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Vicki Iovine Authors 'Girlfriends' Guide' To Eczema

By John Morgan, Spotlight Health
With medical adviser Stephen A. Shoop, M.D.

When it comes to advice for her 'girlfriends,' best-selling author Vicki Iovine's millions of readers know she's telling it like it is. Now Iovine has put her pen to paper to help children and parents dealing with the frustrations and discomfort of eczema.

"Eczema can be extremely difficult for the whole family to deal with," Iovine says. "All four of my children suffered from pediatric eczema at some time in their early childhood."

Eczema is a non-specific term for atopic dermatitis, a hypersensitivity condition characterized by red, dry, scaling patches on the skin that are very itchy.

"I signed on to help create awareness because everything I write is about permission and empowerment - permission to not be perfect and empowerment to be bigger than you think you already are," says Iovine, who was compensated by Novartis Pharmaceuticals as a spokesperson and to write an informational pamphlet about eczema.  "It wasn't about the money. I know about eczema as a mom, and I wanted to be able to help other parents and their children."

Eczema is the most common disease seen by pediatric dermatologists. According to the American Academy of Dermatology, it is estimated that about 7-17% of the general population have atopic dermatitis at some point in their lives. The vast majority of children outgrow the disease by school age.

Eczema typically arises during the first year of life, usually appearing on the cheeks and/or the outer surfaces of the extremities. During the toddler years the disease typically affects the folds -- behind the elbows and knees. In older children, it can occur anywhere on the body.

"Their worst outbreaks were on their face - on their cheeks," Iovine says. "And everybody would say, "Oh my goodness look what rosy cheeks she has!" And I'd sort of nod and smile. Or say that's the Irish in them. But then I noticed that my kids were uncomfortable - it itched or was sensitive and it hurt them."

Eczema basics

"We call atopic dermatitis the itch that rashes," explains Dr. Anthony J. Mancini, associate professor of pediatrics and dermatology, Northwestern University, Feinberg School of Medicine in Chicago. "The patches are very itchy. Kids get engulfed in what we call the "itch-scratch" cycle. They itch a lot, even skin that appears normal to us is itchy to them. Scratching induces more itch, and it becomes a vicious cycle."

Atopic dermatitis is considered a genetic disease that has multiple environmental triggers. In most persons, there is a family history of other atopic diseases, including hay fever, food allergy, and asthma.

"My oldest son was asthmatic but grew out of it," says Iovine. "And my youngest daughter still has asthmatic tendencies."

Like allergy and asthma, eczema has many potential triggers. As such, parents are often advised not get hung up on trying to identify one or two triggers.

"We have parents who rip up their carpeting, get rid of the family dog, even move to a new house because this disease can have such an impact on their kids," Mancini reports. "Unfortunately, finding the one trigger that will magically cure the disease is a futile exercise."

That doesn't mean parents should not eliminate triggers they notice are contributing to their child's eczema flare-ups. Some known triggers include:

  • Temperature changes
  • Low humidity
  • Synthetic fibers
  • Dust mites

Food allergy is often one of the most notorious suspects as an eczema trigger, but according to experts is only a factor in about 20-25% of kids with the worst cases.

"We do know that if there is an allergic trigger, the big ones are dairy, eggs, soy, peanuts, wheat, and fish," says Dr. Amy Paller, Head of the Division of Dermatology at Children's Memorial Hospital of Chicago.

As frustrating as identifying triggers is for parents and physicians, the discomfort of eczema is even worse for children. Perhaps the biggest issue for those living with eczema is its negative impact on quality of life.

"These kids don't sleep because they're often itching," Paller says. "What sleep they do get can often be of less quality. They can't easily play with their friends. All of that affects psychosocial development which is extremely important."

"It's a very sensitive thing for kids and for parents," Iovine says. "I've heard parents say to their kids, "Come over here don't play with that child they're sick today."

Iovine says educating people about eczema is important because a lot of parents, teachers and even school nurses don't know much about it.

"There are so many myths about eczema that if believed can make kids more miserable," Iovine says. "I hope people read my guide and talk to a dermatologist because there are new eczema treatments that really work - and that don't use steroids."

Relief efforts

Treatment is a multi-dimensional approach.

Hydration of the skin - One myth is not bathing children with eczema. In fact, bathing is actually helpful if done correctly. Water should be warm not hot; bathe 10 minutes after which the child is blotted dry and moisturizer applied.

Antihistamines - "It's vital to treat the itch," Mancini advises. "If you treat the inflammation and you treat the infection but you do nothing about the itch, then you'll be right back where you started from." Treating the itch improves the quality of life, particularly in terms of getting a good restful night's sleep.

Antibiotics -- The eczema itself is not contagious unless open areas harbor a secondary infection.  "If infection is present in a small localized area, it is typically treated with a topical antibiotic," Mancini explains. "If the area is more widespread, then oral antibiotics are recommended."

Anti-inflammatories - The standard traditional treatment has been topical steroids. They are safe and effective when used correctly.  But there can be some concerns with long-term use, improper use, or use on the face. The most common side effect is thinning of the skin. 

Non-steroidals -- A new class of FDA-approved medications called non-steroidal topical immunomodulators (TIMs). In general, they tend to work less rapidly than topical steroids but have other advantages.

"They can be used anywhere," Mancini says. "They are especially nice for use on the face and around the eyes where we have long been concerned about the risk of steroid occular toxicity." Many dermatologists use them in combination with more traditional steroid therapy - for instance a TIMs on the face and a steroid on the body.

"There are many kids who seem to be resistant to topical corticosteroids," Paller adds. "We've been able to successful treat them with this new group of agents."

Iovine believes that education and awareness are critical in helping children deal with this noisome condition.

"The most important thing is while you can't prevent it, you can get a handle on eczema," says Iovine, who just published The Girlfriends' Guide to Baby Gear and The Girlfriends' Guide to Parties and Play-dates. "You can minimize your child's discomfort and minimize the embarrassment. It's empowering to be able to know what to do about your eczema."

American Academy of Dermatology

The Girlfriends' Guide to Pediatric Eczema

Spotlight Health is the leading creator of celebrity-featured health-issue awareness campaigns, connecting consumers with impassioned celebrities whose personal health battles can open eyes, dispel myths and change lives. Spotlight Health helps sufferers and caregivers meet the challenges of difficult health circumstances with understandable, in-depth medical information, compassionate support and the inspiration needed to make informed healthcare choices.

Created: 2/15/2003  -  John Morgan & Stephen A. Shoop, M.D.

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