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Melatonin May Help Kids with Eczema Sleep Better

2:00

Eczema is a common skin disease that affects as many as 30 percent of all kids.  It’s an itchy red rash that often causes continuous scratching. Numerous children with eczema have trouble sleeping through the night. A new study suggests that over-the-counter melatonin may help them sleep longer and better.

These sleep problems can be difficult to treat in these children, said Dr. Yung-Sen Chang, an attending physician in pediatrics at Taipei City Hospital Renai Branch in Taiwan. Antihistamines can stop working after a few days, and tranquilizers have potentially serious side effects, Chang said.

But giving children melatonin, his study found, "is safe and effective for helping children with atopic dermatitis fall asleep faster."

The link between the skin condition and insufficient sleep "has an impact on people with eczema at all ages," said Dr. Lawrence Eichenfield, chief of pediatric and adolescent dermatology at the University of California, San Diego and Rady Children's Hospital.

According to Eichenfield, it's generally established that it’s the itching that keeps people with eczema from getting enough sleep. However, Chang said that may not be the case.

Chang and colleagues discovered that patients with eczema, that had difficulty sleeping, had low levels of nocturnal melatonin. That intrigued Chang and inspired the new study.

"Melatonin is a natural human hormone with minimal adverse effects," Chang said, "so it seemed like a good choice for children."

The study was small and involved 48 children, about 22 months to 18 years old, who had eczema. The children received treatment with either an inactive placebo or a 3-milligram daily dose of melatonin at bedtime for four weeks. Thirty-eight participants then took the alternate treatment (melatonin or placebo) for another four weeks.

When the children took melatonin, the severity of eczema dipped slightly, possibly because melatonin's anti-inflammatory effect improved the skin condition, Chang said.

Also, kids taking melatonin fell asleep about 21 minutes sooner than kids taking the placebo, the findings showed.

Total nightly sleep rose by 10 minutes on average (from 380 to 390 minutes, or 6.5 hours total) in the melatonin group, while it fell by 20 minutes among those who took a placebo, according to the report.

The participants did not report any side effects. Melatonin supplements are inexpensive in the U.S.- typically under 9 cents a pill from one major supplier.

Eichenfield, who wasn't involved in the research, said the study appears to be well-designed. Melatonin hasn't been studied much as a sleep treatment for kids, he cautioned.

While Eichenfield said melatonin may turn out to be helpful, he said there are a broad set of other tools available to treat eczema and minimize its effect on children. He suggested tackling the skin condition first to try to mitigate the sleep issues.

Chang recommended that parents talk to their child's doctor before starting melatonin. As for adults, melatonin may help them, too. But more studies are needed, Chang said.

The study was published in a November online edition of the journal JAMA Pediatrics.

Source: Randy Dotinga, http://www.webmd.com/children/news/20151124/melatonin-might-help-sleepless-kids-with-eczema-study-finds

 

Your Baby

“Hard” Tap Water and Eczema in Infants

1:30

Previous studies have noted an association between “hard” tap water and eczema in schoolchildren, but a new study out of the U.K. suggests it may be linked to eczema in babies as well.

Water described as “hard” contains a high degree of minerals - specifically calcium, magnesium and manganese. It’s not considered hazardous, but it comes with a variety of unpleasant effects such as soap scum in sinks and bathtubs, spots on dishes and shower glass, clogged pipes from buildup and clothes that are left dingy after washing.

By some accounts, 85% of U.S. households have hard water.

If your child has eczema, then you know that it is a chronic condition marked by itchiness and rashes. It typically starts at about 6 months old and can last into adulthood.

The study included 1,300 3-month old infants from across the United Kingdom. Researchers checked hardness -- the water's mineral content -- and chlorine levels in the water supply where the babies lived.

Babies who lived in areas with hard water were up to 87% more likely to have eczema, the study found.

"Our study builds on growing evidence of a link between exposure to hard water and the risk of developing eczema in childhood," said lead author Dr. Carsten Flohr, from the Institute of Dermatology at King's College London.

One way to change the composition of hard water is by adding a water softener system to your household

There are several types of systems including salt-based Ion exchange softeners, salt-free softeners, dual tank and magnetic water softeners plus others.

While the other studies focused on school aged children, this is the first to look at the connection with eczema, hard water and babies, the researchers said.

The study wasn't designed to prove a cause-and-effect relationship, so further research is needed to learn more about this apparent link, Flohr added.

"We are about to launch a feasibility trial to assess whether installing a water softener in the homes of high-risk children around the time of birth may reduce the risk of eczema and whether reducing chlorine levels brings any additional benefits," Flohr said in a college news release.

The study was published recently in the Journal of Allergy and Clinical Immunology.

Story sources: Robert Preidt, https://www.nlm.nih.gov/medlineplus/news/fullstory_159150.html

http://extoxnet.orst.edu/faqs/safedrink/hard.htm

 

 

Daily Dose

Winter Season & Eczema

1.30 to read

I received these nice pictures and a question via email the other day. The mother was concerned as she had found this “spot” on her 6 year old son’s back. He was otherwise well and she did not see any other “spots” or rash.   

Her son complained that the “spot” was itchy so being the good mother she applied some over the counter cortisone cream for several days (which I always tell patients to try). After 2 days of it not improving, but not worsening, she thought it might be ringworm (also a good thought) and she applied an OTC anti-fungal cream.  Again, the rash was not better, but really not worsening or spreading.  That is an important part of the history. 

Now in medicine you learn about red herrings, which are part of a patient’s history that may not really have any bearing to their current problem....but one has to consider it. In this case, her dog developed a lesion and was taken to the vet and was diagnosed with a staph infection, but the vet told the mom that the dog was not contagious to humans.  Red herring or is that the problem? 

After looking at all of the pictures (which is never as good as seeing a rash in person), I am thinking that this may be nummular eczema, (nummular means coin shaped, hence the round)  The history is right as is was not bothersome other than being itchy, and eczema is often called the “itch that scratches”.   

With all of this cold dry weather and heaters on full blast all over the country eczema is having a heyday.  I have seen a ton of these little inflamed patches on skin of all ages (my own hands are a mess).   The treatment of choice is to moisturize the skin and also the use of a topical steroid. But, it takes a long time to see an improvement in the spots and they may change on a daily basis depending  on the weather, bathing and how much lubrication and moisturizing you are doing.  

I would use an OTC moisturizer that contains ceramides (Cetaphil Restoraderm, Cerave, Aveeno for eczema) and use it liberally and frequently.  I would also apply an OTC steroid several times a day (under the moisturizer). Eczema also sometimes requires a stronger topical steroid that is prescription. 

Hope that helps.....but if not improving after 7-10 days it may be worth a visit to your pedi for up close and personal diagnosis.

Daily Dose

Best Ways To Treat Eczema

New research on how to treat eczema.I am sitting here with my dear friend “the dermatologist”, and she is educating me about some new research on atopic dermatitis (eczema).

The newest theory is that children with eczema have extrinsically different skin in that they have a defective skin barrier which allows irritants into the skin resulting in inflammation. These children seem to have a defect in the filaggrin, which is a protein in the skin, and is important in maintaining skin hydration. There seems to be a mutation in the gene that makes this protein in the skin.

Think of the top layer of the skin (barrier layer) as a “bricks and mortar” structure. Filaggrin is an important protein in maintaining the normal “mortar” between the cells and if you have defective “mortar” (filaggrin) then this is a major risk factor for development of atopic dermatitis. With the loss of the “mortar”, there is increased water loss in the skin. There are also lipids called ceramides in the skin that play an important role in skin hydration, because they help bind water. Ceramides make up about 50 percent of the total lipids in the skin. The lipid layer is also important in the “mortar” between the skin cells. Patients with eczema may also have a defect in ceramide production that allows irritants to get into the skin and begin the inflammatory process that we see in eczema patients. So, what does all of this mean? There are several products that are physiologic moisturizers that actually contain ceramides, and may repair the skin barrier. These products include CeraVe and Aveeno Advanced Care, as well as Epiceram (which is a prescription). There are also other topical therapies including Atopiclair and Mimyx that act as barrier creams but do not contain ceramides. Lastly, she discussed the use of bleach baths to decrease staph aureus (bacterial) colonization of the skin which seems to also help decrease the inflammatory process of eczema. Staph elicits an immune response which may contribute to dermatitis. It also may induce steroid resistance, in other words, the topical steroids typically prescribed for eczema may not work as well when staph is around. Staph acts as a “superantigen” and is a trigger for atopic derm. By using bleach baths with 1/8 cup bleach in a half foot of bath water and soaking your child for 5 or 10 minutes twice a week you can reduce the skin staph colonization. This may then reduce infection, inflammation and the need for antibiotics. You can also make a dilute bleach solution and put it in a spray bottle to use locally, especially for older kids who aren’t into baths. If a child has scratched themselves and has cracks and fissures, it is helpful to put a layer of Vaseline over the area before doing a bleach bath. This is all new and interesting data coming out in the pediatric dermatology literature that may change some of our treatments of eczema. Get out the bleach, but don’t get it on anything else!! That’s your daily dose, we’ll chat again tomorrow. Send your question to Dr. Sue!

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Daily Dose

New Science Behind Eczema

ANyone in your family suffer with eczema? Here's a look at the latest research on atopic dermatitis (eczema).I am sitting here with my dear friend “the dermatologist”, and she is educating me about some new research on atopic dermatitis (eczema).

The newest theory is that children with eczema have extrinsically different skin in that they have a defective skin barrier which allows irritants into the skin resulting in inflammation. These children seem to have a defect in the filaggrin, which is a protein in the skin, and is important in maintaining skin hydration. There seems to be a mutation in the gene that makes this protein in the skin. Think of the top layer of the skin (barrier layer) as a “bricks and mortar” structure. Filaggrin is an important protein in maintaining the normal “mortar” between the cells and if you have defective “mortar” (filaggrin) then this is a major risk factor for development of atopic dermatitis. With the loss of the “mortar”, there is increased water loss in the skin. There are also lipids called ceramides in the skin that play an important role in skin hydration, because they help bind water. Ceramides make up about 50 percent of the total lipids in the skin. The lipid layer is also important in the “mortar” between the skin cells. Patients with eczema may also have a defect in ceramide production that allows irritants to get into the skin and begin the inflammatory process that we see in eczema patients. So, what does all of this mean? There are several products that are physiologic moisturizers that actually contain ceramides, and may repair the skin barrier. These products include CeraVe and Aveeno Advanced Care, as well as Epiceram (which is a prescription). There are also other topical therapies including Atopiclair and Mimyx that act as barrier creams but do not contain ceramides. Lastly, she discussed the use of bleach baths to decrease staph aureus (bacterial) colonization of the skin which seems to also help decrease the inflammatory process of eczema. Staph elicits an immune response which may contribute to dermatitis. It also may induce steroid resistance, in other words, the topical steroids typically prescribed for eczema may not work as well when staph is around. Staph acts as a “superantigen” and is a trigger for atopic derm. By using bleach baths with 1/8 cup bleach in a half foot of bath water and soaking your child for 5 or 10 minutes twice a week you can reduce the skin staph colonization. This may then reduce infection, inflammation and the need for antibiotics. You can also make a dilute bleach solution and put it in a spray bottle to use locally, especially for older kids who aren’t into baths. If a child has scratched themselves and has cracks and fissures, it is helpful to put a layer of Vaseline over the area before doing a bleach bath. This is all new and interesting data just coming out in the pediatric dermatology literature that may change some of our treatments of eczema. Get out the bleach, but don’t get it on anything else!! That’s your daily dose, we’ll chat again tomorrow.

Daily Dose

New Research Could Help Treat Eczema

I am sitting here with my dear friend “the dermatologist”, and she is educating me about some new research on atopic dermatitis (eczema).

If you don’t have a child with eczema you may not be as interested in some of this science. The newest theory is that children with eczema have extrinsically different skin in that they have a defective skin barrier which allows irritants into the skin resulting in inflammation. These children seem to have a defect in the filaggrin, which is a protein in the skin, and is important in maintaining skin hydration. There seems to be a mutation in the gene that makes this protein in the skin. Think of the top layer of the skin (barrier layer) as a “bricks and mortar” structure. Filaggrin is an important protein in maintaining the normal “mortar” between the cells and if you have defective “mortar” (filaggrin) then this is a major risk factor for development of atopic dermatitis. With the loss of the “mortar”, there is increased water loss in the skin. There are also lipids called ceramides in the skin that play an important role in skin hydration, because they help bind water. Ceramides make up about 50 percent of the total lipids in the skin. The lipid layer is also important in the “mortar” between the skin cells. Patients with eczema may also have a defect in ceramide production that allows irritants to get into the skin and begin the inflammatory process that we see in eczema patients. So, what does all of this mean? There are several products that are physiologic moisturizers that actually contain ceramides, and may repair the skin barrier. These products include CeraVe and Aveeno Advanced Care, as well as Epiceram (which is a prescription). There are also other topical therapies including Atopiclair and Mimyx that act as barrier creams but do not contain ceramides. Lastly, she discussed the use of bleach baths to decrease staph aureus (bacterial) colonization of the skin which seems to also help decrease the inflammatory process of eczema. Staph elicits an immune response which may contribute to dermatitis. It also may induce steroid resistance, in other words, the topical steroids typically prescribed for eczema may not work as well when staph is around. Staph acts as a “superantigen” and is a trigger for atopic derm. By using bleach baths with 1/8 cup bleach in a half foot of bath water and soaking your child for 5 or 10 minutes twice a week you can reduce the skin staph colonization. This may then reduce infection, inflammation and the need for antibiotics. You can also make a dilute bleach solution and put it in a spray bottle to use locally, especially for older kids who aren’t into baths. If a child has scratched themselves and has cracks and fissures, it is helpful to put a layer of Vaseline over the area before doing a bleach bath. This is all new and interesting data just coming out in the pediatric dermatology literature that may change some of our treatments of eczema. Get out the bleach, but don’t get it on anything else!! That’s your daily dose, we’ll chat again tomorrow.

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DR SUE'S DAILY DOSE

Just how much sleep does your child need?

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