Eczema is many things in our community; there are so many myths, theories and beliefs related not only to the pathophysiology of eczema, but also its treatments.

So, how about we do some myth-busting? Sounds like fun to me.

Most of my clinical time is spent working my way through the myths and realities of eczema. It’s hard work, it can be repetitive, and often those I am educating challenge what I say, but logic and fact wins in the end. We all win, because we achieve great clinical outcomes.

Did you know, a parent of a young child with widespread eczema has been found to have the same degree of stress as a parent of a young child with Type 1 Diabetes?

Think about it: skin is your largest organ, it covers your entire body, you rely on it for many things, protection, thermoregulation, sensation, and it stops your other organs from spilling out too. We need it to be intact, flexible, comfortable and resilient.

The Top Ten Eczema Myths:

These are based on my experience with thousands of consultations, number one being the most common. ‘Dr Google’ has a lot to answer for!

1. “Eczema is caused by allergies”
   • If you come into contact with something you are allergic to, your eczema may flare up and be more difficult to manage. If you never come into contact with your allergen, you will still have eczema. Many children with eczema have no known allergies.
2. “Topical Steroids are dangerous”
   • Modern topical steroids are not dangerous, particularly when prescribed appropriately, and used as prescribed. In fact they are crucial to maintaining control, and achieving better long-term outcomes.
3. “It is something in the breast milk, related to what the mother is eating”
   • This is actually quite rare. You would more likely see gastrointestinal upset in relation to certain foods, especially spicy, acidic or sugary foods eaten in large quantities. Occasionally you may see an eczema flare as well. Moderation and a healthy, varied, and balanced diet is the best advice.
4. “Topical Steroids thin the skin”
   • An oldie but a goodie. It’s been around for decades. This may happen if your wrap the child in plastic after applying it, and leave the plastic on. Using them on affected areas only, and not using any dressing over the top, ensures safety.
5. “Topical steroids should only be used for 3 consecutive days, then stopped” (or 5, 7, 10, 14 days, depending on the person you are talking to)
   • Correct use is once daily to affected areas until the skin is clear, start again at the first sign of recurrence.
6. “Eczema is not that serious, leave it alone, and they might ‘grow out of it’”
   • Eczema can be very serious; there are case examples below to highlight this. There is a direct link between effective management and improving the chances of ‘growing out of it’ earlier.
7. “Children with eczema should avoid baths”
   • Not if the bath is prepared correctly, then it can be very beneficial. In fact, it can be the mainstay of treatment.
8. “Coconut oil will fix it”
   • Coconut oil is not absorbed by the skin, it does not help, in fact in some cases, it irritates eczema.
9. “Eczema is contagious”
   • Unless you have an infection, no!
10. “This treatment or cream will cure it” (usually the expensive one)
    • No ‘one cream’ will cure eczema; eczema is a long-term skin condition that can improve over time. Better management and good control improve the chances of eczema becoming easier to manage, and potentially ‘growing out of it’.

The most concerning advice or treatment from health professionals that my patients have experienced:

1. Excluding foods or food groups from the child and/or breastfeeding mum
2. Stopping breastfeeding
3. Multiple formula changes – dairy to goat to soy to organic and back again
4. Oral corticosteroids
5. Repeated courses of oral antibiotics

Further Learning: Complete the Clinical Detective – Skin course

The Reality of Eczema Presentations

I’ll never forget the first two patients that started me thinking about eczema. Working in the emergency department you see so many types of presentations. It was in the ED that I saw Baby J.

Baby J was a six-week old boy. He was covered head to toe in a red, dry rash. Some areas were crusty and weeping. His arms, legs, face, scalp and entire torso were affected.

He had never slept more than 40 minutes in one stretch. Since birth! He had already been through three courses of antibiotics for the infection. That’s an awful lot to experience by six weeks! The parents were strung out, stressed, and exhausted.

Eczema was not my specialty at that stage, so I went and found the best Paediatrician I know, who was fortunately working at the time in the same building. We put a plan in place immediately (and there my education started). That night, he slept a four-hour stretch. Mum kept checking on him to make sure he was actually sleeping! She learned to sleep herself in the coming weeks. There were some setbacks, but overall, steady improvement, with no more antibiotics.

I had completed a lot of extra training and was extremely fortunate to have been supported and mentored by Paediatricians and Dermatologists for several years when I met Baby M in the early days of my Private Practice.

Baby M was a fourteen week old, with severe eczema from head to toe, and he was “failing to thrive”. He was booked in for insertion of a nasogastric tube to assist with feeding, the following week, to gain some weight. He was very small for his age; he had hardly gained any weight since birth.

His parents had heard about my clinic, and came along for some advice. I implemented a management plan immediately. I called his Paediatrician, asking for the nasogastric tube to be delayed a further week or two. I monitored him with weekly weigh-ins. He started to gain weight steadily as his eczema improved, with just a couple of short plateau periods. By 9 months of age, he was just below the 50th percentile. No nasogastric tube! His skin looked fantastic.

Yesterday alone, I saw four children under six months of age that were covered head to toe in eczema, one of whom was well below the 3rd percentiles.

Eczema is very common in dry climates, so being in Melbourne, my practice is incredibly busy.

Don’t under-estimate eczema; it can be a very serious problem. Myths and misconceptions in relation to eczema have a lot to answer for!

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References:

• Daniel, BS & Orchard, D 2015, ‘Ocular side–effects of topical corticosteroids: what a dermatologist needs to know’, Australasian Journal of Dermatology, vol. 56, pp. 164–9, doi:10.1111/ajd.12292.
• Hong, E, Smith, S & Fischer, G 2011, ‘Evaluation of the Atrophogenic Potential of Topical Corticosteroids in Pediatric Dermatology Patients’, Pediatric Dermatology, vol. 28, pp. 393–6, doi:10.1111/j.1525-1470.2011.01445.x.
• Hoyt, AEW, Medico, T & Commins, MD 2015, ‘Breast Milk and Food Allergy, Connections and Current Recommendations’, Pediatric Clinics of North America, vol. 62, pp. 1493-1507, doi.org/10.1016/j.pcl.2015.07.014.
• Mooney, E, Rademaker, M, Dailey, R, Daniel, BS, Drummond, C, Fischer, G, Foster, R, Grills, C, Halbert, A, Hill, S, King, E, Leins, E, Morgan, V, Phillips, RJ, Relic, J, Rodrigues, M, Scardamaglia, L, Smith, S, Su, J, Wargon, O & Orchard, D 2015, ‘Adverse effects of topical corticosteroids in paediatric eczema: Australasian consensus statement’, Australasian Journal of Dermatology, vol. 56, pp. 241–251, doi:10.1111/ajd.12313.
• Royal Children’s Hospital (Melbourne), Knowing your Child’s Eczema, viewed 28 September 2017, https://www.rch.org.au/uploadedFiles/Main/Content/derm/knowing-your-childs-eczema-booklet.pdf.

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