Atopic Dermatitis (Eczema) – PediaCast 233

Dr. Joy Mosser joins Dr. Mike in the PediaCast Studio to talk about atopic dermatitis (eczema). We cover the nuts and bolts of this common condition, including cause, symptoms, work-up, treatment, and prevention. Listen now for practical and up-to-date pediatric information!

Topics

  • Atopic Dermatitis
  • Eczema
  • Dry Skin

Guest

Links

Transcript

Announcer: This is PediaCast.

Welcome to PediaCast, a pediatric podcast for parents. And now, direct from the campus of Nationwide Children’s, here is your host, Dr. Mike.

Dr. Mike Patrick: Hello, everyone, and welcome once again to PediaCast, a pediatric podcast for moms and dads. This is Dr. Mike, coming to you from the campus of Nationwide Children’s Hospital in Columbus, Ohio.

It is Episode 233 for November 14, 2012. And we’re calling this one Atopic Dermatitis. And just so all of the other know what I’m talking about, it’s also known as eczema. So you may have heard that term before.

0:00:56

And we’re really continuing our series today on a very common things parents deal with. Now I know some of you out there scratching your heads and thinking series? I didn’t know anything about a series. Well, you’re not alone because I didn’t really know we were doing the series either. But I looked back and I realized that when you consider our last two interview shows, so the hip clicks and lazy eye, and then you add today’s topic of Atopic dermatitis or eczema, we really do have a series of very common things parents deal with.

And as always, I have agreed guest joining me in the studio today, Dr. Joy Mosser is a Pediatric Dermatologist here at Nationwide Children’s Hospital. But before we get to Dr. Mosser, a couple of housekeeping items for you.

First, a friendly reminder, we are on Pinterest. In fact, it’s so easy to find it, I’m not even going to put a link in the show notes this week. You can find it on your own, it’s easy to do, just go to pinterest.com/pediacast. You can do it, and I encourage you to do so.

0:01:56

And what will you find there, as we’ve been mentioning first there’s an Episodes board where we repin and share your favorite shows and topics, that’s what you can do with it, with the Episodes Board. So we pin the episodes and then that gives you the ability to repin and share those episodes. And we just have the topic list there so you can find it easily and can share the shows.

And then the other board that I’m really excited about is our News Parents Can Use Board and it’s information you won’t find on the podcast. So we have helpful news items, product recalls, reviews, recommendations and the like and it’s a great resource for moms and dads. I basically culm the internet and find news and information that I’ve put in the podcast if we have a few hours each day, but we don’t have a few hours, which I know for some of you, that’s a disappointment and for others, a big relief. So check it out and follow us. Repin and share the stories you think other moms and dads will find helpful. And again, it’s easy to find, just go to pinterest.com/pediacast.

0:03:00.0

And by the way, we’re also on Facebook, Twitter and Google Plus, so if you aren’t following us in those social media circles, I’d encourage you to do so.

Alright, back on track. Today, we are talking atopic dermatitis, also known as eczema. I would remind you that really, any of these topics, if there’s one that you would like us to discuss or invite a guest for an interview, just head over to pediacast.org and click on the Contact link. You can also email pediacast@gmail.com or call the voice line at (347) 404-KIDS. That’s (347) 404-KIDS and just let us know where you’re from and what your question is and we’ll try to get it answered on the show.

Also want to remind you the information presented in PediaCast is for general educational purposes only. We do not diagnose medical conditions or formulate treatment plans for specific individuals. So if you do have a concern about your child’s health, make sure you call your doctor and arrange a face-to-face interview and hands-on physical examination.

0:03:58

Also, your use of this audio program is subject to the PediaCast Terms of Use agreement, which you can find at pediacast.org.

Alright, so let’s turn our attention to our studio guest today. Dr. Joy Mosser is a Pediatric Dermatologist at Nationwide Children’s Hospital and the Central Ohio’s Skin and Cancer Team. She’s also an Assistant Professor of Dermatology at the Ohio State University College of Medicine. Dr. Mosser completed a pediatric internship at Rainbow Babies and Children’s Hospital, a case western-reserve university, a dermatology residency at the Ohio State University College of Medicine and a Pediatric Dermatology Fellowship at Children’s Memorial Hospital in Chicago.

She’s been back in Ohio for more than a decade treating kids with skin conditions and teaching the next generation of pediatric dermatologist. Dr. Mosser is listed as one of America’s best doctors and she joins us now on PediaCast to talk about atopic dermatitis, also known as eczema. So welcome to the program, Dr. Mosser.

0:04:53

Dr. Joy Mosser: Hello.

Dr. Mike Patrick: Great, it’s great having you here. Appreciate you stopping by. Let’s start with just a definition. What exactly is eczema or atopic dermatitis?

Dr. Joy Mosser: So eczema is a condition. I like to tell my patients, it’s a condition where your body is sensitive to the environment. It’s a condition’s very closely related to other immulogic or IGM mediated diseases including asthma, hay fever, hives and even food allergies. All these conditions, the immune system is over-reacting in one part of the body.

For example, an asthma, the inflammatory or immune system maybe are over-acting in the lungs, and hay fever it’s over-reacting in the nose and eyes. But in eczema, it’s over-reacting in the skin. And so in this situation, your skin is more sensitive to the environment.

Sometimes I explain to patients that we can define this as an allergy and meaning that if you have a positive allergy test in animal dander and animal dander flares your skin, you have an allergy as one of your triggers.

0:05:53

However, there’s many triggers for eczema and among those can be things like cold, dry winter air, sweat, saliva. So among those are many things that you’re not actually allergic to.

Dr. Mike Patrick: Sure. Do you see this condition more in certain ethnic groups or male versus female, I mean who gets eczema?

Dr. Joy Mosser: Really the male versus female ratio is equal. It’s about 1:1.4 female to male, but it’s essentially that’s equal. About 10% to 12% of children in the United States have eczema. About 1% of adults have eczema. It is a condition that seem predominantly in developed countries. And in patients who moved from less developed countries into more developed countries like in North America and Europe. But it is a condition that we are also seeing increasing in the world as a whole. So a greater percentage of patients have it.

0:06:53

Dr. Mike Patrick: Sure. What about age-wise? Do you see a difference between younger kids like babies, toddlers, children?

Dr. Joy Mosser: They say about 60% of all eczema presents before the age of one, and 85% before the age of five. So the majority of our patients do present at a very young age. This is something that can change. And it may be the beginning of what we call the atopic march, meaning that many patients may start with eczema in infancy and progress to asthma and hay fever as adults.

Dr. Mike. Sure. Let’s talk a little bit about what actually causes this, a sort of down to the cellular level. What causes eczema and then maybe we can bring that back around to why we’re seeing it in developed countries more or people who moved from under-developed to all-developed. I mean maybe if we understand the mechanism behind it, we can somehow understand why that’s happening.

Dr. Joy Mosser: So as far as the causes of eczema, to be honest, the exact causes are still not known. There’s two kind of current hypothesis among the trigger, among the causes of eczema.

0:08:00

One being this allergic tendency. And so the thought is that a patient is exposed to some form of allergy and for example food allergy and/or a dust mite and that triggers the immune response which then results in red, itchy, scaly skin.

The other hypothesis is the epidermal barrier hypothesis. And in this situation, patients don’t have a good skin barrier. And what I mean by that, I like to explain this as our skin – the purpose of the skin is protect the inside of our body from the outside elements. So I told patients imagine your skin to be like a brick wall. And so you stock all these bricks up. If you don’t have mortar between those bricks, then your wall’s going to fall apart and if you sprayed water from a hose at that brick wall, some of the water’s going to sip through.

Our skin’s very much the same way, but the difference is in our skin, we had these little, teeny skin bricks, we put mortar up between those skin bricks. And the brick wall, you hope that your brick wall stay stable and the mortar stay stable for years.

0:08:56

And the skin, we have to bricks up, the mortar up, but then we have to break down the mortar. So that old skin cells can fall off and new ones can come up. If you’re missing components of that breaking down the mortar, or you’re missing components that hold the mortar and hold moisture into the skin, then essentially you don’t have a good skin barrier. And in this hypothesis, it is thought that your abnormal skin barrier makes you more susceptible to those outside elements, be it sweat, be it saliva, be it dust, be it grass, any of these potential environmental things you come in contact with.

And then in thinking in that situation is that if you don’t have a good skin barrier, these irritants – your body’s exposed to the irritants and then the allergies develop afterwards. This is maybe thought to be also related to asthma where the lungs have an epithelial or skin barrier. And so if the barrier’s not good on the outside, the barrier may not also be good on the inside of your lungs.

0:09:52

So there’s a lot to be learned in the future probably about asthma and hay fever just from the eczema hypothesis.

Dr. Mike Patrick: And I want to point out, in case you didn’t catch that the first time we were talking about it. Kids, so eczema and atopic dermatitis on the skin is really kind of the same sort of thing that’s going on deep in the lungs when we talk about asthma and in the upper airway when we talk about allergic rhinitis, allergies, seasonal allergies, that sort of thing.

Dr. Joy Mosser: Exactly. And one of the reasons I compare these diseases is, of course, because they’re very similar but the patients tend to have this concept that their eczema’s going to magically go away. But patients understand that they have hay fever that they’re going to probably have that for life. And that if the pollen count is high on the television that their hay fever sometimes are going to be worst that day.

So I also explain, compare these diseases so the patients understand their eczema’s going to come and go, day to day, and at times over their lifetime, it may change.

0:10:53

Dr. Mike Patrick: And when we talk about triggers for eczema and you had mentioned quite a few of them, so it can be that the trigger is actually doing something to the barrier or it could be that, that trigger is causing an immune response or a combination of those two things which may be different from person to person.

Dr. Joy Mosser: It is different from person to person and it’s interesting because today’s scientists will sometimes try to split these patients saying, in one end, you have these allergic patients who have the food allergies and the environmental allergies. And in this situation, those patients have nice, smooth skin but have some very red inflamed patches of eczema.

They want to split the other group into this group of patients who don’t have a good skin barrier and they’re going to have very dry, scaly skin, maybe not as many flared eczema, but just this very dry skin. Or scientists sometimes try to split them.

From a clinical standpoint, a lot of the patients fit right in the middle. They’re getting – they don’t have a good skin barrier and they also have allergies. And we probably have a lot more to learn on which starts first or maybe you actually have both and you can meet in the middle.

0:12:02

Dr. Mike Patrick: And then you can kind of understand how they’re maybe a genetic component to this as well, depending on what skin barrier you inherit and what kind of immune system and how easily it’s triggered you inherit.

Dr. Joy Mosser: Exactly, and so you can inherit a poor epidermal barrier from your mother, for example, and allergic tendency from your father. So the scientists have an easier time splitting these two hypothesis than we do as clinicians.

Dr. Mike Patrick: Yes, but in the real world, things get mixed up. So let’s say a kid does have eczema or atopic dermatitis. What signs or symptoms are associated with this?

Dr. Joy Mosser: Probably one of the biggest symptoms is itching. A lot of these patients have excessive itching. The clinical signs though are going to be redness, itching or redness scaling. Sometimes oozing in different patches on the skin.

0:12:55

Some of the worst areas involvement can be the creases. So such as the antecubital fossa or the creases of the arm, or the popliteal fossa which is the crease of the back of the leg. You can also have involvement of palms and soles. Really, anywhere you have skin, you can have eczema.

And I do find some of these areas matched, meaning if your ankles flare, your wrist probably flares. If the creases of your arm flare, the creases of your leg probably flare. But typically, redness, scaling and itching.

Dr. Mike Patrick: Are going to be the main things that you see. Now it seems to me that there’s a lot of things that could cause redness, scaling and itching. What are some other conditions that could be mixed up with eczema?

Dr. Joy Mosser: The most common conditions that can be mixed up with eczema is probably going to be tinea or fungal infections. Contact dermatitis, which a classic example of contact dermatitis might be from poison ivy. Or nickel that might be in jewelry.

0:13:52

You can also have psoriasis that can be confused with eczema and then seborrheic dermatitis which is also known as dandruff.

Dr. Mike Patrick: And so how is a dermatologist or as a pediatrician do you go about differentiating which of these things is going on in a specific kid?

Dr. Joy Mosser: First of all, present time of presentation and then if only has stream. So an infant presents to us, we’re going to ask about family history of hay fever, allergies, eczema. Also based on distribution, you wouldn’t expect to have much psoriasis on around the eyelid where psoriasis to be found more likely in the elbow. So basically, depending on the area of the body and family history and then symptoms. Psoriasis and tinea don’t tend to be nearly as itchy as eczema. So we kind of put all of those signs and symptoms together. But there are situations where they can be very difficult to tell one of these conditions from the other, and it may require scraping for to rule out fungus.

0:14:53

It may be finding out that family history of psoriasis and then looking at involvement of somebody’s fingernails where we can often see psoriasis. We would expect dandruff to be more in an adult than a teenager or maybe in an infant in the first two, three months of life and we know dandruff at that point to be called cradle cap.

Dr. Mike Patrick: And I suspected in some folks, there may be a combination of these things going on as well.

Dr. Joy Mosser: Exactly. We know that seborrheic dermatitis or is triggered by a certain yeast. And that yeast can also trigger eczema. So it’s all very inter-related.

Dr. Mike Patrick: So let’s say we’ve decided it is eczema that a child has, how do you go about treating that?

Dr. Joy Mosser: So first of all, you want to avoid your known triggers. So sometimes that may involve some allergy testing if you suspect the dog or cat in your house or dust mites might be a trigger or if you suspect foods. Because you want to know about this and be able to avoid them.

0:15:50

However, we know that you can’t avoid all triggers. And for example, you can’t avoid cold, dry air living in Ohio in January. You also can’t avoid getting hot and sweaty in July in Ohio. And then babies can’t avoid drooling. Saliva’s a big trigger for babies on their face. So we know you can’t avoid all of your potential triggers.

So first of all, you want to avoid your triggers. The next thing we work on is prevention. And a part of prevention is really repairing this epidermal barrier and retaining moisture in the skin. So the first thing we like to do is recommend a daily bath. We think that’s the best way to get your skin moist everyday. We think that’s the best way to get potential allergens off your skin, whether those allergens are from the dust, the room you walk through, the color and dye preserves in your clothing or the grass you rolled in that day it gets as potential allergens off your skin.

And also best way to get potential bacteria and yeast off your skin. Bacteria that may grow in some of these creases or bacteria that may grow in eczema patches that are being scratched at excessively. Bacteria and yeast can also trigger eczema. So the daily bath helps to achieve this goal. However…

0:16:53

Dr. Mike Patrick: And I was just going to interrupt, when I was training and this is some years ago, we would tell people don’t take a daily bath. In fact, bathing when you get out of the bath, bath water evaporates and it takes skin water with it, and so you end up drier than you were to begin with. And so a daily bath can actually make eczema worst. And I’m sure that there actually are lots of practitioners out there who, when they train, this was the advice. But that’s really kind of changed now, hasn’t it?

Dr. Joy Mosser: It is. It’s kind of an old way of thinking. We actually feel now that the water from the bath or the shower adds that moisture back, but you’re right. The key is, is when you’re out of that bath or shower to lock in that moisture you’ve just gained back in your skin.

And with that, we recommend when you get out of the bath or shower, within three to five minutes greasing down with a sic ammonium moisturizer which there’s an endless number of moisturizers that you can use. Anything from Vaseline to new ceramide-based moisturizers that replace lipids in the skin. We also have moisturizers that have hyaluronic acid in it that actually retain that moisture in the skin.

0:17:56

Dr. Mike Patrick: And then, in terms of other – so the daily bath is important. What other ways do you go about treating this, medication-wise?

Dr. Joy Mosser: We do. Just one more thing as far as the bath. We do recommend, we don’t recommend a lot of excess soap. Usually, we feel most patients can get away with using soaps or non-soap cleansers about every other day or every few days, unless they’re getting back to really infect it and we can discuss that part later.

So every single day at the bath or shower, a good ammonium within a few minutes after getting out of the bath or shower. And then we recommend topical anti-inflammatory agents to be applied to the red, itchy scaly patches. These medications are in the form of topical steroids or what we call topical calcineurin inhibitors. And they decrease the inflammation in the actual eczema patches. So they treat the inflamed areas. They’re only to be used in the inflamed areas until an area clears where in patients who have eczema, we ask them that they continue to do the daily bathing and the moisturizer, every day, all the time.

0:18:58

Dr. Mike Patrick: All the time. But when they have the flares, that’s when they’re going to use the steroid medicine.

Dr. Joy Mosser: Yes, or there’s steroid-free topical calcineurin inhibitors which are considered pimecrolimus or tacrolimus.

Dr. Mike Patrick: What about medicines for itching? I mean I’m sure the itch scratch cycle that…

Dr. Joy Mosser: We call – we still call x mother itch the scratches. The more you scratch, the more you flare eczema, the more you may introduce bacteria into your eczema that would instantly flares it. We want to control that itch scratch cycle. So part of that includes antihistamines and we use not really topical antihistamines but oral antihistamines.

I often tell patients I’d rather your patient – your child sleep all night and instead of scratching and digging and you’re trying to repair their skin for the next week with their topical medications. So it’s okay to put your child to sleep some time with a little antihistamine.

0:19:52

We can also use the non-sedating antihistamines for daytime use particularly in older children who don’t want to be groggy or tired at school. The younger children can usually still use some of the more sedating antihistamines and we just combine them with a nap time because it tends to be that you scratch most when your mind’s at rest.

Dr. Mike Patrick: And then you had mentioned sometimes the eczema will get infected especially if kids are scratching it and they inject bacteria into that poor skin barrier then you can get an impetigo or cheilitis or an abscess. So how do you go about treating for the infection part?

Dr. Joy Mosser: Well, skin infection is the most common complication of having eczema. And what happens is that patients who often tell us that when their skin starts to get infected, they have signs of impetigo which may be excessive crusting explorations, scratch marks or even like that kind of golden crust you see in impetigo. They’ll find that their topical anti-inflammatory steroids or calcineurin inhibitors stopped working.

0:20:52

At that point, that usually only need to add antibiotics. Topical antibiotics can work in very mild cases, very localized area particularly we have to use oral antibiotics that have good staph aureus coverage.

Dr. Mike Patrick: And then what about the immuno-modulating kind of medication? So things like pertopic or elidels. Is there a place for those in kids with eczema?

Dr. Joy Mosser: There is. I often tell patients they’re a little bit more expensive and they probably don’t work as fast, but they’re very important for sensitive skin areas. Often, the face where we may be more worried about thinning… or broken blood vessels with topical steroids.

They’re also very important for chronic eczema patients when they need to give themselves a break from eczema. So they’re great for chronic involvement and on the more mild areas of the body.

0:21:49

Dr. Mike Patrick: And there is some controversy with those or some studies that show maybe they are related to some cancers?

Dr. Joy Mosser: The patients who take tacrolimus internally, for example for transplanted organs, there are increased risks predominantly for skin cancers with use of those long term. Their studies have not found that to be an issue with the topical use and we use them only on areas affected. They’re not to be used as moisturizers head to toe. And so generally, patients with eczema don’t have signs of immuno-suppression with them. It’s just localized.

We do often warn patients that before that they don’t use this medications and go right out into the sun. We don’t want to immuno-suppress the skin and then maybe increased your risk of skin cancer later on. But we think these medications can be used very safely.

Dr. Mike Patrick: Great. And then what about light therapy? So if a parent does a search on the internet for my kid has eczema, what do I do? This is one of those that so UV light exposure who one day will come across often. What do you think about that?

0:22:53

Dr. Joy Mosser: Light therapy is a great treatment for severe eczema. So and it’s essentially very old treatment. The issue is that it’s probably it’s hard to obtain. We typically recommend using a medical tanning facility or a dermatologist office to obtain this light therapy and so it’s monitored by nurses and the physician and you don’t have burning.

It typically is not practical for a pediatric patients because it requires visits to an office two to three times a week. And it’s probably best indicated for the patient who doesn’t respond to moisturizing, bathing and the topical anti-inflammatory. So very severe eczema patients, patients who have head to toe eczema, they’re going to be the best candidate for this form of therapy.

Dr. Mike Patrick: Sure. And then one more, it seem like, as I was researching for this show, one of the things that kept popping up that I had never really heard of before is a tar preparations. What’s with tar?

0:23:50

Dr. Joy Mosser: Tar is also a very old treatment. It’s thought to be anti-inflammatory a little bit, a little bit keratolytic meaning it helps to peel the skin. But it sometimes hard to find exactly how tar works. It is best use for psoriasis and so we’ve had the best results with that particular condition. Not so much for eczema, I like it better for psoriasis. And it can work very well if you can get a tar bath.

Dr. Mike Patrick: So parents out there, don’t cover your kids in tar, at least without talking to a dermatologist first. And then one other thing I wanted to mention is the importance of just, especially for babies, keeping their fingernails cut short so even if they had that itching that they’re not digging and scratching.

Dr. Joy Mosser: And that’s very beneficial.

Dr. Mike Patrick: Causing a problem with the barrier.

Dr. Joy Mosser: Before we get away from the kind of the infection complication, one of the new concepts is using bleached baths. And that’s also important for the patients who get freakingly secondarily infected.

0:24:49

There are something we sometimes instruct patients to put a small amount of bleach in their tub if that patient has frequent infections and do that once or maybe twice a week.

I do have some patients who they’re recommended to have a bleached bath and they have – their eczemas never gets infected . They have diffusely dry, scaly skin. The benefit doesn’t seem to help those patients that help the ones who have stuff as a big trigger for their eczema.

Dr. Mike Patrick: And how do you know how much bleach to put in the bath because most of the things that I see tells you how many ounces and per gallon of water. But you mean you’re not really measuring your bath in gallons of water. So how do you know how much?

Dr. Joy Mosser: What I tell my patients is to fill up the bath tub to how they normally would get in there, OK. And then put about half a cup of bleach into the bath tub. I ask them to walk out, come in about five minutes later. If it smells like they’ve just cleaned their bathroom with bleach and it’s burning their nostrils, they probably need to cut down to a quarter cup. If they don’t smell it all, then they probably need to go up to a cup.

0:25:53

And so if you’re on this big garden tub that you fill up really high, you might need a cup of bleach in the bath. I tell patients I want their bathroom to smell like an indoor pool.

Dr. Mike Patrick: Got you. Great, that’s a great advice. So let’s say we’ve treat eczema or we don’t treat it, or we treat it but not as well as we should be. What kind of complications can arise from atopic dermatitis if it’s poorly treated?

Dr. Joy Mosser: So as I mentioned before, the biggest thing is frequent bacterial infections. But along with this comes patients who don’t sleep well at night time when infant or toddler, even a young school age child does not sleep at night, parents lose sleep, this makes them less functional the next day. They have a harder time developing in the areas they need to develop if they’re staying awake all night scratching and digging.

0:26:51

Patients who get frequent infections, especially infants, they may even fail to thrive. Their bodies working extra hard to fight the infection. If these patients have eczema head to toe and they’re very scaly and red, they’re losing protein to their skin in these areas. They’re also losing fluid to those skins that they made it be dehydrated.

So failing to treat eczema, particularly in infants can be not only disruptive emotionally to a family but then physically to a child that can fail to thrive. As the child ages, if they continue to have chronic eczema, they do deal more with the psychological issues. Sometimes they have a harder time being involved in sports where they may be sweating or rolling around in the grass. This can obviously affect self-esteem. Also the physical parents can affect their self-esteem.

Dr. Mike Patrick: And then, we kind of like to be fair. We want parents to really look at risk versus benefit for anything that we use doctors recommend. And so we talked about the complications of untreated eczema, what about the complications of our treatment?

0:27:51

Dr. Joy Mosser: So I’m definitely I’m a little bias. I feel with appropriate treatment, you won’t have the side effects. But there are situations of inappropriate treatment. Predominantly, this would be using a steroid when you don’t have a flare in your eczemas, centrally using it to your normal skin. We have many strengths of steroids but using a steroid that’s too strong for sensitive skin areas like the face, the armpit, the groin area, in those situations, you can potentially experience some stray hair or stretch marks. You could experience some thinning of the skin. In a few situations, you can experience cataracts and glaucoma with overuse of topical steroids on the eyelids.

With appropriate use and what I mean by that is you use the topical steroids twice a day to an area until it’s completely clear. And when it’s clear, you stop treating it. You only restart these medications when they flare again. We do not typically have any of these side effects.

0:28:51

Dr. Mike Patrick: So were those things to where if you’re treating it appropriately as you go, then you hopefully don’t have as many of the big flares which is going to require more potent treatment that could have a complication or side effect with this? So it’s just again reassurance to kind of keep control of it as best you can by doing what you should be doing on a daily basis.

Dr. Joy Mosser: Exactly. I mean I’ll often use the example of the first time I give a patient a topical steroid. I want you to treat your area twice a day until it goes away, whether it takes two days to go away, two weeks to go away or two months to go away.

I tell them I don’t want it to take two months to go away. If it takes two months, maybe I need to use something different or something stronger. But I emphasize you have to use it until it’s clear. So that you’re not bouncing every other day better, worse, better, worse. We want to get you down to a good baseline.

And then I also use example. So if the first time, it take you two weeks to clear. And then it clears up, it maybe flares a few days later. If you start treating it right away, that next time, it may only take two days to clear.

0:29:49

Dr. Mike Patrick: What is the long-term outlook for these kids? I mean, just in your general experience, is it something that they outgrow or is that something they’re going to be battling on and off for the rest of their lives?

Dr. Joy Mosser: So as I kind of said in the beginning, eczema means you have sensitive skin. And you just can’t magically wake up without the tendency to have sensitive skin someday.

As a whole, most of the patients get better between the age of three and five. I think I read a statistics that about 43% are significantly better or maybe even have resolution by age three. I find this to be the case in my practice. I feel that – why is that? Well, maybe by somewhere between the age of three and five, you know what flares it, you what controls it, you become tolerant to your environment.

About 70% of patients, eczema, it does resolve by puberty. And so most patients do get better. But I also use the example that maybe you’ll be a new mom and you’ll be washing dishes and changing diapers and the eczema’s going to flare in your hands. Or maybe you’re going to be a 65-year old grandparent who decides to retire to Arizona and if you never did well on a dry environment, maybe your eczema flares again. So it can come and go throughout your lifetime, but most patients do get better.

0:30:59

Dr. Mike Patrick: You know I was practicing in Florida for a couple of years. And I was amazed at kids that would come in with very mild eczema compared to Ohio in the winter eczema. And you know, what is this, this is terrible and so I guess, where you live can make a big difference.

Dr. Joy Mosser: Now did you find out that some of those patients were worse in the summer in Florida? Because sometimes the heat and the sweat is the patient’s biggest trigger.

Dr. Mike Patrick: Yes, absolutely. Although I did not – and of course, I wasn’t down there practicing as long as I’ve been in Ohio. But I certainly see more severe eczema in Ohio than Florida.

Dr. Joy Mosser: Yes.

Dr. Mike Patrick: We keep the pediatric dermatologist busier in Ohio.

Dr. Joy Mosser: We would like to change our change our pollination to throughout the year, that doesn’t help anybody.

Dr. Mike Patrick: Yes, yes, exactly. And with this maybe a little obvious, and we sort of talked about this but we do include it with every disease topic that we discussed. Is there any way to prevent this from happening? I guess just good daily control really is the answer there.

0:31:56

Dr. Joy Mosser: Good daily control, but…

Dr. Mike Patrick: And avoiding triggers.

Dr. Joy Mosser: And avoiding triggers, but I mean there are definitely a lot of things you can do as far as decreasing the amount of times that you’re out sweating in the middle of the day. We think kind of clothing, more cotton or soft clothing. Avoiding fragrances and moisturizers and laundry detergent, all those of things and a lot of ways maybe preventative. Probiotics are kind of one of the new things, and the thinking is, is that probiotics, taking them may decrease some eczema. The studies are not so great at this point but that’s something hopefully that we’ll be able to develop more in the future.

Dr. Mike Patrick: So probiotics that you ingest? Like how would that – I’m just trying to think from a mechanism standpoint, how would that be beneficial? Or we do not know?

Dr. Joy Mosser: Yes, I don’t think we know exactly, but it’s kind of along the lines of you exposing your body to the good bacteria that may help boost your immune system.

0:33:05

Dr. Mike Patrick: Yes, and actually, I just realized, we didn’t circle back around on that developed country, underdeveloped country. What’s the deal with that?

Dr. Joy Mosser: Good question. There are two different theories on that and one of the theories is that we are too clean in these developed countries and that our body is too – we don’t have anything to defy it against. Wherein in underdeveloped countries, you’re too busy fighting off all these inspections, in a developed country, our body’s immune system has nothing better to do but turn around and tuck ourselves. That’s kind of one theory.

Another theory is that kind of if you’re running around in a loin cloth all day, that diverses, we get our – we’re eating food from McDonald’s, we’ve got all of our clothes are chemically processed that we are overexposing ourselves to numerous antigens. So there’s two theories on that too.

Dr. Mike Patrick: And they kind of conflict with one another?

Dr. Joy Mosser: They do kind of conflict with one another.

0:33:58

Dr. Mike Patrick: And the truth maybe that there’s a combination of each of those things depending on the person and…

Dr. Joy Mosser: That’s what I think, yes.

Dr. Mike Patrick: Pretty complicated. And it goes along with why we’re seeing more asthma and more allergic rhinitis kind of stuff too.

Dr. Joy Mosser: Exactly. They really do parallel each other.

Dr. Mike Patrick: Any cure on the horizon? Is there any way to make eczema just go away and never come back?

Dr. Joy Mosser: No, that’s the first thing I do on the first visit in my office is explain to patients there really is no cure for eczema, but we can work together to get the best tools to keep it under control and prevent it and so that you can go on and have a normal functioning daytime.

Dr. Mike Patrick: Sure.

Dr. Joy Mosser: Although these patients are high-maintenance, I also warn their parents right off the bat, you have a high-maintenance child if they have eczema because it takes a lot of care.

Dr. Mike Patrick: A lot of work, a lot of work involved. We really appreciate you stopping by and chatting with us about atopic dermatitis and eczema.

0:34:51

We do have some great links for you in the Show Notes for PediaCast Episode 233. There’s one to Atopic Dermatitis, just an information sheet from the Nationwide Children’s Health Library.

We also have an Eczema Helping Hand that we use here at the hospital. We hand it out for kids who have it have some helpful information for parents, we have a link to that. And also a link to our dermatology program here at Nationwide Children’s Hospital.

Before you take off, one other thing we always like to ask the guest. I always forget to warn you before so you can have it at the back of your mind. But it’s an easy question. We really try to have parents stress the importance of just doing stuff on with your kids. It doesn’t involve screen time and parents and kids doing different things at the same time but really getting involve with your kids.

And one of the things that we always have fun at our house is family games and so especially with Christmas coming up and so people trying to think about gift ideas. Just from your childhood or now, what are some of your – what’s your favorite family game to recommend?

0:35:55

Dr. Joy Mosser: Oh, I think we like clue.

Dr. Mike Patrick: Oh, yeah.

Dr. Joy Mosser: That’s probably my favorite family game.

Dr. Mike Patrick: We love that one too.

Dr. Joy Mosser: Although my favorite family activity also good for the holidays coming up is baking. Yes.

Dr. Mike Patrick: Baking as a family?

Dr. Joy Mosser: Baking as a family and maybe because I like sweets and food.

Dr. Mike Patrick: Absolutely, we love that too. So we really appreciate Dr. Joy Mosser stopping by and we’d love to have you back. Oh I can think of a whole list of topics that we could discuss.

Dr. Joy Mosser: Great, thank you.

Dr. Mike Patrick: Yes. I want to thank all of you for taking part of your day to listen to pediacast. We really appreciate it. I want to remind you there’s no podcast next week. We’ll be celebrating Thanksgiving in the United States and so we won’t be here next week. Enjoy time with your family, but we will be back in two weeks.

Also want to remind you, iTunes reviews are helpful. Ask our links on your web pages and mentions in your blogs on Facebook and your tweets and on Google+, be sure to join our community by liking PediaCast on Facebook and following us on Twitter.

0:36:54

You can also hang out with us over on Google+ and be sure to stop by our Pinterest boards and be sure to repin your favorite episodes and news stories. You can also swing by the Show Notes at pediacast.org to add your comments on today’s show. And we appreciate you telling your family, friends and neighbors about the program and don’t forget to talk us up with your child’s doctor at your next well check-up or sick office visit.

We also have posters you can download and hang those up wherever moms and dads hang out. You can find them under the Resources tab at pediacast.org. One more time, the contact information if you have a question that you would like to ask or you have a comment for the program or want to direct us to a new story, just head over to pediacast.org and click on the Contact link. You can also email Pediacast@gmail.com or call the voice line at (347) 404-KIDS. That’s (347) 404-KIDS.

And until next time, this is Dr. Mike saying stay safe, stay healthy and stay involve with your kids. So long, everybody.

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