ECZEMA SKIN CARE MADE SIMPLE

Transcription

1 ECZEMA SKIN CARE MADE SIMPLE BATHING, MEDICATIONS & MOISTURIZING ºC x1 x2 x2 BATHING Bathe once daily with warm water for 5 to 10 minutes. Clean with gentle, non-scented cleansers. Right after the bath, pat skin gently with a clean, soft towel. Make sure you apply moisturizer after every bath or shower. MEDICATION Apply a layer of prescription creams or ointments on the red, itchy and rough rash areas as prescribed by your doctor (e.g. twice a day). One application can be after having a bath. MOISTURIZING Put a good amount of moisturizer on the entire body at least twice a day (three if you can!). See our Seal of Acceptance products for some suggestions. Need help finding suitable skin care products? Look for the Eczema Society of Canada Seal of Acceptance on moisturizers and cleansers at your local drug or grocery store. eczemahelp.ca

2 AROUND THE HOME X X x2 X ºC 1 X 2 CLOTHING & BEDDING Use 100% cotton clothing and bedding, protect your mattress with a dust mite cover, wash sheets weekly, and avoid overheating. LAUNDRY Wash laundry with mild, fragrance- and dye-free detergents. Rinse twice if possible. ENVIRONMENT Keep your house cool, try a humidifier in the winter, avoid playing in grass or leaves, and avoid products that might irritate your skin. FEEDING For babies and young children, apply moisturizer around the mouth before feeding. KEEP IN MIND MANAGING FLARE-UPS Infected eczema (yellow scabbing, visible pus, swollen skin, or increasing pain and warmth) needs to be seen by a doctor immediately. Keep skin moisturized to reduce itch. ºC Reduce stress as much as possible as stress can make your eczema worse. During a flare up or period of intense itching, try a cool compress, take a cool bath or shower and apply moisturizer. Keep nails smooth and trimmed short. Wear soft cotton gloves at night if this helps. Try finding a distracting activity such as reading, watching television or playing a video game. For more information or support, contact Eczema Society of Canada at ECZEMA-1 or eczemahelp.ca We thank Dr. Rachel Asiniwasis, MD, FRCPC (Dermatology) and Dr. Joseph Lam, MD, FRCPC (Paediatrics) for their contributions on this resource. Copyright

3 Hand Eczema Guide Eczema Education Series

4 What is hand eczema? Hand eczema, or hand dermatitis, describes any type of eczema that develops on the hands. It is commonly job-related and can be made worse by factors including frequent hand washing and exposure to chemicals. Hand eczema may require specific testing and treatments. It may cause itchy, dry, scaly patches of skin that cracks and flakes. This can occur acutely, but may also be a condition referred to as chronic hand eczema (CHE) or chronic hand dermatitis (CHD). Hand eczema, and CHE can profoundly affect everyday living and one s quality of life. Chronic hand eczema may not respond to traditional eczema management strategies such as frequent moisturizing, protecting the hands, and topical prescription treatments, and the appropriate treatment plan will depend on a number of factors. Who does hand eczema affect? Hand eczema occurs commonly among the following occupations: bricklayer mechanical industry worker hair dresser health care worker janitors and housecleaners florists food service industry workers agricultural workers Hand eczema can happen to anyone, however, you are more likely to be affected if: you had similar skin problems, eczema, hay fever, or other allergies as a child. your hands get wet a lot, whether at home, work or with leisure activities. your job exposes your hands to irritating chemicals or very frequent hand washing and disinfection. you frequently wash your hands around the house or at work, which breaks down the skin s natural protective barrier. 1 2

5 The next most common is Allergic Contact Dermatitis. Common allergens include nickel, certain food additives and fragrances, and preservatives. Occupational allergens could include antibacterial soaps and solutions, organic dyes, rubber, plastic resins, and plants. What causes hand eczema? Often, the cause is unclear; however there can be one or more conditions present. The three most common conditions related to hand eczema are irritant contact dermatitis, allergic contact dermatitis, and atopic dermatitis. The most common is Irritant Contact Dermatitis. Repeated exposure to irritants such as water, soaps, detergents, solvents, degreasers, lubricants, oils, coolants, fiberglass dust, food products, metals, and plastics can inhibit the repair of the skin barrier. What are the signs and symptoms? affects the fingertips and web spaces skin is dry and chapped, with areas of itchy, red, scaly, and swollen skin skin may sting or burn when in contact with irritants, and may eventually crack and bleed What are the signs and symptoms? soon after exposure, small blisters may appear with itchy, swollen, red skin later, the skin may dry out and with crusts, scales, and cracks prolonged exposure to the allergen can cause the skin to darken and it may become thick and leathery it may appear all over the hands and fingers, particularly on the inside of the hands and finger tips Hand eczema can also be caused by Atopic Dermatitis, whereby skin in other areas of the body is also affected. What are the signs and symptoms? intense itchiness acute skin lesions the condition is chronic skin is thickened Speak with your doctor to get a diagnosis on your specific condition, and to talk about treatment options that are right for you. 3 4

6 How is hand eczema diagnosed? Without proper diagnosis and treatment, hand dermatitis can persist and become chronic. It can often become disabling because it affects one s ability to perform at work and home. Additionally, hand dermatitis may interfere with sleep, cause emotional discomfort, and negatively affect interpersonal interactions. A thorough history and physical examination is essential in helping to deduce the possible cause(s) of hand dermatitis. Medical, occupational and social history are important. It is often challenging to distinguish irritant contact from allergic contact dermatitis. Patch Testing Patch testing should be considered for all with chronic hand dermatitis. The gold standard method for diagnosis of allergic contact dermatitis is patch testing which is an office procedure, in which allergens are applied to the back. Your doctor should strongly consider patch testing if: You have chronic hand dermatitis You are not able to manage your dermatitis Your dermatitis responds to treatment but flares immediately when you stop using your topical treatments See your doctor! The longer the condition goes undiagnosed and untreated, the more likely you are to suffer with chronic hand eczema. What are the treatment options? Self Care & Lifestyle Modification Lifestyle modification and self care are the first line of defense. This includes: Moisturizing and Gentle Cleansing Use hand cleansers and moisturizers that are free of irritating ingredients and fragrances. Moisturizing regularly will help to replenish skin moisture, and will help you to keep your eczema under control. Apply a rich moisturizer immediately after bathing, hand washing, and anytime in between. Choose moisturizers and cleansers that are suitable for the sensitive skin of eczema. Look for the ESC Seal of Acceptance on products at your local drugstore. If your eczema has cleared up, and you are no longer using your prescription treatments, continue with a diligent moisturizing routine, which may help to prolong the period between flares. Hand washing is destructive to the skin barrier and should always be followed by applying moisturizer. Hand sanitizers may be a helpful alternative to frequent hand washing, however avoid fragranced hand sanitizers, which may be irritating. 5 6

7 Lifestyle Modifications Where possible, avoid or minimize wet-work. Avoid excessive sweating and dry conditions which are sometimes triggers. Avoid scratching which worsens the condition and may cause cracks allowing bacteria to enter leading to infection. Sometimes applying cold compress to the area reduces itch. Keep fingernails short. Avoid the substance(s) causing the irritation or allergy. Avoiding all substances can be very difficult-if not impossibleespecially if these substances are encountered at work. Using barrier cream, wearing gloves, and practicing glove hygiene is often helpful. Minimize contact with fruit juices, fruits, vegetables and raw meat while preparing food, or wear gloves. Protect hands by using cotton gloves as a liner under vinyl gloves. Shampoo and style hair while wearing vinyl gloves, if possible. Take off rings before wet-work or hand washing. Use emollients frequently to help restore normal skin barrier function. A thin smear of a thick barrier cream should be applied to all affected areas before work, and reapplied after washing and whenever the skin dries out. Stress triggers flare-ups in many people so reducing stress may be beneficial. Topical Therapy To treat inflammation, topical corticosteroids are commonly used. Use only as needed that is, when your eczema is actively flaring. Prolonged use can cause thinning of the skin. Fearing side effects, patients more commonly use too little rather than too much. If your response is unexpectedly slow, discuss the possibility of corticosteroid allergy with your doctor. Pimecrolimus (Elidel ) and tacrolimus (Protopic ) may be helpful as an alternative to topical corticosteroids. 7 8

8 Phototherapy (Light Therapy) Narrow-band UVB light and PUVA are helpful for their local immunomodulatory effect. Speak to your doctor about the possibility of Phototherapy as a treatment option. There are specific Phototherapy units that are used to treat the hands. Antibiotics Antibiotics are sometimes needed if infection develops, and most infections are caused by staph. Protect your hands! Oral Corticosteroids Oral corticosteroids (e.g. Prednisone) may be effective in a short course for recurrent pomphylx and dyshidrotic hand dermatitis. Warning about serious side effects of prednisone must always be given. Retinoids Toctino (alitretinoin) is an oral retinoid. A once daily treatment, it is available for patients suffering from severe symptoms that never go away completely or keep coming back even after using potent topical steroids. Research has demonstrated significant clinical improvement in patients with chronic hand eczema, especially for the variant known as hyperkeratotic dermatitis. Side-effects include headache and flushing. Strict pregnancy prevention is required 1 month before, during, and for 1 month after treatment with alitretinoin for women of child bearing potential due to the teratogenicity of the product (the product can cause birth defects). Speak with your doctor about finding a treatment plan that is right for you. 9 10

9 The Eczema Society of Canada is a registered Canadian charity dedicated to eczema education, providing support, raising awareness, and supporting research. Eczema Society of Canada Telephone: ECZEMA-1 info@eczemahelp.ca This guide was generously reviewed by: Dr. Neil H. Shear Professor & Chief of Dermatology University of Toronto Medical School The printing of this guide was made possible through unrestricted educational grants. The information contained in this guide offers current opinions from recognized authorities, but does not dictate an exclusive course of treatment. Persons with questions about a medical condition should seek the advice of a qualified physician. Copyright Eczema Society of Canada

10 How to Bathe & Moisturize What to do: bath or shower in warm water (avoid hot water) for 5 to 10 minutes gently pat the excess moisture from the skin with your towel, leaving some water on the skin apply your moisturizer to your entire body within 3 minutes of exiting the water apply a generous amount of moisturizer to your skin apply your moisturizer with gentle strokes in the direction of the hair growth apply moisturizer at least one more time during the day How do I select a moisturizer and gentle cleanser? Look for our Seal of Acceptance on products that we have reviewed and identify as suitable choices for people with eczema. If you are using prescription products, apply at times directed by your doctor. What you will need: bathtub or shower, soft clean towel, timer (soak for no more than 10 minutes) a gentle cleanser and moisturizer How to Use this Chart 1. Bathe or shower at least once daily. After a warm bath or shower, apply a moisturizer to the skin right away, after gently towelling off the excess water. 2. Apply moisturizer to the skin twice daily. Moisturizing after the bath counts as one application. If your doctor has given you prescription products, use as directed. Che 3. ck it off on the charts! Charting your skin care habits will help to make you aware of how you are caring for your skin, and will remind you to make sure you take the daily steps toward healthier skin. This information should not be considered an exclusive treatment course. Speak to your doctor about the use of this card, and about We thank dermatology nurse Michelle Lee for her contributions to this educational tool.

11 Rub it in! Skin Care Chart Bathing and moisturizing are one of the most important steps toward improving your eczema. You can start to see great improvement of eczema after just two weeks of sticking to your skin care routine. Use these charts to keep track of your skin care. Remember: always apply a moisturizer immediately after bathing or showering. Name: WEEK 1 Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 Day 7 Bath or shower using a gentle cleanser A.M. Moisturizer BATHING & MOISTURIZING CHART P.M. Moisturizer Rub it in! Skin Care Chart Name: Bath or shower using a gentle cleanser BATHING & MOISTURIZING CHART WEEK 2 Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 Day 7 Take our eczema assessment before and after to track your progress! A.M. Moisturizer P.M. Moisturizer

12 sometimes i am itchy Written by Shula Klinger Illustrated by Danielle Parmar

13 For all children learning to cope with eczema. We hope this book helps you start good routines, to help ease your itches and end your scratches. This book belongs to:

14 Copyright 2014 Eczema Society of Canada All Rights Reserved No part of this book may be reproduced in any manner without the expressed written consent of Eczema Society of Canada. Inquiries about this book should be addressed to: Eczema Society of Canada 411 The Queensway South, PO Box Keswick, Ontario L4P 4C ECZEMA-1 sometimes i am itchy Written by Shula Klinger Illustrated by Danielle Parmar

15 Sometimes I feel happy Sometimes I feel sad 1

16 2 Sometimes I am itchy And that s when I feel bad. 3

17 4 I m so tired, don t want to play I wish this itch would go away! 5

18 6 My elbows are so red It really hurts to touch Time to use the special cream Enough but not too much. 7

19 8 If the rash is scaly We put on medicine too We moisturize it daily And my skin says phew! 9

20 10 It only takes five minutes I ve timed it on the clock And when we re done I m up and dressed and playing down the block. 11

21 12 When my fingers want to scratch I get into a tizzy So Mom has lots of clever ways to keep these fingers busy! 13

22 14 Scratch all day? Scratch all night? Don t forget your creams! Put them all on as you should You re guaranteed sweet dreams. 15

23 Eczema Society of Canada would like to express our sincerest gratitude to author Shula Klinger and illustrator Danielle Parmar for their generous contributions of time and great talents. Eczema is close to their hearts, and this project could not have come to life without them. Special thanks to the Ottawa-based design firm ninesixteen Creative Inc. for generously donating their services in bringing the project together. ninesixteen.ca Shula Klinger is an author, illustrator and journalist who lives in North Vancouver, BC (Canada) with her husband and two sons. Her publications include a young adult novel, illustrations for another novel and numerous nonfiction articles. Her poetry, essays, and documentaries have been aired on CBC national radio. Her youngest son has lived with eczema since infancy, which inspired the writing of this book. Danielle Parmar is an illustrator, graphic, and industrial designer. She lives in Ottawa, ON (Canada) and runs the design firm ninesixteen Creative Inc., with her husband Ilesh Parmar and cat Ferdinand. She does work for many renowned museums, corporations, agencies and institutions in the Ottawa area and enjoys drawing, painting, knitting, and most things creative in her free time. Danielle has had severe eczema since birth and lives with it still as an adult. Coping with this life-long ailment and drawing on her earliest memories as a young child living with eczema inspired her illustrations throughout this book.

24 Eczema Society of Canada is a registered Canadian charity dedicated to eczema education, raising awareness, providing support, and research. For more information on eczema management, or to find support, visit eczemahelp.ca To order more books or make an inquiry please contact: Amanda Cresswell-Melville Executive Director Eczema Society of Canada 411 The Queensway South, PO Box 25009, Keswick, ON, L4P 4C2 director@eczemahelp.ca ECZEMA-1 eczemahelp.ca

25 Support for People Living with Eczema Eczema Education Series

26 Psychological Impact of Eczema When people have trouble with eczema, they often seek help from their dermatologist or family doctor. The doctor can focus on medical strategies to treat the eczema. But often, there are other difficulties that go beyond just the medical effects of the eczema. It is important to also consider emotional effects of the eczema. He or she may be very self-conscious He or she may feel like others are staring He or she may feel out of control, wanting to stop itching but not being able to He or she may withdraw socially or become depressed Lots of people have thoughts that creep in when they have eczema Everyone is looking at me We tend to see differences in our face or skin as bigger than they actually are; think about times when you look in the mirror and see blemishes that no one else notices. What psychologists call cognitive distortions can occur, where we think things about ourselves that are exaggerated or untrue (e.g., I m hideous! Everyone is wondering what that thing is. ). One way to combat these thoughts is to consider what you would be thinking if you saw someone who looked different. Would you judge her as being a bad person? Would you want to avoid the person? Usually, we are more understanding of others than we are of ourselves. The good news is that most others see you the same way! I can t control the itching A common statement from others is to Just stop scratching! But we know it is not as simple as that. It is very hard to avoid itching when the urge comes. This leaves the person feeling like they are not in control. Psychologists and other medical providers can work with people to develop other strategies when itching urges come. My eczema flares up when I am stressed out. There is a connection between stress and many medical conditions. It is important to be aware of this connection, and to take care of yourself when you are feeling extra stress. Things like relaxation, exercise, talking to friends, and simply doing something fun or enjoyable can all help to relieve stress. Mental health professionals can help you develop other ideas to help too. I hate how it looks. It makes me feel ugly. People often have a hard time when their appearance changes. It s important to see that the eczema does not define you; you can be a beautiful person (inside and outside) with or without eczema! Your character helps to make you beautiful, not your skin. It s OK to seek out help if you are having a hard time coping with your eczema. Many people work with psychologists or counselors when they are stressed by a change in their lives. It s healthy to get help when you need it. You can call your provincial psychology or counselling association to speak with someone who can help. Help is available! Common Challenges of Eczema Adults and children with eczema often have experiences that can make them feel bad. These can include: Sleep problems When people wake up at night due to itching, it can be very frustrating. They often lose out on a good night s sleep. People who don t sleep well are often irritable the next day, at risk for headaches, and not as good at solving everyday problems. When children with eczema don t sleep, often no one in the house sleeps. This can impact the psychological well-being of the parents and siblings as well as the child with eczema. Pain management problems Eczema can be very painful, and can be on the person s mind all the time. People in constant pain have a hard time getting their daily activities and work done. Sometimes they are more emotional because they get frustrated and tired by the pain. Self-confidence problems Sometimes people feel less self-control because of their eczema (like, not being able to stop itching). Some even feel less attractive because of changes in their skin. Together, these challenges can leave people feeling anxious, stressed, and even depressed. There is help! Working with a psychologist who understands these problems can help you manage these feelings better. There are groups in every province that can connect you with someone who can help. For a most up to date list of resources, to find support in your area. Alberta (PAA) British Columbia (BCPA) Manitoba (MPS) Newfoundland and Labrador (APNL) New Brunswick (CPNB) aspx Nova Scotia (APNS) apns.ca/search-psychologist Ontario (OPA) opajoomla.knowledge4you.ca/index. php/findpsychologist Prince Edward Island (PAPEI) Quebec (OPQ) index.sn Saskatchewan (SCP)

27 Find a ESC Support Volunteer ESC Support Volunteers are available by and can offer support to adults living with eczema, as well as parents of children who suffer with eczema. Visit and follow the link to Get Support. For additional information or to order treatment guides contact: Eczema Society of Canada Telephone: ECZEMA-1 Amanda Cresswell-Melville Executive Director director@eczemahelp.ca The medical content within this guide is based on current treatment recommendations by experts in eczema treatment, however, the information contained within should never be used as an exclusive treatment course. Always review your treatment with your own physician. Special thanks to Dr. Shawn Reynolds, Psychologist, for his generous writing and editorial contributions. Copyright Eczema Society of Canada 2015

28 Topical Corticosteroids FREQUENTLY ASKED QUESTIONS Eczema Education Series

29 Eczema Help Topical Corticosteroids FAQ At The Eczema Society of Canada, we are dedicated to helping Canadians living with eczema. This booklet aims to answer some common questions about the use of topical corticosteroids, a group of medications used to treat the inflammation of eczema. Sometimes these medications are called steroids or cortisones. Speak to your doctor about any questions you may have related to the use of topical corticosteroids, other medications, and your eczema care regimen. About Topical Corticosteroids How do topical corticosteroids help eczema? Topical corticosteroids help control inflammation (redness, swelling, pain and itch) thereby healing skin. They can help keep skin comfortable, as well as help reduce rash and itchiness. These topical medications are generally safe when used under the advice of a physician. The use of topical corticosteroids should be tapered off when the skin is healed; however, it is important to allow the skin to heal completely before discontinuing use. Fearing side effects, many people commonly underuse topical corticosteroids rather than overuse them. Topical corticosteroids are actually familiar to the skin, as the body makes a natural form of steroids to regulate many body functions. In eczema, topical corticosteroids temporarily alter chemicals in the skin, thereby reducing inflammation. Does eczema need to be treated with prescription medications? When deciding on any treatment, benefits and risks need to be weighed. Untreated severe eczema can have a negative impact on physical health, as well as mental health, including sleep, behaviour, social interactions, physical comfort, stress levels, ability to concentrate, and family dynamics. When topical corticosteroids are used appropriately and as directed, the risks of untreated eczema far outweigh the risks of treatment. Is a cream or ointment base better? The vehicle (the cream or ointment base) that delivers corticosteroid treatment does matter. An ointment base delivers a more potent medication and is less likely to sting open areas. A cream may feel more comfortable on your skin and may be preferred before dressing. Speak with your doctor about your preferences. What does the percentage number on the cream mean? How is a 2% product of one name less potent than a 0.5% product of another name? Topical corticosteroids range in strength from mild to extra strong. The percentage on the label of a topical corticosteroid refers to the specific medication it contains. There are many different cortisone molecules and the percentages between products are not comparable. For example, a 2% concentration of one product may be much milder than a 0.05% of another product even though it is a higher number. Can I use over-the-counter (non-prescription) topical hydrocortisone instead of my prescription corticosteroid? Over-the-counter (OTC) hydrocortisone can be helpful for very mild eczema, as well as the itching associated with minor skin irritations, bug bites and poison ivy. With moderate and severe eczema, OTC hydrocortisone may not be effective enough to manage the inflammation. If you choose to try OTC products, follow the directions on the package and direct any questions you may have to your pharmacist. You should also let your doctor know if you are using these products, especially if you are attempting to substitute them for a prescription treatment. Using Topical Corticosteroids How often should I apply my topical corticosteroid? Use the treatment as directed by your prescribing physician. These products are generally used one to three times a day. If you apply the cream once per day in an effort to use less product, you may actually prolong the eczema and hinder treatment. Using the treatment less than prescribed does not allow the mediation to work on the inflammation. Different products with different strengths and formulations sometimes require different application frequency. Ask your physician when the product is being prescribed how often to use it. Should I apply the treatment to wet or dry skin? As a general rule, it is best to apply the treatment after bathing to damp, but not soaking wet, skin. If you are applying your topical corticosteroids twice daily for example, you may want to apply it to dry skin in the morning and to damp skin after an evening bath. How much product should I apply? You want to apply a thin film to the skin, but enough that it still feels slightly tacky after you have rubbed it in. People more commonly apply too little rather than too much. Should I apply the topical corticosteroid only to affected skin? Apply the corticosteroid only to affected areas and apply moisturizer to the rest of the skin. 1 2

30 What is a fingertip unit? A fingertip unit is a way to measure the amount of cream you are applying to your skin. While only a general guideline, it can be a helpful way to understand how much cream or ointment is required to cover an area of skin. One fingertip unit is the amount of cream squeezed onto an adult index finger, from the fingertip to the first crease. This amount should cover the size of two adult palms or approximately a 7 x7 area of the body. For example, for an average adult, four fingertip units would be required to cover an entire arm or five fingertip units would be needed to treat an entire leg. This is likely more than you are used to using! Can I apply the treatment before or after moisturizer? Medications should always be applied to your skin before any other products, as moisturizers create a barrier on the skin. Apply topical corticosteroids to affected areas first, then apply a moisturizer to the rest of the skin. Remember that your topical corticosteroid is most likely in a cream or an ointment base, which also acts as a moisturizer. Can I use wrappings, bandages, plastic wrap or wet wraps over topical corticosteroids? Wrappings of any kind should never be used with corticosteroids unless done so under the strict supervision of your physician. Not only can occlusive bandages (wrappings) increase the potency of the medication, but also they can lead to complications or side effects. Can I use topical corticosteroids on my face? In short answer, yes. That said, your doctor may prescribe a less potent medication for your face. Avoid getting the medication in your eyes, as complications may occur. However, if you have eczema around your eye, it is important to treat this. Your doctor will select a cortisone strength and formulation for this area, or may recommend a different type of medication for the eye area. It is fine to use your prescription around the mouth, including when applying products on small children; just avoid getting it in the mouth. Are topical corticosteroids the best treatment for my eyelid eczema? It s always best to speak to your doctor about your specific treatment needs. Other topical agents, such as Protopic or Elidel might be a better choice for the eye area, or other areas of the body with delicate or thinner skin, such as the groin, arm pits, and folds. Ask your doctor about the best treatment for your specific condition and specific areas of the body, and how to use the medications correctly. Safety I m afraid to use 1% hydrocortisone on my baby. My dermatologist told me it s safe, but now my pharmacist has cautioned me. Is it safe? Topical corticosteroids have been used in dermatology, for the management of eczema for over half a century, and the safety profile is very good. When used as directed by your physician, the benefits of the treatment outweigh the drawbacks. A baby (or child, or adult) left with severe eczema that is untreated can pose a much greater health risk than using a topical corticosteroid to effectively manage eczema. When can I stop using the topical corticosteroid? Generally speaking, you should see some improvement in inflammation within a couple of days. You want to continue using the treatment until the inflammation and redness is gone. Commonly, people quit using topical corticosteroids once they see a small improvement in their symptoms; however, it is important to continue treating the affected areas until they are clear. If you are using medication on the same areas of the body for longer than two weeks time, speak to your doctor. My doctor said not to use my medication longer than two weeks, but just as my leg eczema clears, I get a flare on my arms. Can I keep using it? The short answer is yes. Generally speaking, you should not use topical corticosteroids on the same area of the body for a longer than two weeks if the area is not improving. If you are getting a good response to the treatment but you need a little bit longer to clear it completely, it may be appropriate to continue beyond two weeks. Review the specific instructions with your doctor about how to deal with this situation. However, it is very common for people with eczema to experience clear skin on one part of the body and a flare on another. It is fine to cycle treatment around the body as the skin flares. My pharmacist told me to use my medication more sparingly than prescribed by my doctor. What should I do? It is generally recommended that you follow the advice of your prescribing physician, rather than the pharmacist, as your doctor is the expert who has done a clinical evaluation of your condition. He or she knows your medical history and the condition of your skin and can best advise you on a treatment plan that will help improve your eczema. If you have questions about how much medication to use or when to stop using the medication, ask your prescribing physician. Do topical corticosteroids stunt growth? Not to be confused with anabolic steroids often used by bodybuilders and athletes, when used appropriately, topical corticosteroids do not impact growth. However, babies and young children, who have larger skin area 3 4

31 relative to their body mass, can potentially absorb topically applied corticosteroids. This can occur when potent steroids are used, when used too frequently or over a long period of time, or when used under occlusions, such as bandages, wraps, and diapers. Topically applied corticosteroids, when used under the advice of a qualified physician, are very safe. Oral corticosteroids are reserved for the most severe cases of eczema, should be used extremely sparingly, and should be used under the supervision of a dermatologist or specialist. Why did the doctor prescribe two different topical corticosteroids? Different strengths or potencies of medications are used for different areas of the body. A mild treatment may be appropriate for the face, armpits, groin, genitals, neck and folds. Other areas may require a more potent medication. For your hands and the soles of your feet, or other areas that could be lichenified (where the skin has thickened due to long term scratching or uncontrolled eczema), potent medications may be used for short periods of time. Complications of Eczema How do I know if the eczema is infected? If your skin is tender, oozing, or swollen, you should see your doctor, as it could be signs of infected eczema. Infection in eczema is common and can be treated. Do topical corticosteroids prolong eczema in the long term? There is no evidence that topical corticosteroids change the course of the disease. Experts believe that reducing inflammation and maintaining good skin care habits help to maintain periods of clear skin longer. It is believed that uncontrolled severe eczema is harder to get back under control. My hand eczema is not getting better with my topical creams. Now what? Speak to your doctor. Hand eczema that does not respond to topical treatment may require a treatment specific for hand eczema, such as the oral agent Toctino (alitretinoin). Ask your doctor about the best treatment for your specific condition. It is important to contact your doctor immediately or seek emergency care if you experience any of the following symptoms: difficulty breathing or swallowing wheezing severe skin rash bright red skin that burns oozing or puss in the skin; swelling or tender skin Lifestyle Modifications Can I just control eczema through diet instead of using topical medications? While new information and research is constantly evolving, at this time, experts believe eczema to be a condition caused by a variety of factors, including genes, skin barrier dysfunction and the immune system. We know that foods do not cause eczema. For some people, foods can trigger eczema, such as when they handle acidic fruits. For a baby or small child who frequently has a food contact the skin during feeding, certain foods may trigger eczema on the face. If you have known food allergies confirmed by an allergist, such foods should be avoided. Food allergies can certainly cause skin reactions, such as hives. If you suspect you have food allergies, speak to your doctor. Food allergies are more common among people with eczema. Can I just use lots of moisturizer? Frequent moisturizing is a very important part of eczema management, both when the skin is clear and during a flare. However, once the skin is inflamed and red, topical treatments (such as topical corticosteroids) and TCIs (topical calcineurin inhibitors) are needed to reduce the inflammation. Moisturizers will not control the inflammation of moderate to severe eczema. Could I have steroid allergy or withdrawal? Could my eczema be getting worse from the topical corticosteroids? This is extremely uncommon, although there has been a lot of talk about this on social media web sites. If you are concerned about this, speak with your dermatologist. 5 6

32 For more information contact: Eczema Society of Canada 411 The Queensway South PO Box 25009, Keswick, Ontario L4P 4C2 Telephone: ECZEMA The Eczema Society of Canada is a registered Canadian charity dedicated to eczema education, providing support, raising awareness, and supporting research. We thank Dr. Miriam Weinstein for her generous editorial contributions to this guide. The information contained in this document reflects the current standards of eczema management in Canada. Medicine is a constantly changing science, and this information was current as of the date of publishing. The information contained within this guide should in no way dictate an exclusive treatment course. You should always seek diagnosis, treatment, and advice from a qualified physician. Copyright Eczema Society of Canada 2014

33 ECZEMA School and Daycare Guide

34 A Message from the Executive Director Introduction This guide is to help parents, teachers, and daycare providers understand the unique needs and challenges of children living with eczema, and to offer information and strategies for overcoming these challenges. Table of Content Page Dear Parents, Teachers, and Daycare Providers, An estimated 17% of Canadian children suffer from eczema. A child living with eczema experiences uncomfortable physical symptoms such as pain and itch. While eczema is not contagious, symptoms include dry itchy skin with redness, scaling, rashes, and open sores. In addition, the disease has social and emotional consequences. These make life even more challenging for children who are already living with a difficult chronic disease. This resource may also be helpful for principals, daycare staff, grandparents, aunts, uncles, and anyone who cares for a child living with eczema. Understanding the burden of this disease, and raising awareness about the condition, is the first step in caring for those living with eczema. About Eczema 1-2 For Parents 3 How you Can Help 4 Talk to the Teacher 5 Talk to your Child 5 Eczema Care at School Checklist 6 Please contact the Eczema Society of Canada with any questions or for more information. Sincerely, Amanda Cresswell-Melville Executive Director, Eczema Society of Canada For Teachers 7 How you Can Help 7 Recommended Reading 8 An Eczema Friendly Classroom 9 Toll Free: Website: ECZEMA-1 director@eczemahelp.ca For Daycares & Nannies 10 Eczema Care Checklist 10 Daycare Action Plan 11 An Eczema Friendly Environment 12

35 about Eczema about Eczema 1 What is eczema? Many Canadian children live with eczema, a chronic skin condition, characterized by itchy, red, inflamed skin. This skin disease can be mild, but can also become very severe, painful, and life altering. Having eczema can greatly impact the social and emotional life of the child. Children who have this form of eczema are much more likely to suffer with asthma and allergies. Why does a child get eczema? Eczema is not contagious. A child cannot get eczema by playing with another child who has the condition. It is not completely understood how and why a child develops eczema. There are some genetic factors that make someone more likely to develop eczema. Families with eczema are also likely to have asthma and allergies as well. Also, children with eczema seem to have a skin barrier that does not work as well as it should and their immune system is quite sensitive to irritants. Some children develop eczema when they move to a new climate, or if they use a new soap (especially if it has perfume in it). What does eczema look like? Eczema will look like a red rash, possibly raised and bumpy, and possibly with open sores where the skin has been scratched. Eczema is incredibly itchy, so you will most likely see the child itching and scratching the skin, particularly during times of stress. The act of itching further damages the skin and makes the eczema worse. Eczema is often referred to as the itch that rashes so it is possible the skin could look completely normal but feel itchy and then become red and rashy after scratching. This becomes the itch-scratch cycle. What triggers eczema flares? When children encounter a trigger the eczema flares meaning the skin will become more itchy, red, bumpy, and scaly. Each person will have different triggers, however, some are more common than others. Common triggers include: dry skin, heat, dust, sweating, overheating from activity, irritants, allergens (including pet dander, pollens, and particular foods), and infections (like colds or skin infections). Stress can also be a trigger, especially for young children, as they can have difficulty identifying their stressors. The most common areas affected by eczema are the flexors (behind the elbows and the knees), around the neck, on the hands and the front of the ankles. Not all itching is eczema! If the child also has allergies and suddenly becomes intensely itchy do watch for hives or other symptoms (e.g. swelling of the face and lips, hives, difficulty breathing, diarrhea, vomiting, etc.) to ensure that the child is not having an allergic reaction. How does if affect behaviour? Eczema can cause a constant itch, accompanied by pain, and open skin sores. This, of course, can negatively impact the mood and behaviour of the suffering child. Sometimes, a child can even exhibit behaviours similar to ADHD, such as a limited attention span, restlessness, and lack of focus, during an eczema flare. When in pain, tolerance to demands can be lower. As a result, a child may be more likely to engage in tantrums, may not follow instructions, or appear weepy. Also, many children with eczema have difficulty sleeping due to itch and so they are chronically tired. What is the social and emotional impact? Eczema changes the child s appearance and this can be very stressful for a child. The child may fear being bullied or teased and may worry about looking different. Children have to cope with a lack of understanding from others, the unfounded fear that the child is contagious and even have to miss out on certain activities or sports because it could cause a flare. It can also be difficult for teachers and parents to understand the torment of constantly itching skin and painful skin lesions. Can eczema be managed? Yes! While there is no cure for eczema, with proper skin care and medical treatment and understanding from family, friends and teachers, children with eczema can care for their skin and live happy and healthy lives. Bathing and frequent moisturizing are the cornerstone of eczema care. Children with eczema may also need to use prescription products. These can typically be managed at home or before and after school hours. However, if these are needed throughout the school day, parents and teachers can work together to create a plan to ensure the child is cared for during the school day. Dry skin is the most common cause of an eczema flare, so moisturizing the skin, many times a day, is one of the most important things the child can do to help reduce flares and improve the health of the skin. How does eczema impact the family? Whatever impacts one child in a family, impacts the entire family. Parents have a lot to manage medical appointments, treatments, and time-consuming daily skin care. Children can rebel against the daily (or many times daily) skin care routine. Treatment can also be a financial burden. It is not surprising that feelings of helplessness and being overwhelmed can be common in parents of children with eczema. Lack of sleep, stress, anger, feelings of guilt, exhaustion, and depression can also be common. There is hope. The good news is that eczema can be managed. It does take some time to get a good skin care routine in place at home, but putting in the time to get organized can pay off in the long run. Children with eczema live very happy and normal lives. 2

36 for Parents for Parents Introduction We know how difficult it can be to manage eczema and live with this condition in your family: sleepless nights, behaviour disruptions from the discomfort and pain, feeling helpless while watching your child suffer, and struggles with topical treatments and daily skin care routines which can be messy, time consuming and expensive. Your Role As a parent, you have an important role as your child s advocate at school so that the school can provide necessary support, teachers know how to handle challenges that might arise during the day, and all involved can work to build the best environment for your child. Daycare providers and teachers want to help. Make them an ally and work together to create a plan that will help your child to live comfortably, not only physically, but socially and emotionally as well. Management at School Your child may need to apply moisturizer throughout the day, or when they have an acute flare during the school day. It is recommended that they keep moisturizer in their school bag or a small tube in the lunch bag so that your child can apply throughout the day. As A parent there are things you can do to help: Become Educated Learn more about eczema by visiting and talk to your child and his or her teacher to learn how the condition affects your particular child. Talk to Your Child Open communication can be as helpful as your medical treatments. Let your child express his or her feelings and share about any issues that may arise at school. Talk to your child about their role in eczema care, and remind them that they can control this condition and take action. Talk to Your Child's Teachers Communicating with your child s teacher can help him or her to understand eczema, and the care that your child will need at school. Raise Awareness You can talk to others about eczema and the impact it has on the lives of sufferers. You can even raise awareness in your own school community or in the classroom with an Eczema Awareness Day or hold a fundraiser. 3 4

37 for Parents for Parents Talk to the teacher about: Eczema and this resource Share this resource and the teacher guide, and offer to provide additional copies for other teachers in the school. Avoiding temperature extremes Children with eczema should sit away from windows or radiators, and should avoid overheating during physical activities. Outdoor play in colder months should always include hats, mittens and proper protection. Keeping a clean classroom Regular cleaning of dust, chalk dust, and regular vacuuming of carpets can help to reduce triggers. Children can be encouraged to wear light clothing, but garments with long sleeves and pants may also be helpful to reduce contact with irritants such as carpets. Understanding the Scratching Children with eczema will scratch frequently. Avoid telling them not to scratch. An application of a moisturizer or a cool wash cloth can be helpful during a flare to cool the skin and help relieve the itch. Empathy can also help to minimize the distress associated with a flare up. Talk to your child about: Accepting eczema and moving forward with an action plan to manage the condition while at school This will help to take the embarrassment out of eczema and will help them to feel in control of the condition. Feelings related to eczema Teasing and social isolation can be common; however, parents can take proactive steps to help the child feel confident and be a leader in accepting others who are different. Needing to get additional help Sometimes a therapist or counsellor can help your child to articulate feelings and cope with those feelings. There is no shame in reaching out for this type of help. Perhaps your child can find an ally at school, a particular teacher or counsellor, who can be of assistance if the child is being teased or is having challenges due to an eczema flare. Eczema Care at School - Checklist The student may need the following items on hand: 4 Moisturizing cream 4 Gentle hand soap (if the student cannot tolerate the school s hand soap) 4 Cotton gloves (for handing materials that may irritate the skin if required) 4 Adhesive bandages 4 Medications and written instructions on medications required at school 4 A list of triggers to avoid and other ways to keep eczema under control at school Recommended Parent & Teacher/ Daycare Communication This list of questions may help your child s teacher, daycare provider or nanny better understand your child s eczema. Child s Name: Parent Name: 4 Does the child s eczema require the application of a moisturizer during the school day? 4 Does the child require special hand soap in the classroom and the restroom? 4 Are there any substances that make the eczema worse? E.g. sand play, water play, etc. 4 Are there any foods that the child should avoid? 4 Does the child sleep well at night despite the eczema? 4 Some successful strategies for reducing itching and scratching are

38 for Teachers for Teachers A Student with Eczema Eczema is a common skin condition that usually affects children. Some students have only very little involvement, but for others eczema is a chronic disease that causes many challenges. Students with eczema often have very dry itchy skin. They may have difficulty sleeping at night due to the itch and can be distracted during class because of fatigue or itch. They often have sensitive skin that will get worse if they use soaps, touch certain art supplies, or are exposed to pets in the classroom. While there is no cure for eczema, it can be managed with medications and some changes to the environment. Because students with eczema spend many hours at school each day, it is important for their teachers to be part of the team in helping to meet their needs. Eczema Management at School Students in your classroom who have eczema may need to apply moisturizer throughout the day, or when they have an acute flare during the school day. Bandages or wrapping are sometimes needed for eczema management. Children with eczema may be distracted by the itch, exhausted from missing sleep, or embarrassed by the appearance of their skin or teasing they have experienced. Speak to the parents if you have any questions or concerns. As a teacher, there are things you can do to help: Become Educated Learn more about eczema by visiting or talk to your student and his or her parents about how the condition affects your particular student. Foster an Inclusive Classroom An anti-bullying curriculum and inclusive classroom practices help all students and foster a secure environment for children with eczema. Recognize and celebrate differences. Using resources from our recommended reading list can be a great way to incorporate literacy, build self-esteem and increase the understanding and tolerance of one another. Understand Behaviours Related to Eczema Eczema can affect a student s behaviour. Some children describe it as their skin burning while others say it feels like being stung by 1000 bees at the same time. This type of constant irritation and pain may cause the student to feel restless, frustrated, irritable, and may cause they to become disruptive. This can often mimic the behaviours of attention difficulty. Recommended Reading ages 3 12 Don t Laugh At Me Written by Steve Seskin, Allen Shamblin; Illustrator: Glin Dibley - Random House Children s Books Do you wear glasses? Ever been picked last for the team? Afraid you ll be called on in class? Don t laugh at me. Don t call me names. This is not a book for whiners, but a new language that will give you the words you need to take charge and stop the cycle of teasing. Read it, sing it, and cheer! I Like Myself! Written by Karen Beaumont; Illustrator: David Catrow - Houghton Mifflin Harcourt High on energy and imagination, this ode to self-esteem encourages kids to appreciate everything about themselves--inside and out. STEPHANIE S PONYTAIL Written by Robert N. Munsch; Illustrator: Michael Martchenko - ANNICK PRESS A little girl is determined to strike a blow for nonconformity. Her strong female voice will speak to many, asserting the importance of individuality and independent thought. Raise Awareness Talk to others about eczema and the impact it has on the lives of sufferers. You can even raise awareness in your own school community with an Eczema Awareness Day. You can invite the student to participate in awareness building by telling classmates about the disease. 7 8

39 for Teachers for Daycare and Nannies Help Facilitate an Eczema Friendly Classroom Helping to facilitate a healthy classroom for students with eczema is the most important thing you can do: 1. Allow for gentle skin care and moisturizing Allow the student to bring a gentle hand cleanser to school, as typical institutional hand cleansers may aggravate eczema or cause a flare. Permit students with eczema to carry and apply moisturizers. Students may need to be excused to use the rest room to apply moisturizer to areas of the body covered by clothing, or they may simply prefer privacy for areas such as the face or hands. Students with eczema can be extremely self-conscious about their condition, so it is important that we respect their privacy and are sensitive to their feelings. 2. Avoid temperature extremes Students with eczema should sit away from windows or radiators, and should avoid overheating during physical activities. Outdoor play in colder months should always include hats and mittens. A thin layer of Vaseline on the cheeks or affected areas of younger children may be helpful with facial eczema. 3. Keep a clean classroom Regular cleaning of dust, chalk dust, and regular vacuuming of carpets can help to reduce triggers. Students can be encouraged to wear light clothing, but garments with long sleeves and pants may also be helpful to reduce contact with irritants such as carpeting. 4. Work with uniform policies Students with eczema may not tolerate certain fabrics, such as wools and synthetics. Parents and school officials can discuss uniform concessions that will create a balance between complying with uniform regulations and not worsening the eczema. Students with eczema need to stay cool and avoid overheating. Rules need to be flexible for students with eczema, so as to respect their special needs. 5. Consider Field trips Activities that might be benign for some students can be problematic for students with eczema. Field trips to the zoo or involving animals might need some extra planning for students with eczema. Speak to parents when unusual learning experiences arise, so that you may create a plan for the student. Even animals visiting the classroom may be problematic. 6. Be understanding of scratching Students with eczema will scratch frequently. Avoid telling them not to scratch, instead offer support and understanding. Some students find it helpful to rub the skin, so as to bring relief without damaging the skin; however, even this can cause skin damage if it is done forcefully and often. An application of a moisturizer or a cool wash cloth can be helpful during a flare to help cool the skin and relieve the itch. Some students can be easily distracted from scratching and even feel less itchy when distracted. Active engagement in classroom activities and active learning that involves doing things with their hands can be helpful. Empathy can also help to minimize the distress associated with a flare. Daycare providers and nannies have a unique role in the care of children with eczema. Depending on your specific situation, you may have a very involved role in caring for children with eczema, including: bathing, medication applications, and moisturizing. 4 Work together with parents to create an action plan for the child. 4 Have parents explain and even demonstrate routines and work together as you learn. 4 Ask questions and communicate openly, such as reporting how the child is responding to their management plan or any feelings they share related to their eczema. Eczema Care Checklist The parents may need to provide the following items to the daycare: 4 Moisturizing cream 4 Gentle hand soap (if your child cannot tolerate the daycare s hand soap) 4 Cotton gloves (for handing materials that may irritate the skin if required) 4 Adhesive bandages 4 If the child is still wearing diapers, ask parents to bring in their own gentle diaper wipes as some brands may sting the skin. 4 Medications and written instructions on medications required, triggers to avoid, and other ways to keep eczema under control Talk to parents Keep lines of communication open, ask any questions you may have, and discuss ways to cope with the itching during the school day. 9 See the "Eczema Care at School - Checklist" on page 6 10

40 for Daycare and Nannies for Daycare and Nannies Daycare Action Plan The daycare can do the following things to help: Keep classrooms clean, sweeping floors and vacuuming carpets regularly. Keep dust to a minimum. Avoid using chalk boards, or chalking crafts, as the dust can exacerbate eczema and possibly asthma symptoms. Provide or allow the use of gentle hand soap at classroom sinks and in washrooms. Have materials on hand for crafts such as cotton gloves (for handing materials that may irritate the skin if required), non-latex gloves (for wet work, such as papier mache), and utensils such as popsicle sticks for glue or clay work, to avoid contact with the skin. Remember that sensory play, such as play in rice, oat or water tables may cause flares or irritation for children with eczema. Substances such as play dough or clay may also be irritating; however, working with parents on an action plan will ensure that strategies are employed so that the child may be accommodated, and still participate in activities. Keep adhesive bandages and tissues handy. Keep a written log of how often medication and/or moisturizer is used during the day. So that the parent has an idea of what happened with the skin while they were away from their child. Help Facilitate an Eczema Friendly Environment Helping to facilitate a healthy environment for children with eczema is the most important thing you can do. 1. Gentle skin care and moisturizing The child should use gentle hand cleansers for hand washing after using the washroom, before eating, and after arts, crafts, and messy activities. Typical institutional hand cleansers may aggravate eczema or cause a flare. Alcohol-based hand sanitizers can sting or cause increased drying of the skin. Young children may need help in applying their moisturizer. Discuss this with parents prior to use, and follow any policies of the daycare facility with regard to the use of medications, or any special needs policies that might be in place. 2. Avoid temperature extremes Children with eczema should sit away from windows or radiators, and should avoid overheating during physical activities. Outdoor play in colder months should always include hats and mittens, and a thin layer of Vaseline on the cheeks or affected areas of younger children may be helpful with facial eczema. 3. Keep the play-space clean Regular cleaning of dust, chalk dust, and frequent vacuuming of carpeting can help to reduce triggers. Children should be encouraged to wear light clothing, but garments with long sleeves and pants may also be helpful to reduce contact with irritants such as carpets. 4. Outdoor play routines Many daycares/nannies wisely apply sunscreen during the spring, summer, and fall months before outdoor play. Speak to parents about a sunscreen that is suitable for their child. In the winter months, some children may need a thin layer of petroleum jelly applied to their cheeks before going outdoors. Discuss these possible needs with parents. 5 Outings Activities that might be benign for some children can be problematic for children with eczema. Field trips, such as visiting the zoo or a water park, might need some extra planning for children with eczema. Speak to parents when unusual learning experiences arise, so that you may create a plan for the child. Even animals visiting the classroom may be problematic. Open communication is most often helpful. 6. Be understanding of scratching Children with eczema will scratch frequently. Avoid telling them not to scratch, instead offer understanding and support. Some children find it helpful to rub the skin, so as to bring relief without damaging the skin, but even this can be damaging if done with enough force for a long time. An application of a moisturizer or a cool wash cloth can be helpful during a flare to help cool the skin and relieve the itch. Empathy can also help to minimize the distress associated with a flare. 7. Talk to parents Keep lines of communication open, ask any questions you may have, and discuss ways to cope with the itching during the school day. Remember that young children in daycare will need additional care, such as application of medical treatments or moisturizer. Speak to the child s parents about the specific care needed

41 Understanding ECZEMA Eczema Society of Canada 411 The Queensway South, PO Box 25009, Keswick, Ontario, L4P 2C7, Canada eczema-1 ~ director@eczemahelp.ca Special thanks to the writing and editorial team who helped create this resource: Amanda Cresswell-Melville, BA, BEd Amanda is the Executive Director of the Eczema Society of Canada, a former teacher and mother of two children living with eczema. We thank her for using her personal and professional expertise as the lead writer on this project. Dr. Wingfield Rehmus, MD Dr. Rehmus, MD, Dermatology, is a Clinical Assistant Professor at the University of British Columbia. She hosts talks around the world on dermatology, and we thank her for generously reviewing our medical content for this document. Melissa Sweet, M.Ed., BCBA Melissa has a Master s degree in Special Education and is a board certified behaviour analyst. We appreciate her lending her expertise on childhood behaviour and the management of managing special needs in the school and daycare settings. The medical content and recommendations contained within this guide are based on current treatment recommendations by experts in eczema treatment, however the information contained within should never be used as an exclusive treatment course. Always review your treatment plan with your own physician. Copyright