Question 1

In January the Manchester Evening News reported the growing market in bamboo baby wear. Is there any evidence that puts bamboo and cotton in the same league?

Answer

It is certainly possible that bamboo clothing designed for babies and young children with eczema may be beneficial, but I have to confess that I could not find a shred of good evidence to support this notion. I could not find any scientific studies comparing bamboo against cotton, or indeed any other form of clothing, and all I could find were anecdotes on websites advertising bamboo clothing, possibly written by people with a conflict of interest. The advertisements would often list up to 10 reasons why bamboo clothing can help eczema because it is ‘natural’, it may be antibacterial, and because it absorbs up to 4 times more moisture than cotton (probably the last thing you want to do as the skin of eczema is already dry and we spend so much effort in moisturising the skin).

Question 2

I am about to start weaning my baby who already has eczema. Is there any advice you can give me about weaning? My baby is now 6 months of age.

Answer

There are still lots of unanswered questions about the role of diet in early infancy and its relationship to eczema. At the moment, there is no clear evidence to suggest that you should introduce one type of food compared with another type of food in order to try and reduce the risk of food allergy. If food allergy is going to occur, then this is probably genetically determined, or determined by exposure to food substances passed through breast milk or other routes. So be guided by your child and introduce whatever foods you feel comfortable with when weaning. Be on the look out for allergic reactions, i.e. vomiting or coming up with a nettle rash over the body, swollen lips, or the eczema definitely worsening after that food is given on a number of occasions. If this happens, you should discuss it with your doctor, as it is very important that a young child gets a balanced diet containing enough calories, protein and calcium.

I should point out that there is some evidence out there to suggest that early introduction of solids may increase the risk of eczema developing in somebody predisposed to it, but it will not increase the risk of other allergic diseases such as asthma or hay fever. So it sounds as though you have already followed this advice by breastfeeding where possible up to the age of 6 months, and now is probably a good time to start weaning to ensure that your child gets enough nutrition. So my bottom line, is to try and delay introduction of solids if possible, but not to worry about which solids you introduce and when.

Question 3

We live in India and our 20 month old son suffers from severe eczema. He suffers a lot with itching and food allergy tests showed him to be allergic to cows’ milk, mustard seeds and wheat. We have started avoiding these foods although it is difficult with an Indian diet. We have tried wet wraps but our son does not like us to use them. We have also taken advice from a homoeopath and use liquid paraffin and fully cover our son when he dresses to prevent him from scratching.

Answer

My heart reaches out to you as you clearly need the help of a team who are interested in eczema and who can give you clear, consistent advice. You are doing so many things at the moment and none of them sound to be effective. I wish we could see you in our special eczema clinic in Nottingham, and hope that much of the information on our website will help you.

I suspect that the main problem with your child is that he is out of control in terms of eczema and he has never enjoyed getting into remission. You have not mentioned topical corticosteroids at all, and these are really essential to control severe eczema. Ideally, you need the help of your local dermatologist to perhaps get your child a lot more comfortable with a two week blast of a topical steroid, and then once under control, you might use the topical steroids just one weekend, i.e. Saturdays and Sundays, using plenty of moisturiser Monday to Friday. That way, it is virtually impossible to get side effects such as skin thinning, and you will end up getting good control with using only very small quantities of topical steroids.

Food allergy tests are very difficult to interpret, and the best test of all is to be guided by the reactions that your son gets if he eats particular foods like cows’ milk, mustard seeds and wheat. Unless he is clearly reacting to them, then I would encourage a broad healthy diet and concentrate more on getting the skin inflammation under control with the safe use of topical corticosteroids with your doctor. By all means try homoeopathic medicine, but as yet, I am afraid there is no good quality evidence that it is effective in eczema. Liquid paraffin sounds OK as an emollient, but remember it is quite greasy and it is also flammable, and there are lots of more cosmetically acceptable moisturisers out there that you might enjoy using, which can also be used as soap substitutes in the bath.

So the bottom line is that we must get your son’s eczema under control with a safe and clear plan of topical corticosteroid and emollient therapy which must be done in collaboration with your doctor. Like me, I am sure many other readers out there will share your frustrations at the moment, and I hope that the material on our website will provide you with knowledge and ammunition to find a suitable team of helpers closer to where you live.

Please note that Professor Williams is talking about a case specific situation. The information given here is to help this family to ask the right questions of their GP. Its inclusion here is to give others a feel for what is happening to this family and to promote a discussion within your own environment. Every case is different and must include the guidance of a suitably qualified person. The NSGCCE and Professor Williams will not accept any responsibility for any situation that arises as a result of using this information without the guidance of a suitably qualified person. A suitably qualified person would be benchmarked by UK standards.

Question 4

There seems to be a growing discussion about the link between ADHD and eczema. What is the basis for this discussion and is there any related evidence to support the theory?

Answer

Ah! – this refers to the recent work done by my colleague Jochen Schmitt in Germany. He looked at a large database of patient records in Saxony and compared about 1500 young people with eczema (aged 6-17 years) and compared them with an equal number of young people who did not have eczema, and found that the frequency of Attention Deficit Hyperactivity Disorder (ADHD) was 5.2% amongst those with eczema, and 3.4% amongst those who did not have eczema. Such a difference was not present for those who had asthma or hay fever, although the study did not exclude a smaller association with these other atopic conditions.

So what does it all mean? Well, this study does show that the frequency of ADHD was slightly higher in young people with eczema in Germany compared with those who did not have eczema, but the study does not help us rule our cause and effect. Whilst it is possible that ADHD and atopic eczema and indeed other atopic diseases may share similar genetic or environmental causes, it is also possible that the effects of chronic sleep loss and constant itching can either mimic the symptoms of ADHD, or the stress of such sleep loss and itching may precipitate ADHD behaviour in those young people who are genetically predisposed towards it. Over the years, I have witnessed many children with severe eczema in our eczema clinics that are hyperactive, but many of those children’s behaviour are transformed when they are managed appropriately and the eczema is less of a problem to them. It is also possible that dietary manipulation by avoiding food additives and colourings may help such children.

The bottom line therefore is that I do not believe that there is a genuine shared genetic predisposition towards atopic eczema and ADHD. I do believe however that partially treated severe atopic eczema can cause behaviour changes very similar to ADHD which reverse when the eczema is well controlled.