Wednesday, 26 February 2014

Dry skin or Atopic Dermatitis in children

I see a lot of parents in my practice who are anxious and worried about the recurring dry skin of their children or Atopic Dermatitis. This not only is a cause of concern but can be a distressing condition for the children as well. In this blog post on pediatric dermatology, We shall discuss the causes and care required for alleviating the discomfort associated with this under recognized but important skin condition affecting children. I would be glad to answer your queries and comments.

Q – What is the cause of dry skin of my child?

Ans – Our skin has a ‘brick and mortar’ arrangement where the skin cells are the bricks and they are fused with each other by “Natural Moisturizing Factors’ (NMF). NMF is made up of free fatty acids and Ceramides. It is believed that deficiency in this NMF leads to ‘Dry Skin condition’ or “Atopic Dermatitis”. Atopic dermatitis simply can be put as ‘an itch that rashes’. It includes a tendency to have allergies at places where body is in contact with the external environment like allergic rhinitis, hay fever and eczemas.

Q – What are the risk factors for atopic dermatitis?
Ans- A positive family history of similar dry skin, asthma, hay fever or eczema can predispose the children to this condition. It is more found in urban areas than rural. It is largely believed that a cleaner environment and healthier diets to pregnant mothers exposes the child in utero to very few infections. As a result of which their immunity is hyperactive and shifts to a tendency for allergies. (HYGIENE HYPOTHESIS”).

Q – What can I do to alleviate my child’s discomfort?
Ans – There are a basic set of precautions and special care that I advise my patients to reduce the frequency and severity of dry skin in children.
a)      SHORT Bathing time – reduce the shower time to less than five minutes.
b)     SOAP USAGE – Minimal application of soap to the entire body and choose a moisturizer containing soap. (For further reading read my blog on this link ).
c)      LUKEWARM water – instead of very hot water. Water and soap further dry and reduce the lipid layer of ski , hence they aggravate the condition.
d)     MOISTURIZE with a recommended moisturizer within three minutes of bath after gently patting the skin dry. Don’t handle skin in a rough manner at all.
e)      CONTACT with woolen garments, fur and dust should be minimized.
f)       COTTON or LINEN garments should touch your child’s skin.
g)      MINIMIZE things which catch dust like carpets and soft toys around your child.
h)     PREFER vacuum cleaning at least once a month.

Q- Which moisturizer should I use for my child‘s skin?
Ans- Moisturizer is the lifeline to prevent this condition as they seal the fissures and improve the disturbed barrier function. They are of different types-
a)      Emollients - They are naturally found in palm and coconut oil. They replenish the natural moisturizing factors. Shea cocoa butter containing products belong to this category.

b)     Occlusives- They serve to seal the gaps between skin cells and make skin ‘slippery’. They are greasy, messy and have allergic potential.  Petroleum jelly is an ideal example. I would rank them lower in my choice of moisturizers. 

Q- What is an ideal moisturizer?
Ans - Patients who are confused by media hype often ask this question. The ideal moisturizer should be:

Q – Which type of moisturizer do you recommend?
AnsThe following is a quick guide for choosing a moisturizer     
1)Moisturizers designed for the face are typically non-greasy, non-comedogenic emollients, with an emphasis on skin feel and aesthetics with maximal skin benefits.
2) Silicone derivatives in particular are targeted for consumers with oily skin. Kaolin and Talc containing compounds are good for oily skin.
3) Moisturisers marketed as anti ageing should include sun protectants, alpha hydroxy acids (e.g., glycolic acid), and retinol and its derivatives.
4)Prefer lotions for day time use while creams are thicker and should be applied at night.
5)Emollients containing moisturisers like shea butter , squalene should be preferred for very dry skin over body and hands. Avoid them on face as they can trigger ‘acne’ or ‘pimples’.

Q- Which oil should I use for my child?

Ans – Coconut oil has been shown to improve the skin barrier which is deficient in atopic children. Olive oil and other oils are harmful than helpful for skin.It has been proven by studies that the barrier function is best restored with the coconut oil. Coconut milk is equally desirable.

Atopic Dermatitis tends to improve with age. It should not cause unnecessary anxiety and concern. There are simple and effective treatments available which can remit or at-least maintain results. Consult your dermatologist today for daily skin care regimen. 
Stay skin healthy and skin wiser!!

Dr Divya Sharma is a practicing dermatologist at Bangalore. The data shared in this blog is her personal opinion based on her knowledge and experience. The author is not responsible for any adverse event that arises out of following blog opinion


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