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Eczema Form

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Common Triggers and Tips to Prevent Flare-ups of Paediatric Atopic Dermatitis

Part 1: Common Triggers

If your child has ever experienced sudden, unexpected bouts of the red, sore, itchy rash of eczema, then they have experienced an eczema 'flare-up'. Many factors or conditions can make symptoms of atopic dermatitis worse (i.e flare-up). Thus, further triggering the already overactive immune system, aggravating the itch-scratch cycle, and increasing the damage to the skin. These factors can be divided into two main categories: irritants and allergens.

Irritants are substances that directly affect the skin. When present in high enough concentrations with long enough contact, irritants cause the skin to become red, and itchy or burning. Specific irritants affect people with atopic dermatitis to different degrees.

Allergens are substances from foods, plants, animals, or the air that inflame the skin because the immune system overreacts to the substance. Inflammation occurs even when the person is exposed to small amounts of the substance for a limited time. Although it is known that various allergens in the air can worsen eczema, scientists are not certain whether inhaling these allergens or their actual penetration of the skin causes the problems. When people with atopic dermatitis come into contact with an irritant or allergen they are sensitive to, inflammation-producing cells become active. These cells release chemicals cause itching and redness. As the person responds by scratching and rubbing the skin, further damage occurs.

A number of studies have shown that foods may trigger or worsen atopic dermatitis in some people, particularly infants and children. In general, the worse the atopic dermatitis and the younger the child, the more likely a food allergy will be present. An allergic reaction to food can cause skin inflammation (generally an itchy red rash), gastrointestinal symptoms (abdominal pain, vomiting, diarrhea), and/or upper respiratory tract symptoms (congestion, sneezing, and wheezing). A recent analysis of a large number of studies on allergies and breastfeeding indicated that breastfeeding an infant for at least 4 months may protect the child from developing allergies. However, some studies suggest that mothers with a family history of atopic diseases should avoid eating common allergenic foods during late pregnancy and breastfeeding.

In addition to irritants and allergens, emotional factors, skin infections, and temperature and climate play a role in atopic dermatitis. Although the disease itself is not caused by emotional factors, it can be made worse by stress, anger, and frustration (and is more of a factor in older individuals moreso than children).

Irritants and allergens are closely related and sometimes a substance can be both an allergen and an irritant. Irritants and allergens are often grouped together with environmental and miscellaneous factors and called “triggers”. Triggers differ from one person to another and it is only over a period of time that many patients and their family members learn to identify the triggers that cause the most trouble or cause the individual’s eczema to flare-up. Below is synopsis of triggers that are often associated with children suffering from atopic dermatitis.

Wool and Synthetic materials and rough or poorly fitting clothing can rub the skin, trigger inflammation, and cause the itch-scratch cycle to begin. Avoid nylon and wool and use 100% cotton bedding and clothing. Cotton is more comfortable against the skin and allows the skin to ‘breathe’ to keep the skin cool.
Excessive moisture such as from saliva or milk causes frequent wetting and drying of the skin which can affect the skin barrier function.
Pests - Dust mites, fungus, and mold may irritate a child’s eczema. The environment where the child lives should be as free of these irritants as possible. Having hardwood floors, washing the bedding at high temperatures, using special high-powered vacuum cleaners and allergen/dust proof mattress and pillow covers can help to better manage these microscopic creatures.
Pollen - Avoid freshly mown grass, as children with eczema are often allergic to grass pollen.
Soaps and Irritating detergents may have a drying effect and worsen itching. Avoid using soap if possible because even the mildest soap may worsen the eczema. An option is to use a bath emollient or an emollient cleansing bar instead of soap. The parent may also have to experiment with different washing powders/liquids for clothes because some of these may make eczema worse. Good advice is to wash clothing and bedclothes using a mild soap product (avoiding bleach and fabric softeners), and make sure everything is rinsed thoroughly (i.e. twice).
Cigarette smoke - ban smoking in the home because tobacco fumes may irritate the skin.
Avoid pets - if your child has eczema try to avoid pets – contact with fur and feathers can irritate the skin. Keep your child away from household pets. Pets such as cats and dogs often aggravate eczema. They don't have to come into direct contact with the child to cause a problem, so it really is best not to have any furry pets in the house.
Perfumes and cosmetics may irritate the skin.
Solvents, or sand may also make the condition worse.
Food - The World Allergy Congress in 2003 highlighted that 38% of infants and children with infantile eczema have an underlying food allergen cause as the trigger. Common foods that are most commonly allergenic (allergy causing) include cow's milk protein, hen's egg white, peanuts, soya, cod fish and even wheat. These allergies can be identified by Skin Scratch Tests and UniCAP RAST tests on a blood sample. Once identified, withdrawal of the offending food can lead to rapid improvement in an individual’s eczema. Infants with eczema have a four times higher risk of being sensitized to milk and an eight times higher risk of sensitization to eggs than infants without eczema. It is suggested that introduction of the potential allergy-provoking foods such as cow’s milk, wheat and peanut not be introduced before 12 months of age, and it is recommended that eggs and fish only be introduced after 18 months. Food additives and colourings may also aggravate eczema in older children. Other foods that commonly cause adverse reactions in eczema sufferers include citrus fruit, tomatoes, pineapples and Marmite. Infants can be skin tested for food allergies from 4 months of age.
Excessive Dryness – the low humidity of winter or a dry year-round climate in some geographic areas can make the disease worse. The skin should be kept well moisturized, even when a rash is not present. Bathing without moisturizing properly afterwards is a common factor that triggers a flare of atopic dermatitis.
Overheating - Prevent overheating. Use cool, light bedding, loose clothing and always keep the bedroom somewhat cool at night. Avoid long, hot baths or showers.
Cold air
Avoid rubbing and scratching the skin
Bacterial infections

Part 2: Beyond the Doctor

Healthy Diet - The implications of the theory that indigestion is the main cause of eczema in Chinese paediatrics are several. Diet is considered of utmost importance in the treatment and prevention of allergic diseases such as eczema. Besides avoiding known food allergens, other basic dietary concepts should be followed. First, children should be fed a light, easily digested diet. In Chinese medicine, this is called the "clear, bland diet” because clear, bland foods are easily digested. These foods make the child’s digestion work less and therefore more efficiently. For infants, this also means not overfeeding. Breastmilk is the single best food for infants and has been shown to decrease the incidence of eczema. Although breast milk is the best source of nutrition, the infant cannot completely digest it if they are overfed and this may lead to stagnant food in the stomach, dampness and heat. When solid foods are first introduced, one should start with easily digested foods such as cooked vegetables (peas, carrots, sweet potatoes etc.) and well-cooked grains such as rice. Rice is easy to digest and is well-tolerated due to its hypoallergenic nature. The process of digestion in Chinese medicine is likened to the process of cooking and distillation. Cooked foods are more easily digested than uncooked foods. In other words, cooking is a form of pre-digestion. Therefore, infants and very young children do best when they are fed mostly cooked, mashed, partially predigested foods. When children eat uncooked, chilled, or cold foods these foods "douse" the digestive fire. Likewise, drinking too many liquids (especially with meals) "swamps" the spleen and hampers its function. In addition, foods that Chinese medicine term very "dampening" or fluid producing easily harm the spleen when overeaten. Dampening foods include sugars and sweets, dairy products, peanut and other nut butters, and bread. Individuals with allergic conditions often benefit from reducing or eliminating foods that are made through fermentation or which mold easily. This includes bread, cheese, vinegar, tomatoes, peaches, strawberries, etc.. Children do best when they eat a wide variety of foods including well-cooked, easily digested grains, cooked vegetables, cooked fruits, some raw fruit such as apples, pears, and bananas, and small amounts of lean meat. In addition, liquids should be taken at room temperature or warmer.
Give lukewarm baths - Healing the skin and keeping it healthy are important in the prevention of further damage and enhancing the quality of your child’s life. Bathing helps keep the skin free from crusts and scales, which in turn helps to prevent infection. Keeping a moderate amount of moisture in the skin is a cornerstone of treatment. To keep skin healthy, it is better to avoid long baths. Experts once thought that cutting down on all baths was important. Now we know that long baths and soaps are problematic for most children. When the skin ‘prunes’, this disrupts the moisture-retaining layer of sensitive skin.

Bathe your child frequently in tepid, not hot, water for 5 to 10 minutes. If necessary, use mild cleansers free of perfumes and harsh irritants. These brief baths help to cleanse and moisturize the skin without drying it excessively and will hydrate the skin, while not drying it out. Bath emollients are widely prescribed by doctors to treat eczema and they are formulated to work with the bath water to rehydrate and moisturize the skin. The water penetrates the skin and is then sealed in by the emollient, which creates a protective barrier.
Apply moisturizer (emollient) at least two times per day and especially immediately following a bath. Using moisturizers regularly on your child’s skin is important and is the mainstay therapy used by modern medical doctors and dermatologists in the treatment of eczema. Normal skin has an oily layer that controls moisture loss. Children with eczema have a defective oily layer and excessive moisture loss causes itchiness and irritation. Emollients that are composed of a mixture of oil, fat and water leave an oily layer on the skin. This oily nature repairs the barrier thereby reducing moisture loss and rehydrating the skin by restoring it’s oil and moisture content. After a bath, air-dry the skin, or pat it dry gently (avoiding rubbing or brisk drying). While the skin is still damp, apply moisturizers (to the child’s entire body) to create a barrier against water loss. In addition to restoring the skin's moisture, lubrication increases the rate of healing, reduces roughness, scaling and itching and establishes a barrier against further drying and irritation. Lotions that contain a large amount of water or alcohol evaporate more quickly, and alcohol may cause stinging. Instead, make sure any moisturizers or emollients you use are rich enough (have a high oil to water ratio) to help keep moisture in the skin.
Keep child's fingernails filed short and clean. If necessary, use cotton gloves or mittens at night to prevent scratching during sleep.
Select soft cotton fabrics when choosing clothing
Keep the child cool; avoid situations where overheating occurs
Avoid scratching - attempt to distract the child with activities to keep him or her from scratching.
Identify and remove irritants and allergens
Be Patient - Eczema is a chronic disease and must be managed daily. Find a routine both you and your child can manage and be consistent with it.
Involve your child - It's important to involve your child in the treatment of their eczema and their own skincare. It helps them achieve a sense of control over their disease and helps them feel that they can do something to improve their own symptoms.

Main Topics Adolescent Acne Allergic Rhinitis ADHD Asthma Bed-wetting Common Cold Ear Infections Eczema Obesity Other Topics 15 Ways to Boost Your Immunity Allergies Breastfeeding Food for Thought Is natural medicine safe for children? Sleep Miscellaneous Research Clinic Locations	Eczema Form Printable version Common Triggers and Tips to Prevent Flare-ups of Paediatric Atopic Dermatitis Part 1: Common Triggers If your child has ever experienced sudden, unexpected bouts of the red, sore, itchy rash of eczema, then they have experienced an eczema 'flare-up'. Many factors or conditions can make symptoms of atopic dermatitis worse (i.e flare-up). Thus, further triggering the already overactive immune system, aggravating the itch-scratch cycle, and increasing the damage to the skin. These factors can be divided into two main categories: irritants and allergens. Irritants are substances that directly affect the skin. When present in high enough concentrations with long enough contact, irritants cause the skin to become red, and itchy or burning. Specific irritants affect people with atopic dermatitis to different degrees. Allergens are substances from foods, plants, animals, or the air that inflame the skin because the immune system overreacts to the substance. Inflammation occurs even when the person is exposed to small amounts of the substance for a limited time. Although it is known that various allergens in the air can worsen eczema, scientists are not certain whether inhaling these allergens or their actual penetration of the skin causes the problems. When people with atopic dermatitis come into contact with an irritant or allergen they are sensitive to, inflammation-producing cells become active. These cells release chemicals cause itching and redness. As the person responds by scratching and rubbing the skin, further damage occurs. A number of studies have shown that foods may trigger or worsen atopic dermatitis in some people, particularly infants and children. In general, the worse the atopic dermatitis and the younger the child, the more likely a food allergy will be present. An allergic reaction to food can cause skin inflammation (generally an itchy red rash), gastrointestinal symptoms (abdominal pain, vomiting, diarrhea), and/or upper respiratory tract symptoms (congestion, sneezing, and wheezing). A recent analysis of a large number of studies on allergies and breastfeeding indicated that breastfeeding an infant for at least 4 months may protect the child from developing allergies. However, some studies suggest that mothers with a family history of atopic diseases should avoid eating common allergenic foods during late pregnancy and breastfeeding. In addition to irritants and allergens, emotional factors, skin infections, and temperature and climate play a role in atopic dermatitis. Although the disease itself is not caused by emotional factors, it can be made worse by stress, anger, and frustration (and is more of a factor in older individuals moreso than children). Irritants and allergens are closely related and sometimes a substance can be both an allergen and an irritant. Irritants and allergens are often grouped together with environmental and miscellaneous factors and called “triggers”. Triggers differ from one person to another and it is only over a period of time that many patients and their family members learn to identify the triggers that cause the most trouble or cause the individual’s eczema to flare-up. Below is synopsis of triggers that are often associated with children suffering from atopic dermatitis. Wool and Synthetic materials and rough or poorly fitting clothing can rub the skin, trigger inflammation, and cause the itch-scratch cycle to begin. Avoid nylon and wool and use 100% cotton bedding and clothing. Cotton is more comfortable against the skin and allows the skin to ‘breathe’ to keep the skin cool. Excessive moisture such as from saliva or milk causes frequent wetting and drying of the skin which can affect the skin barrier function. Pests - Dust mites, fungus, and mold may irritate a child’s eczema. The environment where the child lives should be as free of these irritants as possible. Having hardwood floors, washing the bedding at high temperatures, using special high-powered vacuum cleaners and allergen/dust proof mattress and pillow covers can help to better manage these microscopic creatures. Pollen - Avoid freshly mown grass, as children with eczema are often allergic to grass pollen. Soaps and Irritating detergents may have a drying effect and worsen itching. Avoid using soap if possible because even the mildest soap may worsen the eczema. An option is to use a bath emollient or an emollient cleansing bar instead of soap. The parent may also have to experiment with different washing powders/liquids for clothes because some of these may make eczema worse. Good advice is to wash clothing and bedclothes using a mild soap product (avoiding bleach and fabric softeners), and make sure everything is rinsed thoroughly (i.e. twice). Cigarette smoke - ban smoking in the home because tobacco fumes may irritate the skin. Avoid pets - if your child has eczema try to avoid pets – contact with fur and feathers can irritate the skin. Keep your child away from household pets. Pets such as cats and dogs often aggravate eczema. They don't have to come into direct contact with the child to cause a problem, so it really is best not to have any furry pets in the house. Perfumes and cosmetics may irritate the skin. Solvents, or sand may also make the condition worse. Food - The World Allergy Congress in 2003 highlighted that 38% of infants and children with infantile eczema have an underlying food allergen cause as the trigger. Common foods that are most commonly allergenic (allergy causing) include cow's milk protein, hen's egg white, peanuts, soya, cod fish and even wheat. These allergies can be identified by Skin Scratch Tests and UniCAP RAST tests on a blood sample. Once identified, withdrawal of the offending food can lead to rapid improvement in an individual’s eczema. Infants with eczema have a four times higher risk of being sensitized to milk and an eight times higher risk of sensitization to eggs than infants without eczema. It is suggested that introduction of the potential allergy-provoking foods such as cow’s milk, wheat and peanut not be introduced before 12 months of age, and it is recommended that eggs and fish only be introduced after 18 months. Food additives and colourings may also aggravate eczema in older children. Other foods that commonly cause adverse reactions in eczema sufferers include citrus fruit, tomatoes, pineapples and Marmite. Infants can be skin tested for food allergies from 4 months of age. Excessive Dryness – the low humidity of winter or a dry year-round climate in some geographic areas can make the disease worse. The skin should be kept well moisturized, even when a rash is not present. Bathing without moisturizing properly afterwards is a common factor that triggers a flare of atopic dermatitis. Overheating - Prevent overheating. Use cool, light bedding, loose clothing and always keep the bedroom somewhat cool at night. Avoid long, hot baths or showers. Cold air Avoid rubbing and scratching the skin Bacterial infections Part 2: Beyond the Doctor Healthy Diet - The implications of the theory that indigestion is the main cause of eczema in Chinese paediatrics are several. Diet is considered of utmost importance in the treatment and prevention of allergic diseases such as eczema. Besides avoiding known food allergens, other basic dietary concepts should be followed. First, children should be fed a light, easily digested diet. In Chinese medicine, this is called the "clear, bland diet” because clear, bland foods are easily digested. These foods make the child’s digestion work less and therefore more efficiently. For infants, this also means not overfeeding. Breastmilk is the single best food for infants and has been shown to decrease the incidence of eczema. Although breast milk is the best source of nutrition, the infant cannot completely digest it if they are overfed and this may lead to stagnant food in the stomach, dampness and heat. When solid foods are first introduced, one should start with easily digested foods such as cooked vegetables (peas, carrots, sweet potatoes etc.) and well-cooked grains such as rice. Rice is easy to digest and is well-tolerated due to its hypoallergenic nature. The process of digestion in Chinese medicine is likened to the process of cooking and distillation. Cooked foods are more easily digested than uncooked foods. In other words, cooking is a form of pre-digestion. Therefore, infants and very young children do best when they are fed mostly cooked, mashed, partially predigested foods. When children eat uncooked, chilled, or cold foods these foods "douse" the digestive fire. Likewise, drinking too many liquids (especially with meals) "swamps" the spleen and hampers its function. In addition, foods that Chinese medicine term very "dampening" or fluid producing easily harm the spleen when overeaten. Dampening foods include sugars and sweets, dairy products, peanut and other nut butters, and bread. Individuals with allergic conditions often benefit from reducing or eliminating foods that are made through fermentation or which mold easily. This includes bread, cheese, vinegar, tomatoes, peaches, strawberries, etc.. Children do best when they eat a wide variety of foods including well-cooked, easily digested grains, cooked vegetables, cooked fruits, some raw fruit such as apples, pears, and bananas, and small amounts of lean meat. In addition, liquids should be taken at room temperature or warmer. Give lukewarm baths - Healing the skin and keeping it healthy are important in the prevention of further damage and enhancing the quality of your child’s life. Bathing helps keep the skin free from crusts and scales, which in turn helps to prevent infection. Keeping a moderate amount of moisture in the skin is a cornerstone of treatment. To keep skin healthy, it is better to avoid long baths. Experts once thought that cutting down on all baths was important. Now we know that long baths and soaps are problematic for most children. When the skin ‘prunes’, this disrupts the moisture-retaining layer of sensitive skin. Bathe your child frequently in tepid, not hot, water for 5 to 10 minutes. If necessary, use mild cleansers free of perfumes and harsh irritants. These brief baths help to cleanse and moisturize the skin without drying it excessively and will hydrate the skin, while not drying it out. Bath emollients are widely prescribed by doctors to treat eczema and they are formulated to work with the bath water to rehydrate and moisturize the skin. The water penetrates the skin and is then sealed in by the emollient, which creates a protective barrier. Apply moisturizer (emollient) at least two times per day and especially immediately following a bath. Using moisturizers regularly on your child’s skin is important and is the mainstay therapy used by modern medical doctors and dermatologists in the treatment of eczema. Normal skin has an oily layer that controls moisture loss. Children with eczema have a defective oily layer and excessive moisture loss causes itchiness and irritation. Emollients that are composed of a mixture of oil, fat and water leave an oily layer on the skin. This oily nature repairs the barrier thereby reducing moisture loss and rehydrating the skin by restoring it’s oil and moisture content. After a bath, air-dry the skin, or pat it dry gently (avoiding rubbing or brisk drying). While the skin is still damp, apply moisturizers (to the child’s entire body) to create a barrier against water loss. In addition to restoring the skin's moisture, lubrication increases the rate of healing, reduces roughness, scaling and itching and establishes a barrier against further drying and irritation. Lotions that contain a large amount of water or alcohol evaporate more quickly, and alcohol may cause stinging. Instead, make sure any moisturizers or emollients you use are rich enough (have a high oil to water ratio) to help keep moisture in the skin. Keep child's fingernails filed short and clean. If necessary, use cotton gloves or mittens at night to prevent scratching during sleep. Select soft cotton fabrics when choosing clothing Keep the child cool; avoid situations where overheating occurs Avoid scratching - attempt to distract the child with activities to keep him or her from scratching. Identify and remove irritants and allergens Be Patient - Eczema is a chronic disease and must be managed daily. Find a routine both you and your child can manage and be consistent with it. Involve your child - It's important to involve your child in the treatment of their eczema and their own skincare. It helps them achieve a sense of control over their disease and helps them feel that they can do something to improve their own symptoms.
The frog does not drink up the pond in which he lives. Native American Proverb
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