down to good personal hygiene and changing your shoes regularly. To keep feet fresh:

  • Never wear the same pair of shoes two days in a row. Instead, wear different shoes on successive days so they have at least 24 hours to dry out.
  • Make sure teenage boys have two pairs of trainers so that they don’t have to wear the same pair for two or more consecutive days.
  • Wash and dry your feet every day and change your socks (ideally wool or cotton, not nylon) at least once a day.
  • Keep your toenails short and clean and remove any hard skin with a foot file. Hard skin can become soggy when damp, which provides an ideal home for bacteria

If you’re particularly susceptible to sweaty feet, it’s a good idea to:

  • dab between your toes with cotton wool dipped in surgical spirit after a shower or bath – surgical spirit helps dry out the skin between the toes really well – in addition to drying them with a towel
  • use a spray deodorant or antiperspirant on your feet – a normal underarm deodorant or antiperspirant works just as well as a specialist foot product and will cost you less
  • put medicated insoles, which have a deodorising effect, in your shoes
  • try feet-fresh socks – some sports socks have ventilation panels to keep feet dry, and antibacterial socks are impregnated with chemicals to discourage the odour-producing bacteria that feed on sweat
  • wear leather or canvas shoes, as they let your feet breathe, unlike plastic ones
  • wear open-toed sandals in summer and go barefoot at home in the evenings

When to see a doctor

Smelly feet are a harmless problem that generally clears up. Sometimes, however, it can be a sign of a medical condition.

See your GP (*doctor) if simple measures to reduce your foot odour don’t help, or if you’re worried that your level of sweating is abnormally high.

Your doctor can offer you a strong prescription antiperspirant or refer you for a treatment called iontophoresis, which delivers a mild electric current through water to your feet to combat excessive sweating.

Here are more tips on how to look after your feet.

 

Editor’s Note: *clarification provided for our US readers.

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From www.nhs.uk

Sun Safety for Kids: Healthier Skin for Life

How do I Keep My Child Safe In The Sun?

Exposing your child to too much sun may increase their risk of skin cancer later in life.

Sunburn can also cause considerable pain and discomfort in the short term.

That’s why babies and children need to have their skin protected between March and October in the UK.

Tips to keep your child safe in the sun this summer 

  • Encourage your child to play in the shade – for example, under trees – especially between 11am and 3pm, when the sun is at its strongest.
  • Keep babies under the age of six months out of direct sunlight, especially around midday.
  • Cover exposed parts of your child’s skin with sunscreen, even on cloudy or overcast days. Use one that has a sun protection factor (SPF) of 15 or above and is effective against UVA and UVB. Don’t forget to apply it to their shoulders, nose, ears, cheeks, and the tops of their feet. Reapply often throughout the day.
  • Be especially careful to protect your child’s shoulders and the back of their neck when they’re playing, as these are the most common areas for sunburn.
  • Cover your child up in loose cotton clothes, such as an oversized T-shirt with sleeves.
  • Get your child to wear a floppy hat with a wide brim that shades their face and neck.
  • Protect your child’s eyes with sunglasses that meet the British Standard (BSEN 1836:2005) and carry the “CE” mark – check the label.
  • If your child is swimming, use a waterproof sunblock of factor 15 or above. Reapply after towelling.

Read more about summer safety for younger children.

Sunlight and vitamin D

The best source of vitamin D is summer sunlight on our skin. Because it’s important to keep your child’s skin safe in the sun, it’s recommended all babies and young children aged six months to five years should take a daily supplement containing vitamin D, in the form of vitamin drops.

See more about vitamin D for babies and young children.

How to apply sunscreen

An expert explains why it is important to protect your skin from sunburn to help avoid skin cancer. She also gives advice on how to apply sunscreen correctly and what to look out for when buying sun cream.

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From www.nhs.uk

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Video: Common Rashes in Babies and Young Children

Most babies will develop some kind of mild skin condition or rash in the first year of their life, as their skin adapts to their new environment. In this brief video a family doctor talks about typical rashes, what to do, and when to seek medical treatment.

Editor’s Note: Video Highlights

  • Most rashes don’t have a serious underlying cause and will clear up on their own
  • Baby lying on blanket on floorOne of the most serious rashes, which needs immediate medical attention, is one which doesn’t disappear when you press a glass or tumbler on it and look through the glass (technique shown in the video)
    • This could be a sign of a condition called meningococcal septicaemia or meningitis.
  • Other signs that may indicate a serious rash include a high fever, a very irritable lethargic child, or a child who is reluctant to eat
  • If you are at all worried, you should see your pediatrician or call the emergency services to seek medical help
  • Common rashes covered in this video (with pictures) include:
    • Eczema (red, itchy, dry rash that cracks and is in elbows or behind knees)
      • Possibly see a doctor for advice
    • Ringworm (single, circular, red patch)
      • Can usually treat with cream from drugstore
    • Prickly heat or heat rash (itchy red rash)
      • Eliminate clothing layers – should disappear in a few days
    • Impetigo (crusty yellow lesions, which are spreading)
      • See a doctor – will require antibiotics
    • Chicken pox (red itchy spots that then become blisters)
      • Call your doctor and avoid contact with other children

For more information on babies and rashes, click on this link from NHS Choices.

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