Frustrating, painful, annoying and hard work but you knew that already! Below is a brief description of eczema and treatments. You will find links to other sites for more in depth info on each topic.

• Eczema/Atopic Dermatitis
• Emollients
• Staph
• Wet Wraps (Tubifast wraps and garment order informations found under this section)

Eczema/Atopic Dermatitis.

Eczema is a group of skin conditions that show up as itchy, red, dry, thickened, lumpy, scaly patches of skin.  Due to the intensity of the itch people often scratch their skin until it is broken and bleeds. This can lead to secondary infections that weep and form crusts. Eczema cannot be cured but it can be managed and some children will grow out of the condition.

Atopic Dermatitis or AD is the most common form of eczema. It is an allergic form and is often seen in people who have or have a family history of asthma and hayfever.

• Dry skin-moisturising the skin with emollients and bath additives.
• Itch/scratch-reducing the itch sensation and the response to it. This may be through antihistamines, topical products, and behavioural management.
• Inflammation-steroids, oral alternative treatments such as Primrose oil.
• Infection-observation for skin infection, diagnosis and appropriate treament such as oral antibiotics, topical antibiotics, bath additives such as bleach or Oilatum Plus.
• Triggers-identification of food and environmental allergies though testing and observation. Avoidence of these triggers. For example dust mite control with bedding covers, restricted diet.

To what degree any or all of these components play in your child's eczema is very individual and may change over time. Therefore it is important to keep in regular contact with your health professional (GP, Specialist, Nurse) for advice and diagnosis.

The following reading will give you a place to start when looking further into what eczema is and its management.

Eczema Fact sheets-list to the following information
Facts about eczema, The skin and how it works, coping with eczema, treatments for eczema.
http://www.netdoctor.co.uk/skin_hair/eczema_index.shtml
 

This page from Eczema Voice gives a sort simple explanation of the skin and what happens to it when a person has eczema
http://www.eczemavoice.com/sections/link/question3.html#What%20Happens%20In%20The%20Skin?
 

What is Eczema (Atopic Dermatitis)? From National Jewish Medical and Research Centre. USA.
http://www.nationaljewish.org/disease-info/diseases/allergy/about/conditions/eczema.aspx
 

Eczema. 
http://www.allergyclinic.co.nz/guides/13.html

Eczema-a patients guide.
http://www.familydoctor.co.nz/index.asp?U=conditions&A=2902

Diet and Eczema in Children
http://www.eczema.org/diet.pdf

Your Guide to Eczema. Allergy New Zealand Booklet. 
Order from info@allergy.org.nz

Emollients.

Emollients (moisturisers) are a major part of eczema treatment. They are used to replace lost skin moisture, help restore the normal barrier function of the skin, help the skin feel more comfortable and reduce itch.

There are many types of emollients and they work in different ways. The following two links give  comprehensive explanations of emollients and bath additives.

Moisturisers and moisturising bath addatives or washes.
http://www.netdoctor.co.uk/skin_hair/eczema_moisturisers_003761.htm
 

Emollients
http://skincareworld.co.uk/libraryscw/learning/emollients.htm

You may find that you need to use several types of emollient at one time in different areas of the body dependant on how dry the skin is. I also find that I prefer to use a heavier emollient in wintertime and a lighter, less greasy emollient in summer. Some childrens skin responds better to some moisturisers than others. What ever you use the most important idea is emolliate, emolliate, emolliate and then emolliate some more!

Hot Tips. 

• Decant your emollients into smaller containers and plant them around the house, car, handbag grandma's house, etc. This way they are always available for a quick swipe. No fuss, no muss. You can ask your pharmacist to do this for you or you can buy containers from stores like the Plastic Box or Warehouse.

• Even from a young age itchy kids can apply their emollients themselves. 
  • Let them help if they show interest. Encourage them if they don't.
  • Itchy kids can gain power over their eczema by being fully involved in their care and moisturising is a safe easy way to do that. It gives them something constructive to do when they are itchy and they can do something FOR themselves rather than have things done TO them.
  • As they get older encourage more responsibility for initiating using their cream. They need to learn self care of their itch just the same as we teach them to brush their teeth. Know the equipment they need for the job, where to get it, how to do it, when to do it and to pack up after (hehehe still working on that one)
  • I once set up an "Emollient Station" that consisted of a large plastic box with a smaller one inside with cream in it, a paintbrush and a small hand towel. Whenever itchy kid wanted to scratch he went to the station, sat down put his itchy limb on the hand towel and proceeded to paint a masterpiece using his cream as his medium.
  • Other ways to encourage participation is to paint shapes and faces with the cream on their body for them and get them to join in. If all parties are willing then siblings can be included in this activity.
  • School children can take a pot of cream to school. Decant into a fun and funky container or decorate a plain container with stickers. Make it their own and something they don't feel embarrassed about pulling out in front of friends.
    
• Emulsifying Ointment
  • Use under wet wraps. Apply like icing a cake.
  • Use frequently through out the day (and night!) as moisturiser.
  • Use as a soap substitute.
  • Use as a shampoo. It can be done. Just use fresh water not the bath water to rinse hair well.
  • Use as a bath oil. Throw in handfuls- 3 or 4 into the bath or spoon out some into a separate container. Pour boiling water from the jug over it and use a fork to whisk until very milky and creamy. Then add to bath. This method keeps it from forming lumps. You can then use more from the main pot to massage into the body while soaking in the bath.
  • I have microwaved it in the past but don't recommend it. It can get VERY hot. Busy household, dinner cooking, homework needing doing, phone ringing, itchy kid in the bath, emulsifying in the microwave.....hmmmm need I say more.
  • We use a sieve (plastic handle and fine wire one from the supermarket) to catch the lumps/"go fishing" and then rub on to body. Also if you squish the lumps through the sieve it goes very creamy and is nice to apply to the body. 
  • The sieve is also great at saving the plumbing. We scoop out the emulsifying at the end of bath time and throw it in the bin rather than let it go down the drain.
  • How to get emulsifying out of clothes? Prevention is the best cure. Prepare your environment. Lots of old towels over area you will be using. Emulsifyer to have specific clothes. I use the same track pants and t-shirt that I keep with the old towels so my kit is all ready to go and I know where it is (usually in a pile on the floor!). Emulsifyee to have specific pyjamas and know not to run all over the house or jump on the couch until process is complete (good luck with that one!) 
    Normal machine washing even in hot water never seems to get rid of it completely. Clothes end up feeling damp. The only way I have found is to hand wash clothes in hot water and to rinse several times.
    

Staphylococcus aureus

When we talk about Staph we are referring to the bacteria Staphylococcus aureus. Staph is generally a hardy orgainisim that can live harmlessly on the skin. A percentage of people in the community carry the bacteria without any active infection or disease. 

Staph is a problem when the skin is broken for any reason. We see this in atopic eczema when dry, itchy skin causes the itchy kid or adult to scratch. Scratching often leads to broken damaged skin. The barrier function that the skin normaly provides is disrupted allowing staph to enter. For some people Staph infections play a major role in the flares and exacerbation of their eczema.

Staph not only causes infection but it releases a potent toxin. This toxin stimulates the body's immune response to release histamine, which in turn causes inflammation and itch. And so the cycle goes on...

The following three articles give more detail about Staph, it's description, types of diseases that it and it's toxins causes, treatments and preventions.

Staphylococcus aureus
http://kidshealth.org/parent/infections/bacterial_viral/staphylococcus.html

Staphylococcus skin infection
http://dermnetnz.org/bacterial/staphylococci.html

The infection connection
http://www.dotpharmacy.co.uk/upeczema.html

Hot Tips

• Prevent infection occuring by maintaining intact skin (this is a hard one!)
  • Cut nails short.
  • While on car journeys consider placing child in sleep suit or protective clothing to minimise damage when scratching while you are driving.
  • Sleep suits at night and nap times.

• Prevent spread and re-infection
  •  Wash hands after contact with itchy kids skin such as putting on creams, bathing etc
  • All those living in the house to be vigilant with hand washing.
  • Each familiy member to have own towel.
  • Put itchy kids towel in laundry after each use.
  • Bath children seperatley.
  • Use clean spatula/spoon/tissue to get out enough cream for one application. If you don't use it all, throw away immediately.
  • Keep lids securely on creams.
  • Use Oilatum Plus or household bleach in the bath (any brand, 1 teaspoon to half a cup per adult sized bath) to kill the staph.
  • If infection is present do not wet wrap.
    

Wet Wraps

Wet Wraping is an eczema control treatment. The treatment involves the application to the skin of a thick layer of emollient that is then covered with a layer of warm wet bandaging. Over this a layer of dry bandaging is applied.

Wet Wrapping works by overdosing the skin with moisturiser to keep it supple. The slow evaporation of the wet bandages cools the skin therefore reducing itch and the need to scratch (which causes skin damage). Nighttime sleep is promoted as the skin is kept moist for longer. The treatment also allows steroid creams to be absorbed more readily and help the skin to progress to a stage when steroid use may be reduced or no longer necessary.

• Tubifast Retention Bandages.
  • Light, elastic tubular bandage. 
  • Purchased in boxes of 10 meter rolls.
  • 5 sizes to fit any part of the body.
  • Hand wash, cool tumble dry.
    
• Tubifast Garments.
  • Light, elastic, ready made garments. (vests, leggings, tights, socks)
  • Purchased in boxes of single items.
  • 5 sizes from 6 months of age up to 14years.
  • Machine washable, tumble dry.

When and if the Wet Wrap treatment is needed is decided by your childs health professional. They will explain the dos and don'ts and povide you with literature and guidance for the process as well as information on where to purchase the bandaging.

It can take a little while to get the hang of the process but once you have your own system worked out the process becomes much smoother for wet wrap-er and wet wrap-ee. My experience of wet wraping is that it does work but it takes time

How to Order Wraps and Garments

The links below will give you more information about the wet wrap procecess.

Wet Wrapping Efficacy.
http://www.skincareworld.co.uk/healthcentre/our_products/WetWrappingEfficacy.htm

Tubifast Garments
http://www.skincareworld.co.uk/healthcentre/our_products/tubifast/garments.htm

Tubifast Bandages
http://www.skincareworld.co.uk/healthcentre/our_products/tubifast/bandages.htm

Learning about Wet Wrapping with Thomas and the Happy Wrappers.
www.wetwraps.co.uk

Eczema Can Relieve Severe Eczema.
http://www.skincarephysicians.com/eczemanet/update2.html
 

Hot Tips

• Getting itchy kid to comply with the treatment.
  • Be calm and confident yourself. Take your time and maintain an air of adventure and positiveness.(faking it is allowed)
  • Have everything prepared and enlist the help of a 'runner' to help you by fetching things you forget. This will cut down the time it takes for the process so itchy kid doesn't get fidgety.
  • Prepare itchy kid for the process by showing the Thomas video and having little age appropriate chats before the treatment begins. Keep information light and positive. 
  • Involve itchy kid in process. Putting on cream, holding a bandage, setting up the area and helping you remember the equipment needed.
  • Have other family/friends involved if itchy kid wants. 
  • Have non-crumbly snacks for itchy kid during process.
  • Save a favourite movie/music/story to watch during wrapping for distraction.
  • Watch the Thomas video/sing the Thomas song during wrapping and other times.
  • Make sure room is warm.
  • Explain that the first few times will take you longer as you both get used to it and that it will get quicker.
  • Get together with another itchy kid for a joint wrap session.
  • Get together for a play with other itchy kids with wraps on.
  • Consider star/sticker chart as reward for compliance.
  • I have even resorted to drawing faces on hand wraps. (Walter and Wilimina Wrap!)
  • Plan for non-eczema realted activity for after wrapping for itchy kid to look forward to.
  • Encourage itchy kid to express feelings about wrapping and how wearing visible wraps makes him/her feel. You might come up with ways together to lessen any worries.

• Making the process quicker and less stressful.
  • Keep all equipment in one place. (towels, creams, scissors etc) so you can grab and set up easily. Also packing up is easier if everything goes back in a box or kit. Replace used supplies before putting wet wrap kit away.
  • Have plenty of 'sets' of wraps. You will generally have one set on and one drying. Consider a third set to give yourself a bit of space if the used set doesn't get washed or a set is not dried in time or, as I do, somehow loose a piece somwhere along the line and am left without a dry layer for one limb and a half wraped itchy kid wanting to run around the house while I search for a replacement.
  • Have two Wrap-ers if possible.
  • Have another trained Wrap-er to give the main Wrap-er a night or two off Wrap duty.
  • Compare notes and hints with other Wrap-ers.
  • Try to choose a time of day that is the least stressful for you both.
  • Have Grandma/friend/playmate available to keep siblings amused and safe while you are busy wraping.

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