Eczema

I would like to preface this article by saying that this is not medical or health advice, rather an interest piece, based on my personal research and experience as a parent.

Eczema is something I have dealt with as a parent with Franklin. He had very atypical eczema from around 3 months old, which resulted in us taking a while to pick up what it was. But, this led me on a quest to solve his skin woes and really take a deep dive into the world of eczema. We have managed to clear Franklin’s skin and he is free from eczema 95% of the time, with the odd very mild flare around his mouth when he becomes unwell or has his vaccinations. In this resource, I have detailed everything I have learnt and implemented personally.

Eczema is a fairly poorly understood condition, which is why there is so much conflicting advice out there. At its core, eczema is a skin barrier and immune system dysfunction, rather than an allergic condition – that is, that certain foods can flare eczema, but not necessarily cause eczema. I like to explain eczema with a brick wall analogy: if you imagine the skin of a person without eczema, it resembles a newly built brick wall with perfectly intact mortar between the bricks. The skin of a person with eczema is like an old brick wall, the mortar is cracked. What this results in, is an easy passage for moisture to seep out (why eczema is often dry) and for irritants to seep in (why eczema is often red). This is why the first line treatment for eczema is a really good moisturizer – the moisturizer acts as mortar for those bricks.

Those with eczema will have a baseline level of inflammation within their body as their immune system is activated more regularly than those without eczema (irritants through the skin), which can make eczema sufferers more susceptible to illness and allergy as their immune system is hyper-reactive. The reverse of this is true as well. Because eczema is so closely connected to the immune system, it is very normal to see eczema flares when your little one is unwell with a viral illness or when they have their usual vaccinations.

In infants/toddlers, the immune system is really malleable, meaning that it can essentially be retrained. So, whilst it is really normal for eczema to flare, settle and flare again, keeping the skin calm and eczema free where possible, is key in retraining the skin/immune system by telling it that calm, eczema free skin is the norm. This is where optimizing topical management is key. 

Topical Management

Topical management is the first line treatment of eczema. Ensuring you are using a good quality moisturizer, soap free wash +/- a bath oil is really important and medicated creams when necessary. My favorite range is the Dermeze range and QV. We have personally tried all of the creams, and can’t go passed this range.

·      Dermeze Treatment Cream (am/pm)

·      Dermeze Soap Free Wash

·      QV Bath Oil

·      Dermeze Moisturising Cream (if needed during the day)

Steroids freak a lot of people out, but they are really very safe when used correctly, and currently the gold standard treatment. Most specialists will recommend a steroid product to treat flares – speak with your individual specialist to determine which is right for your little one. Remember, the more the skin is clear, the more the body understands this is normal and retrains the immune system.

Whilst not something I have needed to do with Franklin, bleach baths are another treatment method. I will include a link below to a wonderful resource on this. 

·      https://preventallergies.org.au/wp-content/uploads/2018/07/how-to-use-bleach-baths.pdf

Environmental Triggers

Environmental triggers are very common with eczema and often the hardest to figure out. These can be things like pollens, grasses, dust etc. One of the big environmental triggers is heat. Because those with eczema have a faulty skin barrier, their ability to regulate their temperature is impaired, making them more susceptible to overheating. Controlling heat/temperature has been a key component to my management of Franklin’s skin, with many of these strategies no longer required now that his skin is clear.

·      Keep bath water at no warmer than 35 degrees celsius

·      Ensure baths go for no longer than 10 minutes

·      Keep his room temperature at 18-20 deg, but never exceeding a 1.0 TOG sleep suit

·      Limit clothing layers – we no longer dress Franklin in a singlet, even in winter

Gut – Skin Connection

Gut health in general is an emerging area of research, with little well understood, due to its complexity. What research has shown, is that those with eczema have a different composition of bacteria, then those without eczema and some even have inflammation present in their gut.

Infants are born with a sterile gut – the womb is free from any bacteria – and the first exposure to any sort of bacteria is through the birth canal if birthed vaginally, or if born via cesarean section the external environment. Both methods of birth have an impact on an infant’s microbiome, with research demonstrating differences between infants born vaginally vs those born via cesarean section. Additionally, those infants exposed to antibiotics early on, or repeatedly are going to have impaired gut health and the method by which infants are fed (breast or formula) also impacts the gut. However, these differences are not well understood.

So, what does this tell us? Well, it tells us that there is likely a connection between the gut and eczema, but it’s not clear as to what that connection is. As a result, aside from probiotics (huge fan!) and a lovely nutrient rich diet, I don’t currently have any recommendations for treating eczema from a gut perspective, as there is not enough research to suggest otherwise.

Supplements 

This brings me to supplementation!! As you would know, I am a huge advocate of a food first approach to health – food is a far more appropriate means of obtaining nutrients as our body is well equipped to absorb nutrients from food. However, there are three supplements I recommend for those with eczema and/or allergies.

Probiotics – research has shown that probiotics can help diversify the gut microbiome and may help to reduce the severity of eczema. Can probiotics treat eczema? No – but they are a great supportive measure.  I use and recommend:

·      BioCeuticals BabyBiotic

Vitamin D – research has shown a link between low vitamin D levels and increased eczema severity. Vitamin D is known to help regulate the immune system and skin barrier function/improved skin integrity. It has also been shown to help prevent skin infection from Staph – a bacteria we all have on our skin, but that those with eczema are more likely to be infected by.

·      BioCeuticals or Brauer

Omega 3 – once again, research has shown that omega 3 fatty acids can reduce the severity of eczema symptoms. It is thought that this is due to the anti-inflammatory properties of omega 3 fats.

·      Brauer Cod Liver Oil (contains fish)

·      BioCeuticals UltraClean OmegaFactors for Juniors (contains fish and soy)

Eczema + Allergies

Whilst the presence of allergies can flare eczema, at its core, eczema is not caused by allergies. In fact, in many cases the opposite is actually true – the presence of eczema, has predisposed a child to allergies. This association arises from the increased prevalence of food proteins entering the skin, due to the faulting barrier. This is referred to as the Dual-Allergen Hypothesis. When eczema is flared and the skin barrier open, food proteins are able to enter the skin, being incorrectly recognized by the body and an activation of the immune system occurring. When the body is exposed to food proteins through the mouth/digestive system, they follow the correct pathway, are received correctly and as such oral tolerance is developed – the body continually recognizes this protein as normal and safe, so the immune system isn’t activated. So, the sooner we can treat and effectively manage eczema, that greater chance we can reduce the likelihood of allergies developing.

It is for this reason that it is very important for all children, but those with eczema in particular, that we never use products that contain food proteins.  Once your little one has been successfully exposed to a food via the mouth, you can then include skin products with that food. Common food proteins present that we want to avoid:

·      Sunflower oil

·      Colloidal oatmeal (big one!)

·      Wheat

·      Avocado

·      Coconut oil

·      Olive oil

Some wonderful and food free brands include: Dermeze, QV, Kenkay, CeraVe and Epaderm

Unnecessary elimination of foods

It is really common to see drastic elimination diets supported as a treatment for eczema. I am not an advocate of this (for reasons above), particularly in children. I found that eliminating peanuts from my diet when breastfeeding (after Franklin’s peanut anaphylaxis diagnosis) did help to resolve his eczema, but this is because he is allergic to peanuts. So, of course in situations like this, elimination of food is necessary. However, what is common to see is that elimination of all allergens, gluten, dairy, eggs, salicylates, amines, histamines etc when there is no allergy present.

To further support this, studies have been conducted on the outcomes of elimination diets for children with eczema. One study in the Journal of Allergy and Clinical Immunology Practice looked at 300 children that had a history of moderate to severe eczema, that parents felt was triggered by certain foods. These children followed the elimination diets started by their parents and were followed up at one and three years. The results showed that 19% of those who eliminated foods despite no allergy, developed new food reactions when the food was reintroduced, and 30% of those developed anaphylaxis. So, this tells us that unnecessarily eliminating foods increases the risk of a food allergy developing in the future. This is because the oral tolerance (discussed above) doesn’t occur. In addition, those that eliminate lots of foods are at risk of poor growth, nutrient deficiency, low bone density, malnutrition and feeding issues (picky eating).

What to do if you think food is playing a role

If you are optimizing the topical management of your little one’s skins, but are still seeing regular and hard to treat flares, and think that food is playing a role, I would encourage you to reach out to your GP in the first instance, and ask for a referral to an allergy specialist to discuss whether allergies may be playing a part in your little ones eczema.

Contact reactions

Something that is really common in those with eczema is contact food reactions. This shows up as a rash around the mouth only. Typically, this is to foods that are acidic like citrus, tomato, eggplant etc, but can also occur with other foods. It is for this reason I recommend using a barrier cream if your little one has eczema, particularly if on their face.  This simply creates a barrier between the skin and the food proteins.

·      David Craig Emulsifying Ointment (pharmacy)

Eczema Specialist Recommendation

If you are in need of a trusted specialist, I cannot recommend Jemma Weidinger more highly. She is based in Perth, however runs Telehealth sessions. She is a Nurse Practitioner, working at Perth Children’s Hospital and runs her own clinic – Children’s Eczema Care. Her website is linked below.

·      https://www.childrenseczemacare.com.au