Q: I really hope you can help my grandson. He is seven years old and has always had eczema. It was worse when he was small, but he still has it on his behind and on his hands. He uses special soap to wash his hands. He also has a cream. He sleeps with thin gloves on to prevent scratching in the night.
I had eczema as a child, but grew out of it. Will he outgrow it at some age? Have they still not found a cure for it? Are there any foods that make it worse that he should stay away from?
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A: We are not really sure what causes eczema so scientists have not found a cure as yet. It can only be partially controlled with special creams and medications.
It is an inherited disease but it arises from the interplay of your genes with external environmental factors.
The cells that are at the centre of the inflammation are called T lymphocytes. They can be thought of as the soldiers of the immune reactions of the body.
Eczema sufferers have increased T-cell activity to various antigens, which are the substances that the sufferer is allergic to.
It is thought that a genetic defect in the external barrier of the skin, the epidermis, makes the skin more susceptible to breakdown from various irritants such as detergents and dust mites. This, in turn, may allow the antigens to penetrate the skin, causing the inflammatory response.
You are correct in thinking that food may be implicated. An intolerance to lactose or dairy products may be a possible cause, particularly if your grandson has been affected since infancy.
Was he on formula or was he breast fed? Did the problem start when he was given cow’s milk for the first time?
Gluten sensitivity can also cause eczema. This is intolerance to wheat or barley and is sometimes known as celiac disease. Sensitivity to fructose, a naturally occurring sugar found in most fruits, is a rarer situation.
As you see, there is a great deal to be investigated. You could start by gradually eliminating these foods from his diet and see if there is any improvement.
I expect that your grandson’s parents are already aware of the dust mite problem and are trying to minimize it by vacuuming the mattress regularly, frequently washing sheets and eliminating as many carpets as possible. Pets can also be a problem.
His clothes should not be washed in detergents, but instead use a natural soap powder. Eczema sufferers should not wash hands with soap. There is a special cleansing lotion available for people with skinconditions. Ask your pharmacist.
I hope the cream he is using is steroid free. One that has been on the market in Canada since 2003 is known as Elidel (Pimecrolimus) cream. It has been approved in Canada for children as young as two, and has been shown to be both safe and effective. It is a major advance in the treatment of eczema.
Your grandson may grow out of it by puberty like you did, but hopefully he will not have to suffer until then. Keep working to find and eliminate some of the allergic trigger factors.
Clare Rowson is a retired medical doctor living near Belleville, Ont. Her columns are intended for general information only. Individuals are encouraged to also seek the advice of their own doctor regarding medical questions and treatments.
