Question 1

How can I manage Jack's eczema during the winter as it always seems to get worse when the seasons change?

Answer

There are many factors that contribute to flares of eczema but one of the top causes for a flare are changes in temperature and variations associated with the seasons . Extremes of temperature can directly worsen atopic eczema. Again each child is different but their skin is very susceptible to these extremes and their skin needs to adapt to the change from summer to a winter skin . What is key is the change in environment and seasons .

In the summer children often find that if they become hot and sweaty their skin gets worse. In the winter months, when it is cold, frosty and windy outside and centrally heated indoors this can have a drying and irritating effect on the skin. In the summer months the use of a lighter emollient (moisturiser) may help, because many of the heavier greasier emollients can add to the overheating. During the colder months a heavier emollient can help to protect the skin when exposed to the harsh weather.

Also we know that over the last fifty years the number of houses with central heating, double glazing and cavity wall insulation has increased dramatically, resulting in a significant increase in the average indoor temperature, and an increase in humidity (the amount of water held in the air is a lot less when the weather turns colder, even though the weather might appear "damp") and dampness . Over this time the number of people suffering with atopic eczema has also risen 2-3 fold. These temperature and humidity changes may partly contribute to the condition by encouraging high levels of house dust mite in the home. Eczema children don't like to be too hot and can often get away with less clothing throughout the year. It may be tempting to use thick layers but generally they are better with several thinner layers rather than one thick layer. They will then be able to add or remove these layers in order to regulate their own comfort levels.

Also another important aspect of caring for Jacks skin during the winter is the use of shampoos. A recent study (Langan et al 2009)* undertaken in Nottingham found that shampoo exposure may be associated with eczema worsening and is more is more pronounced in cold weather. The study also looked at a variety of factors that may cause a flare and found that several factors were important nylon clothing, woollen clothing,dust,unfamiliar pets, sweating and the use of shampoos.

* Ref: S.M. Langan, P. Silcocks and H.C. Williams, What causes flares of eczema in children? British Journal of Dermatology 2009 161, pp640–646