The skin is our largest organ and is a window into the health of our digestive tract, immune system and inflammatory pathways. Atopic dermatitis, or eczema, is an itchy, inflammatory skin condition which is triggered by a combination of genetic and environmental factors1. Eczema is related to an alteration of immune function and has been associated with an increased risk of developing asthma, and allergic rhinitis2. Although steroid creams will ease the inflammation and itch associated with eczema, it doesn’t address the underlying immune dysfunction and will not result in permanent resolution.
Eczema is highly prevalent in children and is thought to affect 10-20% of all children3. The majority of these children will first develop eczema within the first year of life3. It is more common among male children with a family history of atopic conditions such as eczema, asthma or allergic rhinitis4.
In many children with atopic dermatitis, there are also associated gastrointestinal conditions such as constipation, colic, and gastroesophageal reflux. It is important that we address the digestive tract as part of the treatment plan to reduce the inflammatory triggers in susceptible children at the same time as balancing out the immune system.
Prevention of Eczema in Children
- Vitamin D in pregnancy: maternal supplementation of vitamin D in pregnancy has been shown to increase the umbilical cord blood vitamin D status and reduce the risk of eczema in the child6.
- Probiotics in pregnancy: studies have shown that children have a lower incidence of food allergies and eczema when the pregnant mother is taking probiotics7,8
- Fish oils in pregnancy9
Treatments for Eczema in Children
Removal of Food Allergens
Food antigens have the potential to cause enough inflammation to trigger atopic dermatitis in many children. This is especially true for children who experience a flare-up during the introduction of solid food.
For exclusively breastfed infants who are not yet consuming solid foods, maternal antigen avoidance will lower the inflammatory antibodies present in the breast milk. Maternal antigen avoidance during pregnancy doesn’t reduce the risk of eczema; however, avoidance during breastfeeding may be beneficial10.
For infants who are consuming formula, using a hypoallergenic formula is a great place to start to see if the skin clears with a change in the type of formula. These formulas are still based in cows milk but the proteins are broken down to be more easily digested. Alternatives to hypoallergenic formulas include goat formula, soy formula, and amino acid-based formulas.
In children who are consuming solids, it is important to introduce solids properly to assess for food sensitivities/allergies. These food reactions can include a change in bowel habits (i.e. constipation or diarrhea), an eczema flare, hives, vomiting, and difficulty breathing. It is important to only introduce a new food every 3 days to allow for sufficient time for a reaction to take place before introducing the next food. If your child does react to an introduced food, you should remove that food from their diet and try to reintroduce it again at a later late (under a physician’s guidance).
If the mother or the child is having a difficult time evaluating her/his food sensitivities or allergies, it is possible to do a food panel which assesses for antibodies to specific foods. This is a tool I use as a starting point followed by an elimination and challenge of the suspected foods.
Common Food Allergens
Treat Gut Dysbiosis
The term “dysbiosis” refers to a microbial imbalance within the digestive tract. I will most often assess for this in older children via a Comprehensive Stool Analysis looking for inflammation triggered by bacteria, yeast, or parasites. The laboratory will complete a sensitivity testing on any cultured organisms to help select the most appropriate treatment.
There has been a significant body of research showing that probiotics have the ability to balance out the immune system11. Probiotics can be taken both pre- and post-natally by the mother8,9 as well as supplemented directly to the infant12,13.
It is now known that vitamin D has important roles in addition to its effects on calcium metabolism and bone health including affecting immune responses. Indeed, vitamin D deficiency has been associated with an increased risk of childhood atopic dermatitis14. Similarly, it has been shown that vitamin D deficiency in older children is linked to an increased risk of eczema and repletion of vitamin D status improves symptoms15.
It is especially important to supplement exclusively breastfed infants with vitamin D as vitamin D does not pass into the breastmilk in sufficient amounts to prevent a deficiency.
Although eczema is common, affecting up to 1 in 5 children, it should be viewed by the parent as an alert to a deeper problem lying within the immune system of the child that should be addressed to hopefully prevent further problems such as asthma or allergic rhinitis. Mothers who have a strong family history of allergic conditions should use their pregnancy as a time to try to prevent eczema in their child via supplementation with probiotics, fish oils, and vitamin D.
- Mao W, Mao J, Zhang J, et al. Atopic eczema: a disease modulated by gene and environment. Front Biosci(Landmark Ed). 2014;19:707-717.
- Gustafsson D, Sjöberg O, Foucard T. Development of allergies and asthma in infants and young children with atopic dermatitis – a prospective follow-up to 7 years of age. Allergy. 2000;55(3): 240-245.
- Watson W, Kapur S. Atopic dermatitis. Allergy Asthma Clin Immunol. 2011;7(Suppl 1):S4.
- Moore MM, Rifas-Shiman SL, Rich-Edwards JW, et al. Perinatal predictors of atopic dermatitis occurring in the first six months of life. Pediatrics. 2004;113(3 Pt 1):468-474.
- Gdalevich M, Mimouni D, David M, et al. Breastfeeding and the onset of atopic dermatitis in childhood: A systematic review and meta-analysis of prospective studies. J Am Acad Dermatol.2001;45(4):520-527.
- Jones AP, Dip PG, Palmer D, et al. Cord blood 25-hydroxyvitamin D3 and allergic disease during infancy. Pediatrics. 2012;130(5):e1128-1135.
- Kuitunen M. Probiotics and prebiotics in preventing food allergy and eczema. Curr Opin Allergy Clin Immunol. 2013;13(3):280-286.
- Rautava S, Kainonen E, Salminen S, et al. Maternal probiotic supplementation during pregnancy and breastfeeding reduces the risk of eczema in the infant. J Allergy Clin Immunol. 2012;130(6):1355-1360.
- Kremmyda LS, Vlachava M, Noakes PS, et al. Atopy risk in infants and children in relation to early exposure to fish, oily fish, or long chain omega-3 fatty acids: a systematic review. Clin Rev Allergy Immunol. 2011;41(1):36-66.
- Kramer MS, Kakuma R. Maternal dietary antigen avoidance during pregnancy or lacation, or both, for preventing or treating atopic disease in the child. Cochrane Database Syst Rev. 2012;9:CD000133.
- Toh ZQ, Anzela A, Tang MLK, et al. Probiotic therapy as novel approach for allergic disease. Front Pharmacol. 2012;3:171.
- Betsi GI, Papadavid E, Falagas ME. Probiotics for the treatment and prevention of atopic dermatitis: A review of the evidence from randomized controlled trials. Am J Clin Dermatol. 2008;9(2):93-103.
- Isolauri E, Arvola T, Sutas Y, et al. Probiotics in the management of atopic eczema. Clin Exp Allergy. 2000;30(11):1604-1610.
- Wang SS, Hon KL, Kong AP, et al. Vitamin D deficiency is associated with diagnosis and severity of childhood atopic dermatitis. Pediatr Allergy Immunol. 2014;25(1):35-35..
- Mutki K, Koo J. Update on the role of systemic vitamin D in atopic dermatitis. Pediatr Dermatol. 2013;30(3):303-307.