Allergic Reactions In Children

Dr Melanie Majaham, Damai Service Hospital, Jalan Ipoh is a well-known paediatrician in Malaysia. She gave a talk on Common Skin conditions in Childhood at an event conducted in collaboration with Applecrumby & Fish earlier this year.  Here are some excerpts from the talk, in parts. In this article, we cover allergic reactions in children.

Scabies (Kudis buta)

Rashes that appear on the palms and soles of the feet. It starts off as small little red dots and spreads upwards. These rashes are extremely itchy, especially at night. Scabies is caused by a tiny bug called Sacropetes scabiei.It is a very tiny bug and cannot be seen with the naked eye – about 0.2 mm in size. This bug burrows its way into the skin and lays eggs. The skin actually develops allergic reaction to the eggs under the skin and causes a bad itch. It spreads easily and at a time the entire family can be found to be itching their hands and feet. It is important to treat the entire family. It is important to sun-dry all the linen and towels that way you can effectively get rid of the infection. Scratching can lead to bacterial infection.

Urticaria/Hives (Gegata)

This is an acute allergic reaction. When a child is exposed to a certain food or medication or cream/lotion/soap or viral infection, this appears. It looks like mosquito bites, the surface is raised, very itchy, disappears suddenly, appears in another place the next day – spreads quickly as well. It responds very well to anti-histamines. So in such patients, we administer anti-histamines, calamine to make the child feel comfortable. Cool compress, cool baths are recommended.

Eczema

This is a very hot topic these days. Almost 10% of us has eczema, even in adults. There is no clear reason for what causes eczema. Basically eczema is a combination of genes (inherited) and exposure to trigger or allergen. 

In the normal skin, cells are very tightly packed together to protect the skin from allergens entering the skin, to prevent infections, bacteria or viruses from going in. At the same time, it keeps the skin barrier intact to prevent loss of water and fat from the skin – basically keeping it moisturised.

In dermatitis or eczema, the skin cells are loosely packed. This permits external allergens, infections etc to enter into the body easily. At the same time, the skin gets dehydrated easily. So if you notice a child or an adult with eczema, it is very dry, looks scaly because the water is lost very fast.

The rashes appear over cheeks, thighs, knees, inner part of elbows. Location of eczema changes from the time the child is a small baby until he/she is a teenager. In small babies, the eczema tends to occur over the cheeks, over the outer part of the arms, calves. As they grow bigger, it moves towards the inner part of the elbow, as well as the back of the knees. In most teenagers, you can see the eczema in the inner part of the elbow and the back of the knees. These are common locations of eczema in children.

Scratch-Itch cycle

When the child scratches – when the skin is already damaged, it develops inflammation due to the chemicals released, this will again cause itchiness and cause the child to scratch further damaging the skin and causing more itchiness due to release of chemicals. This becomes a vicious cycle. So how does one stop this cycle? It has to be seen from where, at what point the cycle we can address so we can stop the cycle from continuing.

For damaged skin, you can try application of moisturiser to help keep the skin hydrated. The moisturiser used must be fragrance-free, paraben-free, alcohol free as these can trigger eczema. It is better to use normal soap-free cleansers. Normal cleansers, shower gels available in the market actually make eczema worse because it contains several chemicals. Organic soaps can be helpful for the child as well. Also, if it is a known fact that a specific cream or lotion can trigger the eczema, it is best to avoid it. This is not like immunity where you expose the child to a particular environment and the child gains immunity to it, eczema/allergy doesn’t work like that. In fact it triggers the allergy further and worsens the condition.

When the skin is inflammed and damaged, it is important to treat and heal it. Non-steroidal creams can be used to reduce symptoms of inflammation.

Moizturisers, steroid creams and sometimes antibiotics – itching can sometimes lead to bacterial infection, so antibiotics can help reduce the itch. To reduce the scratching, you can use wet wraps and moisturisers.

Common myths surrounding eczema

Myth: It is contagious 

Truth: You cannot get eczema from another person by touching them

Myth: It is an emotional disorder

Truth: Emotional disorder/sadness doesn’t cause eczema but it can trigger the eczema when you already have it

Myth: People with eczema are said to be dirty 

Truth: Trying to scrub away the dirty skin with dettol doesn’t work. There is a problem with the skin, when using anti bacterial soaps and agents you are drying the skin further, causing more reaction to occur. There is nothing to do with cleanliness

Myth: Eczema can be cured

Truth: Unfortunately, eczema cannot be cured. You can control symptoms. The genetics are involved, prevent irritants, use moisturizers

Myth: Avoiding certain foods can cure eczema

Truth: doesnt get better actually, external factors also play a role

Myth: People with eczema cannot use the swimming pool

Truth: This is not true, using the swimming pool is perfectly alright. Chlorine in the water in the pool can worsen the eczema. So it is advisable to clean up well after a swim to prevent the chlorine to remain in the skin.

General principles of treatment

Eczema is a lifelong condition, you cannot cure it but you can control it. For some it gets better with age but not all.

• It is advisable that people with eczema should moisturize often.
• Use a soap free cleanser.
• You may use steroid cream under doctor supervision
• Non steroidal cream such as Tacrolimus is available but a bit expensive
• Wet wraps control eczema
• If the child develops secondary viral, bacterial or fungal infections, they need to be treated or else the eczema gets worse.

Every child needs to be treated for Eczema differently, one cream may work for one while it may not work for another at all.

What is Wet wrap therapy?

Wrapping up the baby like a mummy with a special material. After bath, moisturizer is applied on the baby and he/she is wrapped well. It is essential to spray the baby (on the wrap) constantly so the baby eats with it, sleeps with it and uses it throughout the night. It certainly helps some babies and this method has to be used under the supervision and recommendation of a dermatologist.

As a parent, when should you be worried?

Keep an eye on your child and visit the doctor when you notice these:

• Generally unwell or lethargic
• Refusing to eat and drink
• Any change in behaviour – drowsy/irritable/delirious
• Trust your instincts

Pointers to all parents:

• Keep track of how and when the rash started, how it changed – give a good description of how and where the rash started will help  for a proper diagnosis
• Home remedies can alter the appearance of the initial rash leading to confusion
• Trust your instincts and seek doctor advise(2nd opinion) if there is no change after initial medication.

For further enquiries or to make an appointment with Dr Melanie Majaham, visit GetDoc.

Tags

• allergies
• child diseases
• eczema
• hives
• scabies
• urticaria