I. “Annoying” eczema Jia Jia is already 8 months old, lively and cute, but there is one thing that has been bothering Jia Jia’s mother, is that Jia Jia’s eczema is always bad. Jia Jia has been suffering from eczema since she was born two months ago, and it has been more than half a year now, but there is no sign of improvement. The annoying eczema is always good and bad, sometimes light and sometimes heavy, and it gets better with a little hormone cream, but it comes back soon after stopping the medicine. I don’t dare to use hormones often, for fear of side effects. Because of the itch, Jia Jia often scratched and cried, and when it was serious, she couldn’t sleep well at night. During the physical examination, the doctor said Jia Jia’s height and weight had been affected. Someone said Jia Jia might be allergic to the milk she drank, so Jia Jia’s mother tried to switch to several brands of milk powder, but nothing worked. Some people said that goat’s milk would not cause allergies, so Jia Jia’s mother switched to goat’s milk powder, but the eczema continued to rise. She was so worried, when will Jia Jia’s eczema get better? In fact, Jia Jia’s mother made a mistake in principle here, that is, if Jia Jia’s eczema is really caused by milk allergy, then changing to any brand of milk powder will not work. It doesn’t matter which brand of milk powder, the antigenic nature of the milk is the same and will lead to allergic symptoms in the baby. Switching to goat milk powder will not work either, because goat milk has 90% cross allergy with cow milk. In other words, if your baby is allergic to cow’s milk, there is a 90% chance that he is also allergic to goat’s milk, so you cannot replace it with goat’s milk. The only way to solve the root of the problem is to switch to a deeply hydrolyzed formula or amino acid formula for babies with cow’s milk allergy. Clinically we can often see that some babies with eczema that is always recurring do not heal, when switched to deeply hydrolyzed formula or amino acid formula nutritional powder feeding, their eczema symptoms are significantly improved, or even completely healed. Of course, for some babies with eczema, simple dietary control does not improve their clinical symptoms because the etiology of eczema is very complex, food allergy is only one of the common factors, there are many other factors also related to the recurrence or aggravation of eczema, such as: genetics, air pollution, smoking in the home, hot and cold stimulation, dry skin and a variety of bacterial, viral or fungal infections, so sometimes simple controlling the baby’s diet does not achieve the results we want. The exact pathogenesis of eczema is not well understood and may be the result of an interaction between genetics and a variety of environmental factors. Let’s look at the influence of genetic factors on eczema in babies. If you have a family member with an allergic disease, your baby will be born with an “allergic constitution. In other words, genetic factors make the baby susceptible to allergic reactions in the future. According to current data, if both parents do not have allergic diseases, the chance of the baby suffering from allergic diseases is less than 15%; if one parent suffers from allergic diseases, the chance of the baby suffering from the disease rises to 20-40%; if both parents suffer from allergic diseases, the chance of the baby suffering from allergic diseases is as high as 50 -70 percent. So if mom or dad has an allergic disease, then the baby’s risk of developing eczema is greatly increased. Food allergies: Although not all babies’ eczema is caused by food, food allergies are an important factor in the recurrence and exacerbation of eczema in many babies. Food allergies are related to the age of the baby and the severity of the eczema; the younger the baby and the more severe the eczema, the more likely his or her food allergy is. Some mothers have also suspected that their baby’s eczema is related to food allergies, so they do not allow their babies to eat fish, shrimp and beef and mutton because in the eyes of many mothers, seafood such as fish and shrimp or beef and mutton are the foods to which their babies are most allergic. But not eating these foods did not improve the baby’s eczema in any way. It turns out that the mother made another small mistake here because the same food allergies are present, but the foods that babies are most allergic to are slightly different from those of adults. Fish, shrimp and beef and lamb are the foods that adults are allergic to, while the foods that babies are most allergic to are milk and eggs. Because milk and eggs are the first protein foods that babies are exposed to, babies are most likely to develop allergies to milk and eggs, followed by allergies to wheat and soy. Current information shows that over 90% of eczema babies who have food allergies are allergic to traditional foods such as milk, eggs, wheat and soy, rather than seafood such as fish and shrimp or beef and lamb. However, mothers should understand that not all babies’ eczema is necessarily related to food allergies, and since milk, eggs, wheat and soy are the most basic sources of protein for babies, they should not be blindly avoided, as this will increase the risk of malnutrition in babies. If you suspect that your baby has a food allergy, you must take him to the hospital to see a specialist who will analyze his medical history and perform relevant tests to determine whether his condition is related to food allergy and to eat properly under the guidance of the doctor to avoid malnutrition. In addition to food allergens, some airborne allergens are also associated with eczema in babies, such as dust mites, various tree and weed pollens, molds and dander or secretions of small animals. Excessive skin water loss: Babies who love eczema often have very dry skin, which is due to congenital factors that cause these babies’ skin to lack certain lipids that make it unable to lock in moisture, thus causing excessive skin water loss. The poor barrier function of abnormally dry skin makes its skin more sensitive and more prone to allergic reactions. At the same time, dry skin increases the baby’s itchiness, and scratching will aggravate the baby’s lesions. Air pollution, smoking in the home, overdressing the baby resulting in overheating and sweating, and inappropriate washing and scratching are also associated with the aggravation of eczema in babies. When the baby is small, eczema occurs on the face and scalp, most often on the cheeks, forehead and around the mouth, and in severe cases can spread to the baby’s extremities, hands and feet and trunk. The clinical manifestations are localized skin redness and peeling, with red pinpoint-sized bumps on the surface. Sometimes there are small blisters on the top of the bumps. In severe cases, the skin may become edematous, runny and crusty. Fissures at the base of the ear are also very common when babies are small. As the baby grows older, eczema is gradually confined to the flexors of the baby’s limbs, especially the elbow and leg fossae, when the flow and exudation of the lesions decrease and the local skin thickens and becomes rough and bark-like. Clinically, we divide eczema into three phases according to the different manifestations of the lesions: acute, subacute and chronic. The acute phase is characterized by localized skin redness, swelling, running water, oozing and crusting; the subacute phase is characterized by localized skin redness, peeling and small bumps; and the chronic phase is characterized by thickened, rough and lichenoid skin. Here the mother may have some questions: some doctors say that the baby has eczema, while others say that the baby has atopic dermatitis. What exactly is the relationship between eczema and atopic dermatitis? Eczema, or eczema in English, is a Greek word that means “water overflow”. Eczema is a description of a type of skin lesion, and clinically we refer to all recurrent pruritic lesions that have a tendency to ooze water as eczema. Therefore, eczema encompasses a group of skin conditions that can be referred to as eczema when the cause of the condition is unclear but has a tendency to flow and recur. Atopic dermatitis has the same clinical presentation as eczema, but there are other conditions for diagnosing atopic dermatitis besides eczema-like lesions. The diagnostic criteria for atopic dermatitis vary from country to country, and the one that is currently widely used in China is the Williams diagnostic criteria proposed by the British Atopic Dermatitis Collaborative Group in 1994. The diagnostic criteria are: in addition to pruritus as a necessary condition, babies can be diagnosed as long as they meet three of the following five conditions. 1, the baby has had eczema on the flexors of the extremities (including the face in children under 10 years old); 2, dry skin all over the body; 3, he or she has a history of atopic diseases such as asthma or allergic rhinitis (or a first-degree relative of a child under 4 years old has a history of atopic diseases); 4, there is currently eczema on the flexors of the extremities (or eczema on the forehead/face and distal extremities in children under 4 years old); 5, the onset is within 2 years old (not applicable under 4 years old). The principles of eczema treatment are anti-inflammatory, emollient and anti-itch: 1. Anti-inflammatory -: short-term, intermittent topical hormonal creams Hormonal creams have good anti-inflammatory and anti-itch effects, but must be used under medical supervision. When the baby’s eczema is in the subacute or chronic stage, such as the performance of erythema, peeling and small red bumps, or thickening of the skin, lichenification, can be used externally relatively small side effects of hormonal creams, such as: 1% hydrocortisone, Youzol or Eloson, but to “see good, then close”, the condition improved in time to stop using, to avoid the emergence of The side effects. If eczema recurs later, hormonal creams can be used again. The side effects of short-term, intermittent topical hormone creams are much less than long-term, continuous application. If the baby’s eczema is acute, such as water vesicles, to use 3% boric acid water cold compress. The cold compress is applied by dipping 6-8 layers of gauze or a small clean towel into the solution (without 3% boric acid water, cold water is fine), removing it after it is completely wet, gently wringing it out so that it does not drip, and then flattening it on the surface of the lesions. Apply 3 times a day for 20-30 minutes each time. Cold compresses can quickly reduce the edema and exudation of the skin. The cold compress should be replaced in time if the gauze becomes dry or dirty. After the cold compress, topical zinc oxide ointment can be applied locally. If a baby over 2 years old has side effects such as skin atrophy, capillary dilation or hyperpigmentation due to long-term topical hormonal creams, topical 0.03% tacrolimus cream or 1% pimecrolimus ointment can be used. These two ointments are relatively new topical ointments for the treatment of eczema dermatitis, the ingredients of which are calcium-regulated neurophosphatase inhibitors, which are not hormones themselves, but have hormonal therapeutic effects, can be used for a long time for the baby’s eczema locally, and for the prevention of recurrence has a certain role. 2, emollient: eczema children’s skin is often abnormally dry and rough, especially in autumn, winter and other dry seasons more obvious, thus causing severe itching. In addition, excessively dry skin barrier is poor, the skin is more sensitive and more likely to cause allergies, so it is very important to relieve dry skin for babies with eczema. Since babies with eczema have unusually sensitive skin and are prone to allergies, try to choose medical emollients that are fragrance and color free. Emollients are divided into moisturizing creams and lotions according to their water content. Lotion contains more water and is more comfortable to use, so it is suitable for use in summer and can be used 1-2 times a day. In autumn and winter, the weather is dry, so you should choose a moisturizer with more oil for your baby. Even if you don’t take a bath, you can also use moisturizers externally and apply them at least 3 times a day or more to effectively relieve your baby’s dry skin. 3, stop itching: antihistamines can help: antihistamines are what we often call desensitizers, which have a certain anti-itch effect. Antihistamines are divided into two generations: a generation of antihistamines represented by paracetamol and a second generation of antihistamines represented by loratadine and cetirizine hydrochloride. If only from the point of view of stopping itching, the first generation antihistamines are more effective. Don’t worry too much about the side effects of antihistamines, except for thirst and drowsiness, antihistamines are still very safe. First-generation antihistamines, such as paracetamol, are 0.35 mg per kg per day, divided into three oral doses, with the maximum amount being 4 mg (one tablet) three times a day. If your baby is just itching to sleep at night, you can also just take it at night. The drowsy effect of paracetamol can help your baby get a good night’s sleep. The actual fact that the baby with eczema has allergies, which are irreversible, makes eczema a chronic condition that is prone to recurrence and cannot be “cured” at once. To take care of a baby with eczema at home, the mother must be prepared to fight a “constant battle”. Usually at home to try to avoid all factors that may trigger or aggravate the baby eczema: 1, dress: fabric to cotton is better, try not to wear silk, pure wool and chemical fiber products, because silk, pure wool and chemical fiber fabric clothing is easy to stimulate the baby’s skin, aggravating allergic reactions. The color is natural or light, try not to choose too bright colors such as red and green, because the dye is also a common allergen. Baby’s intimate underwear should be loose and breathable. Overheating and sweating can increase itchiness and make eczema worse, so don’t overdress your baby and dress him/her appropriately with less clothes. If it is not easy to grasp how much to dress the baby, the mother can refer to her own clothes. The mother feels more comfortable in how much clothes she wears, so she gives her baby clothes according to the amount of mom’s clothes, in principle, not more than what she wears. You should never take the old man in the family as the prevailing one, because the old man is afraid of cold, so naturally he will wear more clothes. If the baby’s dressing how much reference to the old man at home, it will make the baby overheat and sweat, thus aggravating eczema. 2, food: because some babies’ eczema is closely related to food allergies, so there are food allergies to avoid all allergic foods, and avoid food must be completely, in order to achieve the effect we want. For example, some babies are allergic to eggs, so not only can they not eat eggs, but they cannot eat any food that contains eggs, such as cakes, noodles, snacks and pasta that contain eggs. The same goes for babies with milk allergy. Not only should they not drink milk, but they should also avoid all foods that contain milk, such as yogurt, milk sugar, cakes, ice cream, etc. However, as mentioned before, not all babies’ eczema is related to food allergies, so don’t blindly avoid food, otherwise you run the risk of causing malnutrition in your baby. You should also pay attention to nutritional balance, let your baby eat more vegetables and fruits, and eat carrots once or twice a week. The vitamin A in carrots is important for relieving dry skin. But be careful, carrots must be copied with oil or stewed with meat, because vitamin A must be absorbed with oil, otherwise it cannot be absorbed. 3, bath: Some mothers believe that babies with eczema can not take a bath, which is a wrong view. Not only can you keep your baby’s skin clean and reduce the chances of infection, but you can also add moisture to your skin by taking a bath. Even in winter you can give your baby a bath every day, but the bath should pay attention to the following points: each bath time is not easy too long, about 5 minutes, try not to exceed 10 minutes; water temperature 35-37 ℃ can be, not too hot; bath soap, soap should not be used more than 1 to 2 times a week, otherwise it will aggravate the dry skin; the last very important point is that after the bath to apply moisturizing moisturizer, to Lock the moisture in the skin, otherwise the evaporation of water will make the baby’s skin become more dry. After bathing, use a soft towel to gently dry your baby’s skin, then quickly apply moisturizing cream to your baby’s entire body while the skin is moist, and gently massage until it is all absorbed. If your baby is also using topical ointments, you must first apply the ointment and then the moisturizer, otherwise it will affect the absorption of the drug. 4, wipe medicine: many mothers used to use cotton swabs to baby wipe ointment, which is not right. Because with cotton swabs, the ointment stays on the surface of the skin, the baby a scratch a scratch a rub, the ointment fell off, and not absorbed by the skin. The correct way is to wash your hands first, as you do for your baby’s moisturizer, and then use your hands to apply the cream evenly on the surface of your baby’s lesions, a thin layer is enough, not too thick. Then don’t forget to rub your hands together so that the cream is fully absorbed into the skin. Some moms don’t pay much attention to their baby’s eczema, thinking that eczema is a “minor problem” that will naturally get better when the baby grows up. In fact, although eczema is not a very serious disease, but the baby’s life may have an impact, such as the itching caused by eczema affects the baby’s sleep, and poor sleep will affect the baby’s growth and development, so that the baby’s height and weight does not reach normal standards. More importantly, eczema belongs to the same category of allergic diseases as asthma and allergic rhinitis, and allergic diseases have a tendency to worsen with age, called the allergic process, that is, when babies are small, they may only show skin allergies and eczema symptoms, and when they grow up, they are likely to develop asthma or allergic rhinitis and other respiratory allergy symptoms, so we must pay attention to the baby’s eczema, the correct treatment and care It is expected to stop the allergy process and make the baby grow up healthy and happy.