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Q: My five-year-old daughter has eczema. It clears up in the summer, but in the winter it is terrible. She scratches all the time. Her body is all red with oozy patches. So far she is allergic to sulfites. They give her a steroid cream and an antibiotic. This is not working. Any suggestions? She has had this since she was six months.
A: Eczema is a type of reaction of the skin. There are many types of eczema that occur in children, with the allergic type being most common. You are describing "atopic" (allergic) eczema and certainly it can be quite problematic. Usually the acute areas involved are noted to be red, weeping, oozing, and some formation of fluid within the skin. Chronic or older lesions usually are thick, dry, and scaly with different changes in color (pigmentation).
The best treatment is to control the environmental things that irritate the disease, such as avoiding contact with things known to trigger itching and scratching. Garments should be smooth textured cotton, wool should be avoided. It is common in the winter months, particularly when the skin is in contact with woollen objects. As you point out, a warm climate of moderate humidity appears to be optimal for a majority of patients. Sweating can lead to itching and aggravate the disease. Exposure to sunlight and salt water is of benefit. Bathing should be kept to a minimum. You want to try to apply moisturizing creams to the skin to seal water into the skin. If it appears that a food or other ingestant makes itching worse, then the food must be excluded. We usually like to control the itching with an antihistamine, which can be helpful and also give a little sedation, particularly at night. Antibiotics are indicated when we think that it's secondarily infected. When infection is present, antibiotics should be given systemically (by mouth). The steroids help reduce the itching and the inflammation. Small amounts of steroid rubbed in infrequent intervals may get better results than large amounts applied infrequently. Usually, steroids by mouth are not required.
Unfortunately, we are not able to cure eczema, but certainly there are things like those described above that we can do to make her comfortable. You should also understand that recurrence is expected, so don't be surprised. Reasonable control can be achieved with the help of your daughter's physician who can give you a clear understanding of the disease and provide the support for you and your daughter that may make the difference.
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Henry Bernstein, M.D., is currently the associate chief of the Division of General Pediatrics and director of Primary Care at Children's Hospital, Boston. He also has an academic appointment at Harvard Medical School.