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The Girlfriends' Guide to Pediatric Eczema: The Basics

The Girlfriends' Philosophy is this:

Nearly everything you'll ever need to know about being a mother, you'll learn from other Girlfriends who've been there, done that. Don't get me wrong -- we LOVE our pediatricians and rarely make a move without consulting them, but sometimes we're embarrassed to ask questions or to "waste" their precious time with things that don't involve projectile vomiting or stitching a head wound. Plus there's the fact that some kid problems are more than just physical -- they're emotional too, and that's always hard to talk about, sometimes even with your Girlfriends.

This Girlfriends' Guide is devoted to eczema for several reasons: first, because it's so darn common that you can't go to a preschool without finding five or six kids who suffer from it; second, because this skin condition is one of the most misunderstood and frustrating, it often remains undiagnosed and inadequately treated; and third, to beg you, plead with you, and generally whine until you promise to consult your child's doctor to see if there's any relief for your little one that you aren't providing simply because you don't fully understand eczema.

Here's the most compelling information I know: Up to 17 percent of all Americans have eczema and of those, 90 percent had their first and possibly worst cases by the age of 5. Think about how many people may have experienced this condition and almost all of them had to deal with it at the same time they were being potty trained, starting preschool, and otherwise joining the outside world. Just the thought of how vulnerable we are makes me feel like crying.

In order to get the best Girlfriends' advice on eczema, I've not only talked with other moms, read everything I could find on the Internet (there's a lot there, by the way), and consulted hundreds of my mommy e-mail friends, but I've also consulted with a pediatric dermatologist and expert on eczema (and now my new girlfriend), Dr. Adelaide Hebert, professor and vice chairman of the department of dermatology at the University of Texas Health Sciences Center in Houston. So, while most of my information is anecdotal -- as it always is in the Girlfriends' Guides -- I'm reasonably assured by Dr. Hebert that nothing I'm saying is bad advice or just plain silly.

There is so much confusing and misleading information out there about eczema. One person tells you to rub your child's rash with petroleum jelly, someone else tells you petroleum products are dangerous, someone else tells you to teach your 2-year-old to give up baths and take only showers, while others tell you the condition comes from not keeping your little darling clean enough.

I have four kids who all went through stages of eczema and I barely survived some of them. If I'd only known with the first two what I learned by the third and fourth kid, I'd have a lot more tread left on my mothering tires. With the first two, I tried Calamine and Camouflage; in other words, I painted my little sufferers pink at night and dressed them in clothes that hid the condition by day. And if one had a flare-up on his or her face, then I'd just apply a Halloween mask or keep the kid home from school -- anything to avoid the stares of the other perfect mothers.

Well gather 'round Girlfriends (and Dads too) because people who've been there, done that are here to give you the skinny on what my daughter used to call "The Itchy Scratchy Disease." Here's some help and encouragement to get you and your child through the rough spots (no pun intended).

How to Treat Eczema
How to Treat Eczema

1. It's pronounced "EGGS-seh-mah"; it does not rhyme with Noxzema. (Although Dr. Hebert says some of her patients swear they get great relief by applying Noxzema they've chilled in the fridge to their trouble spots.)

2. Eczema is absolutely not contagious. Don't let anyone tell you otherwise.

3. A child with eczema may have or be predisposed to asthma and/or allergies. It is most common in people with a family history of asthma, hay fever, or eczema.

4. An outbreak of eczema symptoms is called a "flare-up" by the hip folks.

5. Conditions that make an eczema flare-up are called "trigger factors."

6. Doctors sometimes may refer to your child's eczema as "atopic dermatitis." Don't worry about the exact meaning. Some parents prefer this daintier and more clinical term, but a rash is a rash is a rash, if you ask me.

I will never get over the disappointment of my first baby girl's baptism day. She was wearing a gown that her grandmother had worn and all the family had flown in for the big day and I just knew the photos would be adorable, EXCEPT HER ENTIRE FACE WAS A BIG RED RASH! The poor little thing just kept rubbing her face on her crib sheets and my shoulder. I stopped crying long enough to call my pediatrician and was told that she was too young for cortisone cream and that I should try "expressing some breast milk and applying it to her face." At that point I canceled the photographer.

Sitting on my desk beside me as I write this is a picture of me holding my second child in the snow so he can taste his first snowflake. His cheeks are really pink, and I just thought he was too fair for such cold weather. Besides, it was kind of cute at first. Then they got cracked and angry looking and seemed to hurt him. I know it hurt me. I didn't bother mentioning it to a doctor because I thought it would just go away on its own, which it eventually did. Duh, now I know he had eczema, too. Believe me, it's been back to those precious fair cheeks several more times in the ensuing years.

Now that my kids are school-aged, the eczema seems to show up on their arms for some reason. All four of them walk around scratching. By this time, I know they have eczema -- I mean I've had my suspicions confirmed by medical doctors. But I learn more and more every day about the options available for treating eczema, preventing flare-ups, and coping emotionally.

You will only get a real diagnosis of eczema from a physician. The good news is, it involves no blood tests and only rarely may involve a skin scraping or biopsy to rule out other conditions, so no crying kids! Like Sherlock Holmes, your doctor will probably ask you a number of questions to indicate whether you seem like an "eczema family," like whether you or your mate have ever had the condition or any of its charming companions like asthma and hay fever.

Then they will look for telltale signs that this isn't just any old rash:

  • Does the rash itch? (It may be driving you and your child nuts!)
  • Is the rash recurring, meaning it gets better or worse for no apparent reason?
  • Is the rash red, scaly, dry, or cracked?
  • In babies and toddlers, does the rash commonly appear on the face and on the trunk, but rarely in the diaper area? (That's a separate thing we moms get to worry about.)
  • In older kids and adults, does the rash usually show up on the neck, inner elbows, backs of knees, and ankles?
  • Did you first notice the rash on your child at a very young age?
  • Do eczema, hay fever, and/or asthma run in the family?

If these signs sound familiar to you and/or you've answered "yes" to these questions, then chances are your doctor will diagnose eczema. But PLEASE, go see your pediatrician or dermatologist and have them make a diagnosis! Don't diagnose it yourself. Talk to your doctor about treatment options for your child. For example, there are steroid and steroid-free topical options available in cream or ointment formulations. So, it's important to educate yourself about treatment options and ask your doctor which one might be right for your child.

Effective treatment, as well as a lot of advice from doctors and moms, can help you avoid flare-ups and help clear them up when they occur. And best of all, once you're armed with any medications your doctor might prescribe, as well as an understanding of how eczema works and how to control it, you and your child get your power back!

1. Maybe strangers will think we are lax about keeping our kids clean enough. "BUT HE SMELLS LIKE SOAP AND SHAMPOO ALL DAY LONG!"

2. Maybe we're disappointed that our baby's beauty is marred by the rash. "DO THEY MAKE BABY CONCEALING MAKEUP?"

3. Maybe our child is suffering like this because we gave them our own puny genes for hay fever or asthma. "THEY PROBABLY GOT IT FROM US!! YIKES!"

4. Maybe our child is not doing as well as he or she should in school because of the distractions of eczema. "THEY'LL NEVER GET INTO AN IVY LEAGUE SCHOOL!"

5. Maybe the other kids tease ours when they have a flare-up. "OUR DARLING WILL FEEL SOCIALLY ISOLATED AND NEVER HAVE ANY FRIENDS!"

6. Maybe we worry that we are barking too much at our kids because they're wiggling and squirming and scratching so much. "CAN'T YOU JUST SIT STILL FOR ONE MINUTE?!"

7. Maybe we never had eczema, hay fever, or asthma and our husband's side of the family is just crawling with them and we resent them for it. "THEY PROBABLY GOT IT FROM HIM!"

8. Maybe we've asked around and checked online and we're so confused by the conflicting information that we do nothing. "WHEN IN DOUBT, FREEZE!"

9. Maybe we've tried so many remedies that haven't worked that we mostly just hope they'll grow out of it on their own. "IF I CLOSE MY EYES, MAYBE IT WILL BE GONE WHEN I OPEN THEM AGAIN."

10. Maybe we're afraid to go to the doctor because we don't understand the medications that are available and what's in them. "PLEASE DON'T TELL ME MY ONLY OPTION IS SOMETHING THAT CAN HAVE SERIOUS SIDE EFFECTS!"

If you think that itching is the only thing upsetting your child about eczema, you're deluding yourself, Mom. From a very young age, kids are concerned about their bodies the same as everybody else. Remember, little boys as young as 2-1/2 notice if any of their friends have "lost their penises" -- in other words, they're girls. If they notice patches of angry itchy skin on their bodies and not on their friends', they might start to wonder why. And, as they grow to understand how eczema can interfere with their lives during flare-ups, they will probably feel betrayed by Mother Nature.

My Girlfriend Sherry's little girls both had eczema and, even though the girls are now in college, Sherry can just weep when she thinks about how unkind and ignorant the others in their preschool classes were -- and WE'RE TALKING ABOUT THE PARENTS! As any parent knows, little kids are without social conscience when it comes to pointing out other kids' differences, be they strawberry birthmarks or a physical handicap, but parents can be pretty rough, too. It's our job as moms of eczema kids to educate everybody in our kids' little world to the facts about the condition and stop ignoring the elephant that's sitting in the room.

One of the best ways I've discovered to begin a conversation about eczema with a young child is to give them a piece of paper and crayons and ask them to draw a picture of how they feel when they have eczema. Then give them another piece of paper to draw how they feel when they don't have eczema.

When I've seen drawings like these, I've been shocked by how vividly they depict sadness and anger, and how big and dramatic the rashes look in the first group, and by how happy and clear and social the kids look in the second group.

Take your cues from the drawings. Perhaps you'll want to start a conversation by saying something like, "It looks like you feel like crying when you have eczema. What part of it is the worst part?" Your child may tell you the itching is the worst or having to use medication every day is the worst or being different from other kids is the worst. Then sit back and listen because eczema can have a profound emotional impact and your child needs you to help lessen the blow.

Then help your little one go to his school or daycare armed with confidence and information. You might ask the school nurse, teachers, or aides to join you while you and your child give the class a short, concise lesson on eczema and what it means in your child's life. You might remind the kids that the condition comes and goes, but that it never spreads from one child to the other.

And when it comes to flare-ups, it might be extra nice of the other kids to be even friendlier and more supportive of your child since he might be feeling sad or embarrassed. End the chat by asking the other kids if they have anything, be it eczema, a birthmark, asthma, or any other thing about their body that sometimes makes them feel sad or embarrassed. I promise you will get a vivid response from every little tyke in the room! Just be prepared to become the class's eczema specialist because once the other parents hear about you, they'll start seeking you out.

Vicki Iovine began her writing career after the birth of her fourth child in six years with the publication of The Girlfriends' Guide to Pregnancy. This book struck a chord among women who found maternity an altered state, and Vicki soon became a regular contributor on such shows as "The Today Show," "Oprah," and "The View." She has since published The Girlfriends' Guide to Pregnancy Daily Diary; The Girlfriends' Guide to Surviving the First Year of Motherhood; The Girlfriends' Guide to Toddlers; and The Girlfriends' Guide to Getting Your Groove Back. Vicki has also been an advice columnist for Child magazine for five years. And with nearly twenty years of marriage under her belt, she regularly contributes articles to Redbook as the "Marriage Advisor" on the mysteries of the man/woman thing. Most recently, Vicki has sold a feature film screenplay to Twentieth Century Fox.

Vicki lives in Los Angeles with her husband Jimmy and their four kids, two boys and two girls, ages 8 to 14.

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All content here, including advice from doctors and other health professionals, should be considered as opinion only. Always seek the direct advice of your own doctor in connection with any questions or issues you may have regarding your own health or the health of others.