What Pharmacists Need to Know About the Onset of Eczema and Food Allergies in Toddlers
When the first signs of eczema appear in infants and toddlers, parents often think it’s a temporary rash. Before long, they’re faced with an ongoing cycle of flare-ups that persist for years. It’s agonizing to have a child who is miserable from itching and prone to infections—and that’s not even to mention that eczema heralds a higher risk for food allergies.
Pharmacists will be in a better position to help these parents when they know how to recognize the characteristics of eczema, which are different depending on age. Then you can take intervention a step further by sharing information from the latest study about eczema and food allergies in toddlers.
Association of Eczema and Food Allergies in Toddlers
Even though experts acknowledge that eczema is related to various allergies, researchers continue to define its association with food allergies. A study published in 2010 correlated eczema onset, appearance of food allergies, and the timing of food introduction. Based on 960 children participating in a family-based food allergy cohort, researchers learned that:1
- Children with eczema have an 8-fold higher risk of food allergy
- In children with eczema, timing of formula and food did not change the risk for food allergy
- In children without eczema, timing of formula and food made a difference—the risk of food allergy was lower with later introduction of formula and solid food (after 6 months for formula and at least 1-year-old before solid food)
More insight was gained in November 2016, when the Journal of Dermatological Sciences published a study that collected information about 1550 children at 6 months, 1, and 3 years of age.2 They found that:
- Eczema within 1 to 4 months after birth is a significant risk factor for food allergy
- Eczema onset in the first 2 months had the highest risk of food allergy at 3 years of age.
- Eggs and cow’s milk were the most common allergens.
When it comes to eczema and food allergies, it’s important to know that dermatologists and allergists still tend to disagree about cause-and-effect. In spite of ongoing discussions, pharmacists should still counsel parents about the risks for food allergies so they can watch for symptoms and get early testing if necessary.
Recognizing Eczema in Infants and Toddlers
When identifying eczema, age must be taken into consideration because it manifests differently in infants, toddlers, and older children. The National Eczema Association describes its appearance as follows:3
Babies up to six months old:
- Eczema most likely to appear on the face, cheeks, chin, scalp and forehead
- May spread to other parts of the body but not typically the diaper area
- Skin appears red and oozy
Six months through one year:
- Eczema most often occurs on elbows and knees
- More likely to develop small, raised bumps that leak and form a yellow crust
Toddlers aged two to five years:
- Eczema tends to appear on wrists, ankles, and hands, or in the creases of elbows and knees
- Sometimes appears around mouth and eyelids
- Skin typically becomes dry and scaly, turning thick and hard with deep lines
Eczema often occurs in the first six months of life then persists into childhood and adolescence. During that time, parents must stay on alert for food allergies.
Skin Care to Treat Eczema
The underlying cause of eczema isn’t well defined—it arises from some combination of genetics, immune dysfunction, environmental triggers, and bacteria on the skin. It can’t be cured, so treatment focuses on relieving symptoms and restoring the skin barrier using moisturizers and topical medications.
Parents should begin by identifying and eliminating irritants such as rough towels or clothing, scented skin care products, and circumstances that cause excessive sweating. Then their attention must turn to healing dry skin and maintaining their child’s skin barrier. Recommendations include:
- Lukewarm baths – Children with eczema can soak in non-soapy, lukewarm water. Parents should use a moisturizing soap, gently pat them dry, and immediately apply a moisturizer.
- Moisturizers – Moisturize the child’s entire body, with special attention to affected areas. Apply two to four times daily or according to the doctor’s recommendation. Children with eczema are prone to dry skin, so this routine should continue between eczema flare-ups.
Pharmacists should take every opportunity to remind parents to never let up on applying moisturizers. While this is standard and essential care, a study published in JAMA Pediatrics in December 2016 suggests that daily moisturizing may prevent eczema—and it doesn’t have to be expensive.4 Researchers from Northwestern University evaluated the cost-effectiveness of daily prophylactic moisturization of infants younger than 6 months who were at a high risk for dermatitis. Here’s a rundown of their study:
- Emerging evidence suggests that applying moisturizers daily, from the first few weeks of life through 6 to 8 months, lowers the risk of eczema.
- Seven common moisturizers including petroleum jelly, Aquaphor, Cetaphil, and Aveeno were compared using the same unit of weight per moisturizer per given body area.
- Incremental gain in quality-adjusted-life-years (QALY) was calculated over 6 months.
- Average price of products used was $1.07 per ounce—the range was 13 cents to $2.96 per ounce.
- All of the moisturizers improved QALY except the most expensive product.
- The most cost-effective product was plain petrolatum.
This is important information for parents because moisturizing costs may not be covered by insurance. Of course, some parents may prefer not to cover their baby in heavy, plain petrolatum, so you can help them choose other petrolatum-based products.
Medical therapy: Depending on symptom severity, physicians may prescribe topical corticosteroids, antibiotics, antiviral, or antifungal drugs. Topical calcineurin inhibitors are approved for second-line treatment, but only for children 2 years and older. When you dispense topical medications, assess the delivery base being used to be sure it’s the most emollient and least likely to avoid sensitive skin. Parents of infants and toddlers are understandably concerned about using potent medications on their children, so pharmacists should take a few minutes to personally counsel them about safety, proper use of the medication and adverse effects.
Pharmacists Help Support and Encourage Parents
Parents of infants and toddlers with eczema face years of treating intractable itch and skin infections. They must deal with issues that arise from sleep deficient children. Parents will miss work, children will miss school, and then on top of it all, parents have to worry about food allergies and how to avoid further complications. As you guide OTC choices and offer medication counseling, remember that it only takes a few words of encouragement to lift a parent’s spirits.
Pharmaceutica North America provides prescription drug products and high-quality active pharmaceutical ingredients that help relieve symptoms of eczema. Contact us today to talk about how we can support your pharmaceutical needs.
- “Early Life Eczema, Food Introduction, and Risk of Food Allergy in Children,” September 2010, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3281290/ ↩
- “Timing of Eczema Onset and Risk of Food Allergy at 3 Years of Age: A Hospital-Based Prospective Birth Cohort Study,” November 2016, https://www.ncbi.nlm.nih.gov/pubmed/27523805 ↩
- “Understanding Your Infant or Toddler’s Eczema,” accessed December 2016, https://nationaleczema.org/eczema/child-eczema/infants-toddlers/ ↩
- “Cost-Effectiveness of Prophylactic Moisturization for Atopic Dermatitis,” December 2016, http://jamanetwork.com/journals/jamapediatrics/article-abstract/2588412 ↩