Mommy, it itches!

This article was written for bibaleze.si and can be found in the Slovene language here. The article has many useful pieces of information on atopic dermatitis in children. Happy reading.

Atopic dermatitis: »Mommy, it itches!«

The atopic skin of children is very dry and sensitive and demands consistent daily care and constant action to prevent the illness from flaring up. The symptom that has the strongest negative impact on the quality of the life of patients with atopic dermatitis and for which there is no effective cure is the chronic itch. By definition, chronic itch is an itchy sensation that lasts longer than six weeks and affects every atopic dermatitis patients. To sooth it, doctors usually prescribe antihistamines, which are rarely effective since histamine isn’t the main inflammation mediator in atopic dermatitis.

It’s a widely accepted opinion that the atopic skin itches due to the rashes that appear on it. If patients would stop scratching and had appropriate skin care, the rashes would disappear and take the itch with them. In reality, it’s not that simple. In the English language, there’s  a very suitable and frequently used phrase to describe the itch in atopic dermatitis patients: “It is not the rash that itches, but it is the itch that rashes.”

What can parents do?

Atopic dermatitis is a complex and complicated condition. Much about the condition is still unknown in spite of the increasing scientific attention that it has received in the past few years. One of the main questions that patients or parents with children with atopic dermatitis pose to their doctors is how to deal with the devastating itch. What can us as parents do ourselves to prevent the child from scratching and ease the the itchy sensation? I will try putting forward a few pieces of advice that proved useful against the itch. Here, it’s important to stress that not every single advice will be appropriate for all atopic dermatitis patients. There are as many differ ways in which atopic dermatitis manifests itself as there are patients suffering from it, which is why an individual approach and personalised treatment are very important.

What to do when your child begins to scratch?

It’s been proven for some time now that scratching the skin worsens the signs and symptoms of atopic dermatitis. The skin gets damaged further and becomes more prone to secondary infections and irritations from allergens. These aren’t the only factors that intensify the itch, but they make circle of the itchy sensation and scratching even more inescapable.

Regardless of where on the body the atopic dermatitis appears, the itch is the worst of all the illness’ symptoms. Children scratch until drawing blood. They rub the itchy skin against bed covers and other surfaces and seek out cool areas in their beds with which to ease the itch momentarily. The wounds are extensive. The distress that accompanies the itch is intense, and the child will use each and every opportunity to scratch and thus relieve his or her anguish.

Don’t try to prevent your child from scratching at all costs

I’ve often seen parents who try to physically stop their child from scratching by holding the child’s hand. I’m well aware that these parents want to help their child and prevent the damage to the skin, but in doing so they overlook the child’s basic physical necessity – the soothing of the itch. The itchy sensation is unbearable, and the child has no choice in whether to scratch or not. He or she simply needs to scratch. Scratching is actually most often the result of subconscious motor activity – it’s a reflex towards soothing the itch through pain. Each painful sensation brings relief.

In order to prevent the damage from scratching and sooth the itch, clip the child’s nails short and have him or her wear long, light and breathable clothing as well as gloves that prevent direct contact with the skin. The child shouldn’t be too hot in order to prevent the sweating and the resulting itchy sensation. When the child shows his or her anguish due to the itch, you can help by stroking the affected skin, pinching it lightly, tap on it with your fingers, keep it cool with wraps and so on. Listen to your child’s wishes, pay attention to what calms him or her down and see what you can do to help. Always take your child’s wishes into account.

Distraction

The parents of children with atopic dermatitis know that the distress due to itchy skin is enormous. The constant search for ways to sooth the itch is frustrating. Because of the itch, children only focus on what brings them partial relief, which always boils down to scratching. One of the methods that help reduce the itchy sensation is distraction. When children become distracted with an activity that keeps their hands busy, they scratch less. Observe your child to see when the itch is most intense.

With babies and very small children, you can try picking up a special toy that you will use to play with and animate your child when the itch appears. This toy should only be used for diverting the child’s attention away from the itch and the scratching. Afterwards, put the toy away. Older children can be distracted with their favourite activities. Be creative in finding ways to keep your child’s mind and fingers busy. Try drawing together; play with plaster and clay and so on. The intensity of the itch usually increases the early evening hours. In the late afternoon, plan a walk in the nature, and in the evenings, pass the time with various calming family games.

Triggers

The goal of all parents whose child is an atopic patient is to keep the signs and symptoms of the illness under control. In controlling the scratching, it’s very important to avoid the potential triggers of the illness. It’s important to stress that triggers affect children differently – what worsens atopic dermatitis in one child has no effect on the other. Sometimes the body responds to a trigger immediately, while sometimes the response is delayed for a few days

It’s not easy to identify your child’s triggers, so I advise you to keep a diary. Write down what your child drinks and eats and what sports activities he or she engages in. Note the locations in which your child spends time during the day and the types of chemicals that you use when cleaning the house. Observe also whether your child experiences stress (both positive and negative kinds). Pay attention to each and every change even if it seems unimportant to you. If your child has confirmed allergy to certain substances or you’ve noticed that the state of his or her skin deteriorates after eating certain foods or coming in contact with other allergens, avoid the food and the allergens strictly.

Skincare

Proper skin care and hygiene of the atopic skin are crucial. Wash the child’s skin twice a day to remove sweat, potential allergens and the remaining cream. The skincare routine should be particularly thorough in the evening. The ways of washing – using a sponge, dousing or taking a bath – differ from person to person. Find out what suits your child’s skin best. The water should be lukewarm and the bathing time limited. Stick to the 3-Minutes Rule: after washing the skin, wipe it gently while keeping it moist and apply the skincare product to in the next three minutes. By using skincare products, we bolster the skin’s barrier function and reduce the amount of allergens and microbes that can enter the body. In this way, we reduce the inflammation of the skin and the intensity of the itch. If our child suffers from secondary skin infections, a visit to the doctor is necessary.

It may take a long time before you find the suitable skincare routine and skincare products for your child, but keep at it. Try out different skincare and cooling creams, zinc creams and various combinations of creams, lotions and ointments. Each skin is different, each atopic rash is different and not every dry skin is dry in the same way.

If you’re breastfeeding, try using your milk on the atopic skin of your child. Breast milk is reported to have the effect equivalent to the one percent of the hydrocortisone ointment.

Clothing

Selecting clothes suitable for the skin of atopic dermatitis patients is important, as the skin is sensitive to all kinds of mechanic irritation. It’s been proven that wool and artificial fibres such as polyester, acrylic and polyamide make the skin more irritable and itchy. If possible, buy your child clothes that are made of natural textiles, are light, loose and breathable. Cotton, linen, bamboo, hemp and silk materials are best. Cotton is the most popular textile amongst the patients, as it’s durable and affordable. It’s a great heat conductor and absorbs moisture well.

However, we must be aware that even natural clothes can irritate the skin. Cotton fibres are short and can prick at the skin. Even the colours used in textiles can irritate. When it comes to silk, another popular material, some atopic dermatitis patients can develop an allergic reaction to sericin, a protein found in silk. Read the labels on the clothes carefully before allowing your child to take home an item of clothing. Babies and children aren’t able to pick the appropriate clothes for themselves. Remember that your child’s skin also comes in contact with your own clothes and the bedsheets, so make sure that these items are made from appropriate materials as well.

Apple vinegar bath

The itchy skin can be soothed with baths to which different natural substances are added. One of the most frequently used baths is the apple vinegar bath. Apple vinegar has a mild antimicrobial effect and can help establish a healthy state of the skin. The natural pH of the healthy skin is slightly acidic (around 5), while the pH of the atopic skin is usually alkaline (above 7). When the pH of the skin is alkaline, the balance in the skin is broken, the skin barrier ceases to function properly, and the skin begins to lose moisture. The microbiotic environment in the skin is also disrupted. The skin can be colonised by pathogens, which strongly worsens the atopic state. Vinegar baths help reduce the pH of the skin and have an antimicrobial effect, which allows for better regulation of the bacteria on the skin and thus prevents the development of pathogen bacteria and fungi. Preparing a vinegar bath is simple and can reduce the need for using antimicrobial creams.

The beneficial effects of apple vinegar on the atopic skin have been recorded already in the times of Hippocrates

The beneficial effects of apple vinegar on the atopic skin have been recorded already in the times of Hippocrates, but the application of the vinegar to the atopic skin is often inappropriate and also dangerous. In the hope of reducing the itch, parents wash the damaged atopic skin of their children with 1:1 vinegar-water solution or even use undiluted vinegar on the skin. Vinegar is an organic compound that can, in rare cases, cause chemical burns even on a healthy skin. In the presence of extensive, fresh and open wounds in atopic dermatitis, applying undiluted vinegar is pure agony to the child.

Children with atopic dermatitis experience a great deal of suffering due to their illness already, and it’s important that we don’t cause them additional pain. Child patients are used to painful sensations and may marshal through your inappropriate vinegar treatment. In a lot of cases, children also want to please their parents and won’t complain of the pain. To make an appropriate vinegar bath for a child with atopic dermatitis, add 1 to 2 dcl of homemade apple vinegar to the child’s bathtub. The vinegar-water ration should be 1:80, depending on the severity of the skin condition and the skin’s tolerance to vinegar.

Conclusion

It’s worth remembering that adopting appropriate skincare and life style can reduce your child’s need for stronger medications and sooth the itch, especially with mild-to-moderate forms of atopic dermatitis.