Childhood Eczema

November 29, 2019

Childhood Eczema

#GBites: Eczema

by Natalie Gentile, MD and Dan Goldstein

Childhood Eczema

Eczema (atopic dermatitis) is a chronic condition of the skin, causing dryness and rashes which may have an itchy sensation. (1) Rashes often occur on the face, the inside of the elbows, and the backside of the knees, hands and feet. While few adults have eczema, it may affect up to one in every five children (2) and these rates appear to be climbing. (3) This increase is especially pronounced in infants under one year of age. (4) While there may be a genetic component to eczema, in many cases, food allergies are the trigger.

Eggs and milk are the two foods most commonly involved with eczema. (5) These also happen to be the first and second most typical food allergies among American children, respectively. (6) More kids are allergic to eggs or dairy than are to nuts or shellfish. The first medical study on the role these foods play in eczema symptoms occurred in 1978. Researchers replaced eggs, milk, chicken and beef with soy milk in childrens’ diets and 70% of them saw an improvement in eczema symptoms. (7) Further studies have confirmed that removing eggs (8) and dairy (6, 9) from the diet of a child suffering from eczema is an effective treatment, (5) leading to clinical improvements in up to 80% of cases. (10) Even children who have not tested positively for an egg or milk allergy can improve their eczema by staying away from these foods. (7)

Interestingly, women who consumed more meat during pregnancy are more likely to have children with suspected or diagnosed eczema. (11) Similarly, mothers who avoid eggs, milk and fish during the first three months postpartum are significantly less likely to see their child develop eczema by age four. (12) Staying away from animal products when pregnant or nursing seems to be an effective measure of prevention.

While animal products appear to play a role in the development and symptoms of eczema, fruits and vegetables are valuable in its prevention and treatment. (13) While there has been little research looking directly into plant-based diets and eczema, we can make some inferences from studies on asthma. We know that eczema and asthma are related and that many who suffer from one also suffer from the other. In one study where children with severe, life threatening asthma were put on a plant-based diet for one year, 92% of them saw drastic improvements in symptoms and many were able to reduce or even eliminate their need for medications. (13) Additionally, parents with kids who suffer from eczema should consider limiting their childrens’ intake of sweets, as refined sugar may play a role in the inflammatory process underlying the disease. (14)

When I counsel my families on ways to manage and treat eczema, I begin by assessing for lifestyle factors that may be contributing. As far as diet goes, I start with recommending avoiding eggs, dairy and refined sugar. (5-10, 14) Replacing these foods with a variety of fruits, vegetables, grains and legumes may further improve symptoms and enhance health. (13) This can be challenging for moms who may be breastfeeding or who are choosing solid foods for their little ones. It is important to team up with a doctor or dietician who knows how to help you make these swaps so that you can feel supported in the process.

Next steps in eczema management include topical applications to the affected areas. I am a strong supporter of applying breastmilk to the skin whenever possible as it has been shown to be equally as effective to 1% hydrocortisone cream in some studies, with no side effects. (15) After exhausting all options of topical breast milk, steroid cream, heavy moisturization of the skin, and dietary changes, then it is time to discuss other medications or treatment options with your physician.

1. Atopic dermatitis (eczema) - Symptoms and causes. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/atopic-dermatitis-eczema/symptoms-causes/syc-20353273. Accessed November 22, 2019.

2. Health (UK) NCC for W and C. Epidemiology. RCOG Press; 2007. https://www.ncbi.nlm.nih.gov/books/NBK49355/. Accessed November 24, 2019.

3. Mi A, S M, B B, et al. Worldwide Time Trends in the Prevalence of Symptoms of Asthma, Allergic Rhinoconjunctivitis, and Eczema in Childhood: ISAAC Phases One and Three Repeat Multicountry Cross-Sectional Surveys. Lancet (London, England). doi:10.1016/S0140-6736(06)69283-0

4. Ch M, Hs B, Ja H, P N, M V, P L. Incidence Trends of Atopic Dermatitis in Infancy and Early Childhood in a Nationwide Prescription Registry Study in Norway. JAMA network open. doi:10.1001/jamanetworkopen.2018.4145

5. Jf S, Mi H, St N. Food Avoidance Diets for Dermatitis. Current allergy and asthma reports. doi:10.1007/s11882-015-0563-8

6. A F, J B, H S, et al. World Allergy Organization (WAO) Diagnosis and Rationale for Action Against Cow’s Milk Allergy (DRACMA) Guidelines. Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology. doi:10.1111/j.1399-3038.2010.01068.x

7. Dj A, M S, Jf S, Rs W, Ce C. A Double-Blind Controlled Crossover Trial of an Antigen-Avoidance Diet in Atopic Eczema. Lancet (London, England). doi:10.1016/s0140-6736(78)91199-6

8. R L, C M, P W, T A. Randomised Controlled Trial of Advice on an Egg Exclusion Diet in Young Children With Atopic Eczema and Sensitivity to Eggs. Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology. doi:10.1111/j.1399-3038.1998.tb00294.x

9. C V, B P, J G, et al. Incidence of Parentally Reported and Clinically Diagnosed Food Hypersensitivity in the First Year of Life. The Journal of allergy and clinical immunology. doi:10.1016/j.jaci.2005.12.1352

10. L B, E B, A C, E G, R I, N B. Results of a Milk and/or Egg Free Diet in Children With Atopic Dermatitis. Allergologia et immunopathologia. https://pubmed.ncbi.nlm.nih.gov/7180794/. Published August 1982. Accessed November 22, 2019.

11. K S, T Y, Y M, et al. Maternal Meat and Fat Consumption During Pregnancy and Suspected Atopic Eczema in Japanese Infants Aged 3-4 Months: The Osaka Maternal and Child Health Study. Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology. doi:10.1111/j.1399-3038.2009.00897.x

12. N S, G H, B K. Maternal Avoidance of Eggs, Cow’s Milk, and Fish During Lactation: Effect on Allergic Manifestations, Skin-Prick Tests, and Specific IgE Antibodies in Children at Age 4 Years. Pediatrics. https://pubmed.ncbi.nlm.nih.gov/1557270/. Published April 1992. Accessed November 22, 2019.