Family doctor

Atopic dermatitis - also known as eczema is a common skin condition that can be very distressing for both those experiencing it and parents of children with eczema. In moderate to severe cases, eczema flares can be difficult to manage particularly as children build tolerance to steroid creams through repeated use.

A large randomised study has shown that the regular use of emollients significantly reduces the number of eczema flares experienced over a 12-week period, reduces corticosteroid use, improves quality of life and leads to higher complete remission rates in children between the ages of 2-6. The study confirms the long-held belief by doctors that emollient application, even in the absence of symptoms is an important pillar of eczema treatment.

Most eczema is caused by a combination of immune system hyper-reactivity, environmental irritants and a disruption of the barrier function of skin. The management of eczema is aimed at improving the integrity of the skin barrier through emollients, reducing exposure to triggers in the environment such as dust, and reducing the inappropriate immune response through topical steroid use.

During eczema flares, the skin is far more susceptible to infection because the normal immune functions of skin as a protective barrier are reduced and bacteria can enter the body easily, occasionally antibiotics are also used to treat infected eczema.

The terms emollient and moisturiser are often used interchangeably but there is a subtle difference between the two. Moisturisers refer to a general group of lotions, ointments or creams that soften and moisten the skin, however they often include additional chemicals such as scents that can irritate and worsen eczema. Emollients are also moisturising but are more specific in that they contain 15% glycerol and 10% soft paraffin and don’t usually contain any irritating substances. Commonly prescribed emollients are Sorbolene or aqueous cream, which are also readily bought over the counter.

Emollients allow the skin to retain more moisture and improve the barrier function of skin, while not causing any irritation. The study found that regular emollient applied to the whole body and face two times a day and left on to absorb, significantly reduced flares.

Tips for applying emollients:

• Keep the application of the emollient as clean as possible, wash hands thoroughly before and after application, and trim fingernails to reduce dirt and bacteria

• Wear cotton rather than wool and other irritating fabrics after application

• Apply emollients in the direction of hair growth

• Buy emollients in a pump bottle or tube rather than a tub to reduce the chance of bacteria contaminating the emollient. Use of a spatula or clean spoon if a tub is the only packet the emollient comes in.

• Check the expiry date, using old emollients is less effective.

• Get into a routine and also encourage your child to apply the emollient themselves

• It may sound silly but: use enough emollient. Many people don’t realise how much emollient they can and should use. Children younger than 10 should be applying one 500g bottle every 2 weeks (or 250g per week) and children over 10 around 500g a week for mild to moderate eczema.

• Keep applying emollients, even when eczema seems to be well-controlled. Emollients work through prevention rather than direct treatment of eczema.

• Avoid irritants such as soap in general - emollients are a great soap substitute when showering/bathing or hand washing

• Products containing sodium lauryl sulphate (SLS) should be used with care because SLS is a skin irritant and may worsen eczema. SLS-containing products should not be used as a leave-on emollient but can be used as a soap substitute. Some over-the-counter brands of emollients do contain SLS so check the packet to make sure.

References:

1. "Childhood Eczema: Improving Adherence To Treatment Basics - Best Practice Advocacy Centre New Zealand". Bpac.org.nz. N.p., 2017. Web. 29 Apr. 2017.

2. Tiplica, George Sorin et al. "Prevention Of Flares In Children With Atopic Dermatitis With Regular Use Of An Emollient Containing Glycerol And Paraffin: A Randomized Controlled Study". Pediatric Dermatology (2017): n. pag. Web. 29 Apr. 2017.