We are concerned about infant eczema together with parents

  Infant eczema is one of the most common dermatological conditions seen in infancy. In the north of China, it is commonly known as “fetus”, while in the south of the country it is often called “tinea cruris”. There are no exact figures on the incidence of infantile eczema in China, but the clinical consultation and follow-up rates for pediatric dermatology are undoubtedly very high (about 25-30% of pediatric dermatology clinics). The trend is increasing year by year. Parents are often troubled by its recurrent nature and itchiness.  Infant eczema occurs around 40 days after birth, first on the head and face, especially the cheeks and forehead, initially as scattered pinhead-sized red papules, or dry erythema, part of the fusion into large red patches, or break down and ooze yellow liquid and then crust, oozing fluid can be washed away when the crust, leaving a red vesicular surface. The scalp often has small yellow crusts on the roots of the hair. In severe cases, the entire head and face may be involved. The child does not speak, but the itching is intense, as indicated by rubbing the head and face against the mother’s arms or scratching with the small hands to create a crust.  The lesions may be evident after feeding or crying and may look significantly less severe during quiet sleep. Poor digestion or secondary bacterial infections often make the lesions worse. About 80% of infant eczema children have recurring lesions intermittently until 2 years of age, where the 4-8 month stage tends to intensify, with a tendency to gradually migrate from the head and face to the extremities as they get older. And has the seasonal characteristics of winter heavy, summer light.  The occurrence of eczema in infants is now thought to be related to genetic and environmental factors and immune factors. Such children often have congenital genetic allergies, and some can be asked to have a family history of asthma, allergic rhinitis or atopic dermatitis. The increase in the incidence of allergic diseases in recent years is also related to the rapid environmental changes since the 20th century and the dysfunctional adaptation of the human body to environmental changes. Infancy is the initial contact stage between human and the environment, and the skin, as an organ in direct contact with the environment, will be the first to show signs of allergic reactions.  Infant eczema is a manifestation of such maladjustment. Parents are often very concerned about their child’s diet and the type of diet that the nursing mother needs to pay attention to during daily outpatient visits. Our skin prick allergen screening of 58 cases of eczema in infants aged 3 months to 1 year showed the highest rate of egg positivity, followed by milk, peanuts, and beans. These food allergic reactions may diminish or disappear by about 3 years of age and are replaced by reactions to inhaled allergens such as house dust mites, pollen, and fungi in some children.  After briefly understanding the manifestations and factors associated with infant eczema, parents are more concerned about how to treat it and what to look for in their lives.  About treatment: Parents should first understand the recurring nature of the disease and should not demand a one-time cure. They should cooperate with their doctor to keep infant eczema at its lightest state and help their child to pass through infancy smoothly. Usually we only have dry skin damage for mild cases choose some non-irritating emollient moisturizer can be used topically; with emollient moisturizer can not improve the symptoms skin lesions continue to aggravate, can choose weak corticosteroid ointment used topically; for the lesions area is large, exuding vesicles crust thick children can use heat detoxification astringent herbal solution bath or wet compress to dry, remove scabs, add corticosteroids, topical antibiotic ointment. The symptoms can be relieved quickly. The possible side effects of topical corticosteroids are a concern for parents, but corticosteroid ointment is the main topical drug in the current treatment of moderate and severe infant eczema.  Note that corticosteroid ointment can be discontinued when the lesions disappear, but the application of emollient moisturizer should not be interrupted. Recent studies have shown that the dryness of the skin of infant eczema children and imperfect barrier function is the histological basis for the development of the disease, and insisting on the application of emollient moisturizer can improve the barrier function of the skin, reduce the amount of corticosteroid ointment and reduce recurrence. When itching seriously affects the child’s sleep, the child can be given oral antihistamines (such as ketotifen and selbendine) that help him/her sleep. By following the above treatment principles, the symptoms of infantile eczema can mostly be controlled without the need for oral or injectable corticosteroids.  The long-term, recurring nature of infant eczema can be very difficult for parents to care for, making parents aware of the considerations in life care is an important part of the initial treatment of infant eczema abroad in recent years, and is something parents are eager to learn about. In summary, this includes feeding, dressing options, skin cleaning care, living room environment, prevention of bacterial and viral infections and vaccinations.  1, feeding: promote breastfeeding. In order to ensure the growth and development of children, in addition to the discovery of clear evidence of food aggravation of infant eczema, do not have to prohibit the consumption of milk. Because eggs are the food with the highest positive rate of infant eczema allergen testing, it is recommended that infants with eczema be fed egg yolks until after six months and egg whites until after one year of age. Add other exotic proteins or fruits in small, incremental amounts. You should not feed too much, so as not to increase the burden on the intestines.  2, wearing: eczema children should be dressed in cotton, soft, loose clothing, to avoid artificial fibers and woolen fabrics in direct contact with the skin, without feather pillows, quilts, clothing, washing clothes with weak alkaline, weak irritant detergent, rinse as clean as possible when washing. It is inappropriate to apply plastic products, and try to use less or no paper diapers.  3, skin cleaning care: infant eczema child skin cleaning should not use human breast milk, with warm and cool water to gently wipe the skin, bath soap, soap, skin care products choose to add ingredients simple, less irritating varieties. Reduce the number of baths in winter, bathing can be applied emollients, after the bath to apply ground-sensitive humidification or moisturizing cream.  4, the living room environment: eczema children living in the living room requires cool, ventilated, clean, in order to avoid house dust mite inhalation, it is recommended to use a wet mop, rags to clean. Winter room should use a humidifier to improve environmental humidity.  5, to prevent bacterial, viral infections: eczema children’s skin surface is prone to parasitic Staphylococcus aureus, Staphylococcus aureus can induce aggravated dermatitis damage has been recognized, should avoid trauma, keep the skin clean. The more you should avoid contact with patients with herpes simplex to avoid Kaposi chickenpox-like rash.  6, vaccination: childhood is the concentration stage of immunization. Infant eczema on what vaccines are contraindicated is a common question asked by parents, except for children with severe symptoms, the rest should be in remission stage of normal vaccination.  Usually, oral polio vaccine, vaccination with rubella virus, hepatitis B virus, mumps virus and rabies vaccine made by cell culture method are safe and not contraindicated; local redness and urticaria after measles vaccination for infants with eczema have been reported and should be noted; BCG vaccination for infants with eczema with reduced immune function has the risk of skin tuberculosis; there have been cases of encephalitis vaccine for infants with atopic dermatitis and There have been reports of localized erythema, hard nodules, and blisters in infants with atopic dermatitis vaccination, which subsided after 3-5 days. In addition, children with atopic dermatitis should not be randomly injected with penicillin and blood preparations.  As doctors, we are as concerned as parents about these children with infantile eczema, and hope that through our joint efforts, we can help each child with infantile eczema to pass through infancy with proper life care and correct and safe treatment methods.