Atopic or allergic dermatitis is a common
condition that shows up as dry skin and inflamed rashes.
A woman's
history of allergy affects the odds of her child developing it within six
months of birth.
From age
six to 12 months, the odds are further raised if the child attends a daycare
centre and his mother also has a history of allergy.
If the
condition sets in after the child turns one - in what is known as late-onset
atopic dermatitis - it is linked to two other factors.
One, the
child may have been given probiotics when he was between nine and 12 months.
Two, he
could have been given antibiotics between his birth and sixth month.
These
local research findings were published online in April last year in the
International Archives Of Allergy And Immunology.
There
search is part of an ongoing project called Growing Up in Singapore Towards
Healthy Outcomes, which was started in 2009 with about 1,200 expectant women.
It is a
collaboration between the National University Health System, KK Women's and
Children's Hospital and A*Star's Singapore Institute for Clinical Sciences.
Atopic
dermatitis has been highlighted as a likely first step in the "atopic
march", which is the progression of allergic disorders from early
childhood onwards.
Dr Lynn
Chiam, a dermatologist at Mount Elizabeth Novena Specialist Medical Centre,
said: "In the atopic march, young patients develop atopic eczema early on,
followed by a typical sequence of allergic rhinitis and asthma.
"One
allergy may subside as another starts, or the allergies may overlap so that
they suffer from more than one at a time. Some may persist for years, whereas
others may resolve with age."
The
researchers note that, because of this march, the predisposing factors for
atopic dermatitis must be identified.
Professor
Lee Bee Wah, one of the study's authors, said atopic dermatitis is likely to be
caused by a combination of an abnormal skin barrier - often manifested as dry
skin - and a propensity for the skin to get inflamed.
Those
with an earlier onset of atopic dermatitis seem to be at a higher risk of
developing environmental allergies, she added.
Dr Chiam,
who was not involved in the study, postulated that the higher odds of getting
atopic dermatitis after attending a daycare centre may be linked to the child's
exposure to viruses, pollution and an altered skin hygiene.
But Prof
Lee, from the department of paediatrics at the National University of
Singapore's Yong Loo Lin School of Medicine, pointed out that the risk from probiotics
may be confounded by the tendency of mothers to use it on their children who
are already at risk of atopic dermatitis, hence giving the false impression
that probiotics increases the risk of atopic dermatitis.
As for
antibiotics, animal studies suggest that they alter the "good"
bacteria in our body and reduce our defence against inflammatory conditions.
Antibiotics
are prescribed to treat bacterial infections but viral infections are, by far,
more common in children, she said.
She
emphasised that the factors mentioned, including maternal history, probiotics
and antibiotics, may not be direct causes of atopic dermatitis but may raise
the risk of a child developing the condition.
Here are
tips from Prof Lee and Dr Chiam on caring for children with atopic dermatitis:
MOISTURISE
SKIN WELL
Choose a
moisturiser that suits the child's skin. It should not make the skin red and
should not sting .
Commercial
moisturisers aim to replace the natural moisturisers that our skin produce.
Choose one that contains products of filaggrin - a protein that helps to keep
skin condition healthy - such as arginine, sodium pyrrolidone carboxylic acid
and ceramides, to rebuild the child's natural skin barrier.
A good
example is the Cetaphil Restoraderm moisturiser. An ideal body wash should also
contain these filaggrin products.
DO NOT
IRRITATE SKIN
Avoid
excessive heat, use of harsh soaps and applications such as liniments and
powders, which dry the skin. Instead, use bath oils or non- soap cleansers.
After a shower, dab the skin dry instead of rubbing it .
For those
whose skin condition is made worse with heat and sweat, it is important to stay
in a cool environment. Avoid excessive exposure to sunlight and the use of
thick woollen clothes which may further irritate the skin.
BEWARE OF
INFECTED ECZEMA
Broken
and oozing skin is often a sign of infected eczema. Keep fingernails short and
remind children not to scratch, which will worsen the rash. Apply cold packs to
reduce the itch. Atopic dermatitis is particularly prone to bacterial
infection. When infection occurs, eczema often flares and it may need medical
treatment.
KNOW
AGGRAVATING FACTORS
Illnesses,
fevers, stress, insufficient sleep and tiredness can aggravate eczema. Some of
these cannot be avoided but, in these situations, skin care may have to be
intensified.
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