Cold Winters, Dry and Cracked Skin? How to Conquer Dry Skin in Children and Eczema

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Dr. Mom blog explores Cold Winters, Dry and Cracked Skin? How to Conquer Dry Skin in Children and Eczema

Any Canadian knows that winter is the WORST for our skin. Without copious lathering of cream we get scaly, alligator dry skin. My hands are constantly feeling dry, especially since I wash my hands multiple times a day in clinic. Children’s skin is no different.  Babies in particular, especially premature babies, have fragile skin that makes them very vulnerable to having dry skin. Eczema is actually a skin disease in which inflammation causes the skin to be dry, crust, crack, and ooze.  Its surprisingly common, and can affect up to 1 in 5 children.

In my medical practice I often get patients asking what caused the dry skin.  The truth is that the cause of eczema is not completely understood, but genetics is likely to play a role. 70% of children with dry skin have a family history of asthma or seasonal allergies. The other factor is the climate – winter and cold, dry climates are likely to trigger eczema flares. Emotional stress, overheating of the skin in the bath and shower, sweating, exposure to soaps, detergents, and fragrances can all play a role in Eczema flares.  

Eczema is a problem of dry skin that can lead to itchy, scaly red skin and usually presents at a young age.  The hallmark of eczema is dryness and itchiness. 

  • Lesions can look like little red bumps that are itchy, ooze, and have a scaly appearance.  
  • In infants and young children (less than 2 years of age), eczema is typically located on the back of elbows, front of knees, cheeks or scalp. In older children and adolescents, eczema is often found on the inside surfaces of elbows and knees, wrists, ankles and neck.
  • The lesions usually are NOT in the area where the diaper touches (this is important to differentiate from a diaper rash).

Eczema flares can be triggered by certain food and allergen exposures, irritating chemicals in lotions/soaps/gels, pollution, poor humidity, exposure to bacteria, and stress.  An important layer of the skin called the epidermis protects our body from the environment by keeping allergens, bacteria, and irritating chemicals outside of the body.  

In Eczema, this moisture barrier is genetically impaired resulting in more water loss, leading to very dry scaly skin.   The more water loss, the worse the Eczema.  The consequences of dry skin in children over time really that it is itchy and uncomfortable.

  • It can be extremely itchy and therefore very uncomfortable for your little one to deal with.  
  • The skin may also thicken over time from too much scratching. 
  • If the skin barrier breaks, they may be more vulnerable to bacterial infections of the skin. 

In my family medicine practice, these are the recommendations I give parents to help treat dry skin in children.  First, I educate them that the goals of treatment are to reduce the itchiness, and prevent worsening of the symptoms.  

  • Limit the use of soaps and detergents: Use a soap-free cleanser.  
  • Do not use any products that have fragrances:  Watch out for products that are “unscented” – these may actually HAVE fragrances in them that mask the smells of lotions to produce a neutral smell.  Instead, look for products that are “fragrance free.”
  • Avoid dry environments: in Canada this is hard – so try and bundle your little one up as much as possible in the cold and avoid skin exposure to the hard dry air.  
  • Use a humidifier: in the home as much as possible.
  • Avoid excessive heat in the shower and bath: – this can speed up water loss from the skin.  Infact, minimize your bathing routine for your little one as much as you can.  If possible, use luke-warm water this will reduce the amount of water loss from the skin because every time you bathe your skin loses water.  
  • After bathing, pat their skin dry (do not wipe) and slather them in a fragrance-free lotion: (vasaline or CeraVe are good options).   This will help form a barrier on the skin to slow down water loss and lock in moisture into the skin.  
  • Apply the same “fragrance free” moisturizers many times throughout the day. 

Eczema is a chronic disease of childhood therefore the symptoms will come back if proper moisturizing/bathing practices are not undertaken. 

If the symptoms of Eczema are severe, or the bathing and cream routines above aren’t working well, your doctor may consider treatment with medications.  

  • Topical antibiotics: if the skin is infected due to a breakage in the skin barrier.
  • Topical steroid creams: will reduce the inflammation associated with Eczema
  • Antihistamines: will help reduce itchiness, which in turn will reduce the Eczema 
  • In severe cases, oral steroid mediations, ultraviolet light therapy, immunosuppressive drugs may be required to control Eczema.  

Next time you’re reaching for your bottle of Lubriderm or CereVe don’t forget to share with your little one! If you’re at all concerned that your child’s dry skin might be eczema, don’t hesitate to make an appointment with your healthcare provider. 

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How can I transition my toddler from 2 naps per day to one?

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This article was co-written by Megan Crosby (Medical Student at the University of Alberta)

References:

1.     Clinical Dermatology, Fifth Edition. Richard B. Weller, Hamish J.A. Hunter and Margaret W. Mann. 2015

2.     Atopic dermatitis (2017). In DynaMed Plus. Michael Woods, Anthony M. Rossi. 

3.     Eczema. Canadian Dermatology Foundation (2017).https://dermatology.ca/public-patients/skin/eczema/

4.     Dermatology Manual (2016). John Elliott, Andrew Lin & Alain Brassard

5.     Weidinger S, Novak N. Atopic dermatitis. Lancet 2016; 387:1109.

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Seidenari S, Giusti G. Objective assessment of the skin of children affected by atopic dermatitis: a study of pH, capacitance and TEWL in eczematous and clinically uninvolved skin. Acta Derm Venereol 1995; 75:429.

Kelleher M, Dunn-Galvin A, Hourihane JO, et al. Skin barrier dysfunction measured by transepidermal water loss at 2 days and 2 months predates and predicts atopic dermatitis at 1 year. J Allergy Clin Immunol 2015; 135:930.

Kim JP, Chao LX, Simpson EL, Silverberg JI. Persistence of atopic dermatitis (AD): A systematic review and meta-analysis. J Am Acad Dermatol 2016; 75:681.

Matiz C, Tom WL, Eichenfield LF, et al. Children with atopic dermatitis appear less likely to be infected with community acquired methicillin-resistant Staphylococcus aureus: the San Diego experience. Pediatr Dermatol 2011; 28:6.

Balma-Mena A, Lara-Corrales I, Zeller J, et al. Colonization with community-acquired methicillin-resistant Staphylococcus aureus in children with atopic dermatitis: a cross-sectional study. Int J Dermatol 2011; 50:682.

Huang JT, Abrams M, Tlougan B, et al. Treatment of Staphylococcus aureus colonization in atopic dermatitis decreases disease severity. Pediatrics 2009; 123:e808.

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