Neonatal eczema, commonly known as tinea cruris, is an acute or subacute form of eczema that occurs on the head and face of infants, and the cause of which is not fully understood. Many scholars currently believe that neonatal eczema is a manifestation of atopic dermatitis in infancy, but some scholars believe that there are some differences between the two and therefore advocate retaining the name of infantile eczema.
The general management is similar to atopic dermatitis, and the principles of topical medication are the same as those for eczema. Breastfeeding can prevent eczema due to allergic allergy to heterogeneous proteins caused by milk feeding. Atopic dermatitis is a chronic, relapsing, inflammatory skin disease that usually begins in infancy and accounts for approximately 50% of all patients before the age of 1 year.
The development of atopic dermatitis is closely related to genetic and environmental factors; AD often has a Th2-mediated immune abnormality, and may also have a weakened or disrupted skin barrier function such as reduced or absent filoproteins in the epidermis; environmental factors include changes in ambient temperature or humidity, sun exposure, lifestyle changes, excessive washing, infectious agents and allergens, and irritants. In addition, psychological factors such as mental stress, anxiety, and depression also play a role.
In both eczema and atopic dermatitis, dry skin (persistent, generalized dry and scaly skin, etc.) is one of the main symptoms, and its stratum corneum barrier function is impaired. Skin care for eczema involves how to cleanse the skin well and keep it moist (referred to as moisturizing). Good skin care can promote the repair of the skin barrier function in order to maintain the treatment of eczema and prevent recurrence, so how exactly does it work?
A. Proper skin bathing
It is essential to cleanse the skin of children with eczema, especially when superficial bacterial infections occur to remove scabs from the body surface is particularly critical. There are various types of non-irritating and hypoallergenic formulations of cleansing products available. It does not matter whether the cleansing products contain preservatives or not, the key is whether there is excessive frictional irritation during washing.
Light washing involves applying the lotion product directly to the skin surface rather than polishing it on the surface of the child’s body with a bath brush, and controlling the bathing water temperature to fresh warm water, not too hot, to no more than body temperature. A short bath of 5 minutes is recommended to avoid dehydration of the skin after bathing. Wiping the skin after bathing need not be completely dry, it is recommended to use emollients when the skin is slightly wet.
Mild soaps and local pH adjustment of the skin: frequent use of dry soaps can delay skin healing. The use of mild or fatty soaps should be promoted and should be used less frequently. The use of hypoallergenic soaps or avoidance of soaps is usually not necessary, although fragrances can induce allergic reactions, but the incidence is low. Hypoallergenic and nonirritating skin cleansers are recommended, and alkaline soap-based cleansers (pH 6 or so is preferred) should be avoided. Those with significantly dry skin should reduce the number of cleaning products used and try to choose fragrance-free cleaning products.
Second, the use of moisturizers
Dry skin not only loses the moisture of the skin, and in most cases also loses the lipids and proteins that maintain the wetness of the epidermis, which involves how to replenish the lipids and the use of moisturizers.
1.Replenish lipids
It is best to use physiological lipids such as ceramides, cholesterol, etc. Non-physiological lipids such as petroleum jelly are only deposited on the skin surface after topical application; while topical physiological lipids can act directly on the granular layer, and some lipids are encapsulated in the body of the plate layer, secreted into the stratum corneum and form a complex plate layer structure. Topical lipids can accelerate the recovery of skin barrier function and help prevent and control local bacterial infections of the skin.
2.Use moisturizer
Humectants simulate the natural moisturizing system composed of oil, water and natural moisturizing factors in human skin, and their function is to delay water loss, increase dermal-epidermal water penetration, provide temporary protection for the skin, reduce damage and promote the repair process.
There are 3 types of humectants.
(1) closed moisturizers (encapsulants): such as paraffin oil, petroleum jelly, silicone oil, beeswax, cocoa butter, lanolin, etc.;
(2) Wetting moisturizers (wetting agents): such as glycerin, honey, propylene glycol, urea, allantoin, sorbitol, animal glue, hyaluronic acid, etc.;
(3) moisture-absorbing matrix moisturizers: such as hyaluronic acid, chondroitin sulfate, collagen, elastin, etc.
How to choose moisturizers?
There are many types of moisturizers, such as body lotion type, cream, ointment, lotion, gel and spray type. Among them, creams are thicker and more lubricious than lotions, while petroleum gels and mineral oils do not contain water.
Creams are usually more effective than creams, and the former are more oily; however, the child’s self-perception should be taken into account, and the key is to choose the right type of emollient for the child, and parents can choose multiple types of emollients at the same time in order to select the right product for the child’s own skin type. For children who go to school during the day, creams are usually given during the day and oilier creams are used at night to meet the requirement of twice daily treatment.
Fourth, what should be the combination of moisturizers?
Moisture-absorbing matrix moisturizers are large molecular weight substances that can form a net chamber to prevent water evaporation and can naturally absorb water. NMF in the interstitial matrix of epidermal cells belongs to moisture-absorbing matrix moisturizers, and other vitamins such as linolenic acid and linoleic acid, arachidonic acid, etc. For eczema patients with impaired skin barrier function, the use of moisturizers containing only wetting agents can actually make the skin drier, and wetting moisturizers must be used in combination with closed moisturizers.
To obtain longer periods of remission, a regimen of intermittent use of strong glucocorticoids combined with daily skin care agents may be used. Short-term topical glucocorticoid encapsulation therapy (repeated every 2 to 3 days) combined with moisturizers is used for 1 to 2 weeks of continuous treatment in areas prone to repeated scratching over time, such as arms, wrists, fingers, legs, and ankles. The best effect is achieved by applying emollients a few hours after the topical glucocorticosteroids and should be used continuously for several days or weeks after the inflammation subsides.
V. When should I start using moisturizers?
There is an old but classic rule to follow: if it is dry, make it moist; if it is wet, make it dry. It should be noted, however, that while wet lesions can also be moistened to suppress inflammation and remove crusts and serum, alternating wet and dry cycles can cause lesions to dry out, and excessive wetting can lead to severe dry and chapped skin. Therefore, once the exudative phase of the disease is under control, wet dressing should be stopped and emollient creams and lotions should be applied to restore skin lipids and proteins.
VI. The best time to moisturize?
The best time to apply moisturizers is after bathing, but it should not be limited to after bathing only. Emollients should be used as often as possible in life to keep the skin moist. You can moisten your skin when you are not showering, pat it dry, and then apply moisturizer immediately in a slightly wet state. The effectiveness of moisturizers lasts for a short time and the moisturizing effect will disappear with the normal shedding of skin’s keratinocytes; therefore, moisturizers should be applied several times a day (1 to 4 times/day).