Living with eczema: A life-altering and expensive condition and affects 1 in 5 children

Eczema affects one in five children and one in 12 adults. It is a life-altering and expensive condition, writes Helen O’Callaghan

Jeannette Brazel’s 15-year-old son just wants to get on with life — understandable, given the inroads eczema made on his life as a young boy. “From the moment he was born, he started to scratch,” says Howth-based Jeannette.

At his six-week check-up, covered in a rash that doctors diagnosed as infantile dermatitis, Jeannette was told this was common, he’d be fine. Instead the eczema got worse. “He’d wake at night, tearing at his hands and face, the sheet covered with blood. I’d bathe him, use [a] steroid and an emollient. It’d clear slightly but once the steroid was finished, it’d come back worse than ever.”

On the internet, Jeannette found lots of conflicting advice that involved magic potions and lotions promising to ‘cure eczema forever’. “Old wives’ tales persisted — use olive oil, use coal tar, put him on goat’s milk, put him on soya.”

Things came to a head when he was 11 months and teething. “We couldn’t get his cheeks under control. They were on fire.”

At Our Lady’s Hospital for Sick Children, Crumlin, a dermatology nurse took charge. A proper eczema-care regime began. “We were shown how to bathe him correctly, how to apply emollients and steroids when needed. We [learned about] special garments that protected his skin from damage caused by scratching.”

Caring for a child with chronic eczema is exhausting and frustrating. “The bathing, emollient, and steroid application could take up to two hours every morning and evening. At times the same treatment wouldn’t have the same efficacy,” says Jeannette.

Living with eczema: A life-altering and expensive condition and affects 1 in 5 children

She recalls a nightmarish holiday in Spain when her son was two and got seriously ill with eczema herpeticum. Doctors didn’t know what it was and pumped him full of intravenous steroids. A dermatologist, recognising the illness, prescribed an anti-viral drug. “The virus was so virulent he lost his fingernails and toenails. We were told children die from this condition — the virus can pass into the brain.”

Some years went by without improvement. “We followed treatments relentlessly, bathed him daily, used stronger steroids when advised, yet his legs were constantly infected.”

The team at Our Lady’s Hospital recommended immune suppressant therapy. It was a huge step but — with primary school imminent — his family felt it was the only option. After six weeks’ therapy, his skin was transformed.

“It had plumped out. It was healthy and smooth on his legs and thighs. It looked normal. He lost the dry cracked area around his eyes and mouth.” But junior infants wasn’t easy, says Jeannette, who co-founded the Irish Eczema Society in 2004 to address the gap in information provision. (It since merged with other skin charities to form Irish Skin Foundation).

“He still needed to be bathed and have his hands in gloves much of the time. He couldn’t use finger paints and hold crayons. We explained he wasn’t going to ‘give anything’ to other children. Heat and sun through glass triggered his eczema — the classroom had a lot of glass so they installed new blinds to shade it.”

So much had to be modified in primary school, but they “worked through it”, says Jeannette. Now in transition year, “he doesn’t want it to interfere with his life — he just wants to get on with being a teen”.

Eczema affects one in five children and one in 12 adults in Ireland. Some 65% of children grow out of it by age 7; 75% by age 16. But for a quarter of patients, it continues to adulthood.

Mater Hospital consultant dermatologist Dr Niki Ralph (also a dermatologist for skincare brand La Roche-Posay), says eczema’s impact on health-related quality of life can’t be overstated. “Impairment of quality of life is greater or equal to other childhood diseases such as asthma and diabetes. If your child has diabetes, people will say ‘that’s terrible’, but if your child has eczema, they’ll say ‘oh, doesn’t everyone?’”

What people don’t realise, for example, is that for 60% of sufferers, itchy, sore skin causes sleep deprivation, leading to poor concentration and poor school/work performance. “It causes mood changes — teens with eczema can become depressed and introverted.”

Parents of children with moderate/severe eczema must establish a strict routine of daily baths, apply moisturiser at least three times daily, and apply topical steroids. “It’s time consuming. Parents can feel fatigued, frustrated, hopeless.”

David McMahon, head of advocacy for Irish Skin Foundation (ISF), says eczema can affect self-image and confidence. “Skin disease is very apparent to others. You’re prone to being looked at. Misconceptions arise— people think: Contagious disease. This is very trying for children and particularly for teens. The micro-expressions can be very unsettling — when cashiers and people at bus-stops look at you twice.”

Living with eczema: A life-altering and expensive condition and affects 1 in 5 children

For children on sleepovers, he cites the worry of waking next morning to blood-stained sheets — eczema causes skin to split, bleed, and flake. For young adults dating, there are further ramifications. “Eczema’s unpredictable. It can suddenly be there in a private part of your body or in a part you’re sensitive about. In a dating context, this knocks confidence.”

Then there’s the expense. According to ISF, one 22-year-old college student reported annual cost of her eczema at approximately €330. This included GP and dermatologist visits, hygiene products, and emollient creams. As a student, she got discounted GP/consultant visits — cost would be higher for private patients.

There’s no cure for eczema but it can be managed — newer treatments are coming on stream all the time. Regular emollient therapy (specially formulated moisturisers) is the cornerstone of treatment. But, says McMahon, only three products are available on the medical card that suit eczema sufferers. “These are limited, basic, and old-fashioned treatments. If they don’t suit you or aren’t effective, you have to look to other brands — some of these more modern, advanced products are pricier.”

With emollients needing to be applied generously (500g-600g weekly for adults; 250g weekly for children) up to six times daily to large parts of the body, people don’t use the pricier products or, if they do, they use them sparingly. “This vicious circle puts people in hospital or their doctor prescribes steroids — perhaps unnecessary if they had broader access to over-the-counter products.” The ISF has made a submission to Government to address cost.”

  • A free public ‘Eczema Expert: Advice for life’ event takes place in the Red Cow Moran Hotel on September 17. Registration is vital – visit irishskin.ie.
  • ISF has a new booklet, ‘What you need to know about eczema’.
  • La Roche-Posay has launched a new product in its LIPIKAR range to help treat eczema symptoms.
  • irishskinfoundation.ie
  • larocheposay.ie.

Healthy tips on how to tackle eczema

  • Establish good daily skin care routine – stick to it.
  • Emollients help maintain skin hydration. They create a barrier to external allergens, e.g. animal dander; bacteria; viruses. Apply
  • Establish good daily skin care routine – stick to it.
  • Emollients help maintain skin hydration. They create a barrier to external allergens, e.g. animal dander; bacteria; viruses. Apply in smooth, downward motion in direction of hair growth.
  • Teach children early how to apply emollients correctly.
  • Don’t stop moisturising when skin is clear.
  • Adults should use approximately 500g of emollient weekly; 250g for children.
  • Avoid soap and bubbles. Use clear, pH neutral and fragrance-free shampoos.
  • Bath/shower in lukewarm water. Five to seven minutes bathing is enough.
  • After bath/shower, pat skin dry. Apply emollient all over. Use long-handled sponges to reach your back. Wash them after every application.
  • Dry skin itches – always keep moisturiser handy no matter where you/your child are.
  • Treat eczema flare-ups at first sign of symptoms.
  • Use topical steroids for flare-ups as recommended by your healthcare professional. Record amount you’re using.
  • As child grows, ask for review – they may need treatment adjusted.
  • If skin becomes wet/weepy/red/very itchy, think infection. Seek medical advice.
  • Keep fingernails short.
  • Avoid synthetic clothing – wear cotton where possible.
  • During warm weather/exercise stay cool – sweat aggravates eczema. Keep bedroom cool.
  • Protect skin from temperature changes – during colder weather, wrap up well when moving from centrally-heated environments to cold outdoors.
  • Use non-biological washing powder; avoid fabric conditioner.
  • Avoid fragranced candles, plug-in air-freshener, chemical sprays and harsh household cleaning products
  • Reduce dust mite at home: dust and vacuum regularly, wash bedding weekly at 60 degrees; replace curtains/carpets.
  • Wash children’s soft toys regularly (temperature must reach 60° C). Or put them in freezer for 24 hours to kill house dust mites.
  • When pollen count is high, avoid hanging clothes, bed linen out to dry.
  • Protect hands – wear cotton gloves under protective gloves if working with chemicals/cement. Wear barrier hand-cream if you need to wash hands frequently.
  • Remove freshly dry-cleaned clothes from plastic and allow to air for 24 hours before wearing. This reduces risk of chemical irritation of skin.

 

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