Skin Problems in Babies

Emma Howard: Here at the Baby Channel we are proud to have a huge array of doctors and midwives that we have on hand to deal with your medical queries. Today Dr. Tabi Leslie, a consultant dermatologist is here to answer all your questions on skin problems. Hello! Dr. Tabi Leslie: Hello! Emma Howard: Welcome and thanks for coming here to talk to us. We have got lots of questions on this subject, because it's something quite close to heart, Eczema is the first question, what is it? Dr. Tabi Leslie: Well, there are various forms of eczema, but the most common from of eczema is Atopic Eczema which is inherited and it's inherited through genes that carry asthma and eczema and hay fever. So, one member of the family might have hay fever, another member might have asthma and then you have got one child with eczema. Emma Howard: So, producing lethal combination between them? Dr. Tabi Leslie: That's right. Emma Howard: Do you think that more and more people and are producing children who have eczema, because it's talked about so much, lots of people say, thirty-years-ago, I don't remember as many children suffering from eczema. Is that something that we are all talking about, that's not actually true, or is there some truth in that? Dr. Tabi Leslie: There is an increase in eczema, in general, in all the eczemas. But I think we are more aware, people are more health-orientated than they were previously. I think the children are exposed to a lot more allergens and chemicals than they were in previous years and perhaps pollution has something to do with it as well. Emma Howard: Yes, I was going to ask you about pollution. Lots of people say that's a contributing factor. Do you believe it is then? Dr. Tabi Leslie: We do, yes. We believe it's one of the reasons that it's on the increase. Emma Howard: So, one of the questions was, why has my child got eczema, you have just answered that, I know that what parents will really want to know is, what do they do, what do they buy, how do they ease it? Dr. Tabi Leslie: It's not very easy, you go into a chemist or a shop and there are lots and lots of bottles to look at and stare. Emma Howard: Yeah, and they are screaming at you. Dr. Tabi Leslie: Exactly, I think the basic thing is to keep it very simple, avoid creams with fragrance in excess and avoid them with lanoline and common sensitizing agents. You don't have to pay more money to get a good moisturizer. Some of the cheapest moisturizers available are as good as the others. Bath oils, parents have a tendency to put bubble bath in their children's baths, that's fatal and lethal for someone with eczema because it just dries out the skin. So, you should be putting a moisturizing bath oil. Again, not a nut oil, not one with lanoline or lots and lots of preservatives. Emma Howard: Is lanoline something that again dry the skin out. Dr. Tabi Leslie: It does and it's a sensitizing agent. So, you can be rubbing in creams to help the eczema, but actually you are perpetuating the eczema because the child is actually allergic to it. Emma Howard: Oh I see. Dr. Tabi Leslie: And this was almost one of the thinkings with Aqueous Cream is that the dermatologists were the first ones to prescribe Aqueous Cream over and over again and then suddenly, we realized that there was a cohort of patients who weren't getting better and when you switch them to another cream, like emulsifying ointment or diprobase, and there are many in the market, I think improved, so it's worth changing your moisturizer if the one you use doesn't work for your baby. Emma Howard: Right. Isn't making any difference at all. What about eczema being something that is worse sometimes in your life. Will children grow out of it? Dr. Tabi Leslie: Most children, not all children would grow out of it and the philosophy is with time they get better, so even though they may not stop being eczema children, you won't have to be so intensive about the treatment. Emma Howard: Is there anything you can do to prevent it, I mean, one of the parents who has written in here just saying, can I do anything to prevent my baby getting eczema? Dr. Tabi Leslie: Well, you can't prevent eczema but you can avoid certain things which will make it worse. If the child has impetigo, an infection on the skin, you should get it treated sooner rather than later. Emma Howard: Treated how? Dr. Tabi Leslie: Treated by the GP, with antibiotics, so it doesn't spread and flare up the eczema. If they were nickel or artificial jewelry or bracelets or earrings or watches and you feel the rash is appearing under these, then avoid those absolutely. And avoid, some people can't avoid nail polish, I know it's not relevant to babies, but the mothers wear it and if the child is in contact with it then there would be problems. Emma Howard: Like a reaction. Dr. Tabi Leslie: Exactly. Emma Howard: Now, somebody has asked you, if there is a cure, and I know you have probably said, there isn't a cure, you must have your own set of favorite ways of treating -- Dr. Tabi Leslie: Sure, there isn't a cure but there is a way to achieve a remission so that effectively you are cured. You are treated. And therefore, although I can't switch it off with a button, I can actually make baby skins go back to normal and then teach the parents how to keep it that way. So, you will have a child who is constantly suffering from eczema for months and months and months and you treated -- Emma Howard: Very distressing. Dr. Tabi Leslie: Exactly. Very distressing for the child and for the parents, none of them have slept, neither the parent nor the child. So, you break the itch-scratch cycle. So, scratching makes eczema worse, so you sedate the baby at night, so it doesn't scratch so much. You sedate the parents, so they get a good night sleep as well. And you can use topical steroids and I know parents shriek the word steroid, but you can and there are other agents that are non-steroids that are available. Emma Howard: What about bandaging over the eczema areas? Dr. Tabi Leslie: You can, there were towel bandages, there are wet bandages, there is dry-bandaging, there are a number of ways that you can tackle it. And again, that stops the child from scratching which perpetuates the eczema. So, there are various ways of tackling it and you can get a really, severely effected child clear and then they only get flare ups. If they are allergic to milk, if they eat a dairy product or if they are allergic to nickel -- Emma Howard: And of course, there are lots of tests that you can do to establish what the child is allergic to? Dr. Tabi Leslie: Absolutely. The parents usually have a good idea, I gave my child strawberries and they flared on and we have something called RAST testing, which is a blood test available and there is a standard battery of dairy, soya, nut, sweet and fish that we do and then the parents direct me to any other food they want specifically tested. So, parents will find, I gave my child yogurt and she started scratching and you say, well, then to be sensible you withdraw yogurts for two weeks and then reintroduce it again. Emma Howard: And that's the period, is it two weeks? Dr. Tabi Leslie: Approximately, two weeks is a good. Because sometimes you find parents have taken everything out of a child's diet and there is no proof that the child was ever allergic to any of those things. So, you say -- Emma Howard: So, do it with guidance. Dr. Tabi Leslie: Yeah, do it with guidance. Take one thing out at a time. Reintroduce things that you have already taken the child off and see what happens. So for example, if you had a child who drinks goat's milk, because you are worried that they have got a dairy allergy, you could actually after two weeks of goat's milk give them a small dairy challenge and see what happens, and if there is no flare up and you roll -- Emma Howard: Yeah, if they are not getting the problem in the first place. Dr. Tabi Leslie: Then that's not the problem in the first place. Emma Howard: I know for me that's very often, so I chose not to try that when I get back. So, moving away from eczema, because basically you said, with help and do you get it, you can clear it and you can certainly ease it. Dr. Tabi Leslie: Definitely. Emma Howard: That's really great to hear. Cradle Cap, most mums and dads of newborns come across this, what is it? That's what this question is, what is cradle cap? Dr. Tabi Leslie: It is a form of eczema, but it's not the inherited from, it's called a seborrhoeic eczema or seborrhoeic dermatitis and in older children, it's thought to be driven by a fungus but in the young children it's just exfoliation of the skin on the scalp. Emma Howard: And is that drying out? Dr. Tabi Leslie: It is drying out. And we tend not to treat it aggressively. We tend to treat it with olive oil bought over-the-counter and chemist and you leave it overnight on the baby. And you can use gentle shampoos on it. Occasionally, you need to use the stronger shampoos which will contain selenium sulphide or other chemicals that would strip the scalp a little but, a favorite of mine is coconut oil, if they want something prescribed, with a little bit of tar in it. Emma Howard: And left on overnight? Dr. Tabi Leslie: Left on overnight. Emma Howard: I have seen a few babies, whose parents have clearly gone down that road, put oil on the head and the next morning take enough flumping. Slowly worked it off, but they have been too scared to do the fontanelle area, so you often see babies with a little diamond of cradle cap which is quite sweet, but do we need to be afraid of the fontanelle of can we be firm with it? Dr. Tabi Leslie: Well, you do need to be firm. You can apply cream gently to that area. Emma Howard: And the cradle cap should lift off. Dr. Tabi Leslie: Absolutely. When you comb out the hair the following morning -- Emma Howard: So, you need to bit a bolder. Dr. Tabi Leslie: Slightly. Emma Howard: Slightly, yes not too much pressure, it is delicate. Isn't that? Dr. Tabi Leslie: Exactly. Emma Howard: Is there anything in his or her diet that can be avoided, one parent wants to know, about cradle crap, can we stop it -- Dr. Tabi Leslie: I think cradle cap isn't really ever associated with diet unless it's related to the atopic eczema that they have genetically earned. Again, use your common sense, if you feel that your child after dairy product is scratching and it's quite often within the cradle cap, some babies will scratch quite a lot that you will see the bleeding and the cuts in the hairline. Emma Howard: Yeah and you don't want it to go that far. So withdraw anything you think will be causing that. You mentioned steroids earlier, one parent wants to know what are the side effects of using steroids are. And I think this is what people can get hysterical about. Dr. Tabi Leslie: Yes. Steroids have in the past been used inappropriately and in vast amounts and for long lengths of time, before the side-effects were truly known and then, patients have said, as a child I was treated with steroids and that's why my skin is very thin and the blood vessels are more prominent. Thinning of the skin is the major side effect that you would get, but in this day and age not many people would remain on steroids for a long period of time. And as I say, there is now a new alternative for those parents that absolutely refused to put steroids on their child's skin. Emma Howard: And they are often looking at homeopathic remedies, I mean, lots of us are these days, I know, I am very interested in them as well. Do you like them, do you think they are any good? Dr. Tabi Leslie: Quite often I get the patients or the babies that have had homeopathic treatment and then they get a rebound phenomenon and they often get worse after it. Homeopathy is using bland natural products, which we do in general medicine anyway. So, some of homeopathy is part of our practice and I would say, if it works for the child that's fine, but you have to be aware of the side-effects. Emma Howard: Do you think there are any side-effects? Dr. Tabi Leslie: There can be because the child can be allergic to the cream, the cream may, I mean, especially in Chinese herbal therapy which is also been used for eczemas, we found, well laboratories found that there was quite toxic substances, because some of the natural substances we used to make medicines, all the barks of tree, the Canadian Yew is anticancer drug. Emma Howard: Yes, just because they are natural doesn't mean to say, they are going to get any powerful reaction. Dr. Tabi Leslie: That's right. So, you have to be sensible and know that, if something isn't working, you withdraw it -- Emma Howard: Right, immediately. Dr. Tabi Leslie: And try and go for conventional treatment. Emma Howard: What other common skin conditions might effect my child, this parent wants to know, I am aware of eczema, but what other things are about that could happen? Dr. Tabi Leslie: Well, it's mainly the different types of eczemas but they can, I mean, chicken pox is a skin condition, I know it doesn't last very long. Emma Howard: But we do think it doesn't last that long. Dr. Tabi Leslie: No and viral eruptions, there are some blistering disorders that some babies get genetically. Emma Howard: That sounds really painful, what's that? Dr. Tabi Leslie: Well, there are things like epidermolysis bullosa which not many people will come across, but it's a genetic disease. And where a child blisters every time it traumatizes his skin, so every time it rubs on something, you will get a blister come up at that side. And then the healing can be very poor. The commonest things other than eczema is impetigo and that's where the children get an infection from a cotton, this can spread, you can get cellulites or inflammation under the skin where bacteria have spread. Emma Howard: Presumably you will take your child to the GP and the GP will refer your child to somebody like you. Dr. Tabi Leslie: Unless they recognize it and chicken-pox a GP would recognize. Emma Howard: Yes, of course. Dr. Tabi Leslie: But if the chicken-pox is severely infected, they may refer you to hospital to have the antibiotics through the veins or anti-viral treatment, which is where drug reactions are common, penicillin allergies often picked up in children. Emma Howard: Tabi that was wonderful. Thank you very much. Dr. Tabi Leslie: Thank you. Emma Howard: I am sure we will see you again. Because this, when it comes to looking after your little ones -- Dr. Tabi Leslie: It's complicated. Emma Howard: Complicated and full of lots of worries for parents and clearly you have given us important advice. Dr. Tabi Leslie: Thank you. Emma Howard: So, for now thank you very much. Dr. Tabi Leslie: You are welcome.