By Julie Deardorff, Tribune Newspapers
2:50 PM EDT, April 11, 2011
Eczema is notoriously difficult to treat in children. The torturous dry-skin disease causes intense itching and sleeplessness, and sometimes parents try making dietary changes in addition or in place of conventional treatments.
For about one-third of eczema patients, specific foods — dairy, eggs, soy, wheat, peanuts, tree nuts and fish — can trigger flare-ups. But the majority of kids with eczema don't have any food allergies. Restricting or eliminating common foods from the diet, meanwhile, is often unnecessary and can pose a nutritional risk, according to a recent study in The Journal of Pediatrics.
"We're seeing a growing number of patients placed on strict, unproven food-elimination diets that have led to poor weight gain and malnutrition," said Dr. David Fleischer, an assistant professor of pediatrics at National Jewish Health in Denver and the study's lead author. While the overly restrictive diets are chosen for a variety of reasons, the most common cause appears to be an "overreliance on immunoassay (blood) tests," he said.
Blood and skin tests, which are often used to diagnose food allergies, can produce false positives, leading families down the wrong path. In Fleischer's study, his team gave the children the suspected allergenic food, a gold standard test known as the oral food challenge. In 86 percent of the cases where they performed oral food challenges, they were able to restore the food that had been eliminated from the child's diet.
"You can't just depend on a blood test to guide therapy," said Dr. Bill Berger, a professor of allergy and immunology at the University of California at Irvine. "There is a difference between showing clinical sensitivity on a test as opposed to an allergic reaction"
Eczema, also known as atopic dermatitis, first appears during infancy, usually on the face. As children get older, it can affect the hands, feet and creases inside the elbows and behind the knees. "The lesions are a result of the scratching," said Berger. "Certain areas of the body are more affected because they're easier to reach. If we don't control the itching, we never get the eczema under control."
That, of course, is the hard part. The dry and irritated skin begs to be scratched. Scratching, in turn, makes the skin more vulnerable to allergens, irritants, pollutants and infections caused by bacteria and viruses.
Though there's no cure, eczema can be controlled with anti-inflammatory treatment and often disappears before age 2. Parents whose children have eczema should brace themselves for further allergies: Of the approximately 15 million people in the U.S. who have eczema, about half will develop respiratory allergies.
Dealing with eczema
Bathe in bleach. Patients with eczema often have staphylococcal infections on their skin, the bacteria that causes and worsens infection. Giving children diluted bleach baths significantly reduced the severity of their eczema and prevented flare-ups by killing the bacteria on the body arms and legs, according to researchers from Northwestern University Feinberg School of Medicine. Interestingly, the face, which was not submerged in the bath, did not improve. In the study, the children soaked in about half a cup of bleach in a full, standard-size tub, twice a week for about five to 10 minutes.
Try wet wrap therapy. For severe cases — eczema that covers the body — applying wet wraps after bathing may help stop the itch-scratch cycle. At National Jewish, patients are given topical steroid medicine after soaking; they then dress in a wet layer of clothing against the skin covered by a dry layer. The wet wraps, which have a cooling, anti-itch effect, are rewet or taken off when they start to dry out, said Fleischer. For facial eczema, nurses will wrap the face with wet gauze and surgical netting. "The wet wraps can clear the infection without needing antibiotics," said Fleischer.
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