On this week’s episode, I speak with Dr. Shreya Patel
We chat all about Eczema 101:

• What does eczema looks like?
• Are some children predisposed to eczema?
• Are there preventable measures?
• When should a child see an allergist for their eczema?
• What would workup entail at the allergist?
• What are some basic skincare tips for eczema?

00;00;06;16 – 00;00;37;15

Dr. Mona

Hey, everyone, welcome to the PedsDocTalk podcast. I’m your host, Doctor Mona, where each week I hope to educate and inspire you in your journey through parenthood with information on your most common concerns as a parent and interviews with fellow parents and experts in the field. My hope is you leave each week feeling more educated, confident and empowered in the decisions you make for your child.

 

00;00;37;17 – 00;00;56;24

Dr. Mona

Hey everyone! Welcome to this week’s episode where I have Doctor Shreya Patel, who is a allergist and immunologist, and she’s joining me today so we can talk about eczema, a topic that many of you as parents deal with in your life. So thank you so much for being here. Doctor Patel, how are you doing today?

 

00;00;56;27 – 00;01;00;24

Dr. Shreya Patel

I’m well. Thank you so much, Mona. I’m really excited to chat with you today.

 

00;01;00;27 – 00;01;06;22

Dr. Mona

Thank you. So tell me a little bit more about you, your training and your specialty.

 

00;01;06;25 – 00;01;27;02

Dr. Shreya Patel

Okay. Yes, sure. So my name is Shreya Patel, and I’m an allergist immunologist, just like you said. I’m in private practice right now in Orlando, Florida. So to get where I am today, I completed four years of medical school. I did three years of pediatric residency, and then I went on to complete two more years of fellowship training in both adult and pediatric allergy and immunology, actually.

 

00;01;27;07 – 00;01;34;09

Dr. Shreya Patel

So although pediatrics has always been my passion, of course I do currently treat all ages from 0 to 99.

 

00;01;34;11 – 00;01;49;06

Dr. Mona

Awesome. And Doctor Patel has her own Instagram account. Shreya Patel, M.D.. I’m going to attach that to the show notes on this page. But in terms of the pediatric standpoint, what are the conditions that you manage or see mostly in your practice?

 

00;01;49;09 – 00;02;11;22

Dr. Shreya Patel

So I see the whole wide array of allergic conditions and I see allergic rhinitis. I mean that’s commonly known as hay fever. Of course I see asthma. Food allergies, drug allergies. I also treat a wide array of rashes. So it’s actually surprising how many rashes I see in my practice. But I see a lot of hives, contact dermatitis.

 

00;02;11;29 – 00;02;16;01

Dr. Shreya Patel

And then of course, what our topic is today I see a lot of eczema.

 

00;02;16;04 – 00;02;33;15

Dr. Mona

And so do I. And that’s why I was so happy that we could connect on Instagram so that we can talk about this, because so many parents come to me for eczema or, and, you know, any general pediatrician and we are able to manage a lot of eczema, but there are certain cases that they need to go to an allergist or immunologist for.

 

00;02;33;15 – 00;02;53;03

Dr. Mona

So, you know, through this conversation, we’ll we’ll get into that, which I’m just so excited to educate people on something that’s actually really common, common condition that we see in children. So, you know, we’re talking about eczema. But as a general pediatrician, you know, I see a lot of rashes. And I know parents will report that they see a lot of rashes.

 

00;02;53;06 – 00;02;56;28

Dr. Mona

How would you describe how the eczema rash would look like?

 

00;02;57;00 – 00;03;21;10

Dr. Shreya Patel

Yeah. So eczema is usually characterized by like this itchy red and scaly patches on the skin. If you were to touch it, it would feel really rough to the touch because it’s dry. You’d usually see a lot of overlapping scratch marks or as we call them, excoriation. If it’s been there longer, it’ll be, thicker. It’ll be discolored, like you might have some areas that are darker or some areas that are lighter.

 

00;03;21;27 – 00;03;37;26

Dr. Shreya Patel

And then where you’ll find it on the body actually, interestingly enough, varies by age. So infants and younger children, you’ll usually see it on the scalp, the knees, the elbows, and then on the face. But on the face you’ll see it more on the cheeks and your characteristically have what the the so called head light fine.

 

00;03;37;26 – 00;03;54;02

Dr. Shreya Patel

Which means like that the nose is spared, so it’s usually going to be on the cheeks, on the face. For older children and adults, you’re going to see it more in the creases of the wrist, the creases of the elbows, the knees. So that means behind the knees, also on the ankles, the face and the neck.

 

00;03;54;05 – 00;04;11;03

Dr. Mona

Okay. And then you know, we, we always kind of look at okay. Is it mild moderate severe I know that might just be based on how the person who’s looking at it is describing it, but how would you as an, you know, allergist immunologist, how would you describe or categorize mild moderate severe eczema.

 

00;04;11;06 – 00;04;31;16

Dr. Shreya Patel

So if I want to determine the severity of an eczema, there’s two major things that I look for. The first thing I look for is how much of the body is actually affected. And then the second thing I look for is the intensity of the item. So just generally looking at, you know, how do I calculate the body surface area affected as I look at the head, the trunk, the upper limbs and the lower limbs?

 

00;04;31;25 – 00;04;46;00

Dr. Shreya Patel

And then you look at it all kind of together and you determine how much of the skin is actually involved. And then for the intensity, I look at four things as well. I look at the redness, the thickness of the skin, how much scratching there actually is or scratch marks. And then the like can ification.

 

00;04;46;02 – 00;05;04;17

Dr. Shreya Patel

And that’s a term that usually you’re going to see that more in chronic eczema. And that describes when you see lines in the skin furrowing. Sometimes if it’s really bad it’s in there long term. And you’ll actually see nodules on the skin. So usually you can kind of take those two big categories together and determine is it mild, moderate or severe?

 

00;05;04;27 – 00;05;25;17

Dr. Shreya Patel

A lot of times allergists and dermatologists like to have a real score attached to it. And so we’ll actually use standardized scoring tools to determine that. And so one example of that is like the eczema er area and severity index, the aeaci. That’s a common one that we use, such as give people an idea of what your doctors will use to determine the severity.

 

00;05;25;19 – 00;05;33;15

Dr. Mona

And you described it earlier that it would be kind of like dry patches. Does it always have to be red or can it just be dry? It can be just.

 

00;05;33;15 – 00;05;56;17

Dr. Shreya Patel

Dry, especially if it’s not acutely inflamed. But usually you will have some sort of at least faint redness there. But I see a lot of kids who just come in. They have like even these circular areas of eczema. And they’re almost just like the circle of dry skin, not necessarily red. So yeah, you can definitely just have these dry patches of skin and it could be eczema.

 

00;05;56;19 – 00;06;04;05

Dr. Mona

And know Mueller eczema, by the way, that’s actually commonly misdiagnosed or, you know, confused for ringworm.

 

00;06;04;06 – 00;06;04;16

Dr. Shreya Patel

Yes.

 

00;06;04;20 – 00;06;23;01

Dr. Mona

Sometimes you know in and I’ve seen that. Right. Like sometimes they’ll come in and they’ll be like, well, so-and-so gave me antifungal creams and it wasn’t getting better. And I’m, I, I’m actually very honest with them. I’m like, it is really hard sometimes to notice that differentiation. So I don’t think it’s like a misdiagnosis. I think it’s just that, hey, it looks so similar.

 

00;06;23;01 – 00;06;31;08

Dr. Mona

You try one thing and if it doesn’t get better, sometimes you get your diagnosis that way. That nope, it wasn’t ringworm. It was actually numb, which looks like a little coin. Like you said.

 

00;06;31;08 – 00;06;35;05

Dr. Shreya Patel

I totally agree, they look very similar. It’s a difficult thing to differentiate.

 

00;06;35;07 – 00;06;53;02

Dr. Mona

So in terms of, you know, some children, you know, obviously are possibly predisposed, more predisposed than others, do you think that there’s some some relationship in terms of genetic predisposition, family history, what makes one child more prone to eczema than another?

 

00;06;53;05 – 00;07;22;25

Dr. Shreya Patel

Absolutely. Yes. I do see this. So first of all, eczema is genetically transmitted. So having a family history of eczema does predispose a child to develop it. We also know that eczema has become widely accepted as something that is, at least in part, initiated by some sort of skin barrier defect. Along the way, these barrier defects can either be acquired or genetic too, but either way, we know that some children who have these defects are more predisposed to developing eczema along the way.

 

00;07;23;06 – 00;07;42;25

Dr. Shreya Patel

Lastly, there’s also this known interaction kind of between the inflammatory cells in our body with genes and the environment. So even though we don’t really know exactly, like I just haven’t been able to pinpoint exactly what these genes are, what these specific environmental triggers are, they do put children at at a risk of increased eczema if they do have them.

 

00;07;42;28 – 00;07;58;27

Dr. Mona

And one common question I get asked from, you know, from families is that is there a certain age that you would see it by or can it develop later in childhood, or is it something that, you know, if you’ve reached five years old, you’re in the clear kind of one? Would you say kids typically present with that?

 

00;07;58;29 – 00;08;16;18

Dr. Shreya Patel

So most kids will typically present in infancy. So within like, you know, the four months, six months. But absolutely you can’t rule it out. So it just because they haven’t presented at the age of five, I mean, I see adults who come in for the first time, like I’ve never had allergies, I’ve never had asthma in my whole life.

 

00;08;16;18 – 00;08;30;01

Dr. Shreya Patel

And now all of a sudden, boom, they have eczema, you know? So no, I don’t think that you can say you’re in the clear once you hit a certain age. But I do think that most commonly it’s going to present in the younger years.

 

00;08;30;03 – 00;08;40;20

Dr. Mona

And, you know, talking about how there’s there’s a genetic predisposition. Are there any preventative measures a family can take if they know that they have medical history of eczema or allergies?

 

00;08;40;27 – 00;09;03;19

Dr. Shreya Patel

Yeah. So that’s such a good question because as we know, there’s a lot a big shift in medicine right now towards more prevention of diseases. Right. And so for eczema I think the best prevention is just using the right products the right way. So the goal, the goal should really be to repair that skin barrier. And then of course to avoid triggers, whether those may be something in the environment or something in a child’s diet.

 

00;09;03;19 – 00;09;29;12

Dr. Shreya Patel

So like like you said, if a family knows that we have a history of eczema, let’s be proactive about this in this new baby. That’s in our family. So there was a really interesting study done several years ago by dermatologists, which I found really fascinating. And they looked at children after birth. You know, they had a group that the parents moisturize their skin twice a day with, like a very good, you know, thicker emollient, like Aquaphor based type, moisturizer.

 

00;09;29;18 – 00;09;51;02

Dr. Shreya Patel

And then they had children who didn’t necessarily do that. They follow them over time. And they found that the children that had that initial, strengthening of the skin barrier with this moisturizer, they went on to develop less eczema. So that’s something that parents should know, that if they if their child is at an increased risk of developing eczema, then, hey, there’s these things we can do to strengthen that skin barrier.

 

00;09;51;02 – 00;10;14;06

Dr. Shreya Patel

Initially, I know I get asked a lot of times about probiotics, so that’s something else that we could talk about, too. It’s an evolving topic in the world of I, to be honest. So one of the main hypotheses for the development of allergies in general is the so called dysbiosis in our gut. So okay, so this is an impaired microbiota, which essentially means you have this bacterial imbalance in your gut.

 

00;10;14;08 – 00;10;37;07

Dr. Shreya Patel

So people often ask how can this dysbiosis be corrected by taking probiotics. Which makes sense right. Like if I take probiotics and I fix this bacteria, then will I not have as many allergies? And unfortunately, even though that in theory sounds great, unfortunately there’s just no definitive studies yet for that. There’s been a lot of meta analyzes out there, and they’ve shown moderate benefit of probiotics for eczema prevention.

 

00;10;37;10 – 00;11;02;16

Dr. Shreya Patel

But because there’s, of the very low quality evidence and the heterogeneity between the studies, we can’t fully give any specific advice on this. There’s still needs to be more well-defined studies before we can adopt specific recommendations, at least about probiotics and prevention, you know, and then there’s another thing, with especially if, you know, okay, you know, you have a family history of allergies, family history of eczema, you want to prevent it in your new baby.

 

00;11;02;23 – 00;11;23;25

Dr. Shreya Patel

Breastfeeding is, of course, something that we know has been shown to reduce the risk of most atopic conditions, actually, including eczema. And I’m going to make a point because I get asked this by parents. This does not mean applying breast milk on top of the skin. This means actually feeding the child for what’s recommended. I mean, at least six months that’s been shown to reduce the risk of eczema.

 

00;11;23;27 – 00;11;33;12

Dr. Mona

Is there any for if a family’s formula feeding, are there certain formulas that we typically, you know, would use over other formulas in terms and in treating eczema.

 

00;11;33;14 – 00;11;53;25

Dr. Shreya Patel

So there’s nothing that that you can use to kind of treat eczema. There’s nothing in terms of formula that, hey, similar to breast milk like this type of formula has been shown to prevent the development of eczema. However, of course, and we’ll get into this a little bit later too, as once we identify if there’s specific triggers in the diet, like for example, dairy, then you want to use dairy free formulas.

 

00;11;54;05 – 00;12;01;22

Dr. Shreya Patel

More of the allergenic formulas. That’s more just to prevent exacerbating factors. It doesn’t necessarily prevent the eczema.

 

00;12;01;25 – 00;12;15;07

Dr. Mona

And, you know, as I said earlier, we as general pediatricians, we see a lot of eczema. In your opinion, when should a child go from seeing their general pediatrician to now seeing an allergist for their eczema?

 

00;12;15;09 – 00;12;35;10

Dr. Shreya Patel

Okay, yeah. So eczema affects, like 10 to 20% of children, right? So it’s so common that, I mean, most of these kids are probably, if not all are probably going to start with the pediatrician or primary care provider. And I think that from my experience, a lot of the mild to moderate cases are successfully treated by pediatricians and primary care providers, and comfort level varies.

 

00;12;35;25 – 00;12;55;20

Dr. Shreya Patel

I find that some pediatricians are more comfortable treating eczema than others. Some will refer right away, others will, you know, see them several several visits before before referring them. And and to each their own. Like I said, some are just more comfortable. So when would I refer? Well, remember that eczema has a significant impact on the quality of life for both the patient and the family.

 

00;12;55;27 – 00;13;19;21

Dr. Shreya Patel

So I usually say that if you have that initial evaluation with your primary care doctor, your pediatrician, you know, you have the follow up visit, you still really haven’t seen quite the results that you would like to where the family’s not happy. It’s totally reasonable to refer to a specialist at that point. If at the initial visit, you’re still not comfortable, I would never fault, you know, a primary care provider for sending a patient to me earlier rather than later.

 

00;13;20;03 – 00;13;37;12

Dr. Shreya Patel

And then in addition to that, if the parent or the pediatrician is concerned about possible allergic triggers, like if it’s in the child’s diet in their environment, they should probably consider referring them a little bit earlier so that we can identify what those triggers are and potentially remove them.

 

00;13;37;14 – 00;13;48;18

Dr. Mona

Is there a ways that a family can notice those triggers in terms of like if they eat certain food, it flares up? Or how would how would a family kind of determine that there may be some external trigger causing their eggs about a flare up?

 

00;13;48;20 – 00;14;10;14

Dr. Shreya Patel

Yes. So I get parents coming to me all the time saying, yeah, so the eczema is usually okay. And then when you know, little Timmy goes and the dog licks his arm, it just flares like right away, you know? So that’s an example of an environmental trigger or for example, a little Timmy eat egg, and every time he eats that egg, his his face just flares up.

 

00;14;10;14 – 00;14;38;04

Dr. Shreya Patel

And eczema flares. So those are just examples of stories that I get all the time. And those would be times that we would consider, you know, let’s actually delve into this little bit more. Let’s potentially test to to these things to see if does a dog need to be removed from the home or if, you know, if that’s obviously a little bit aggressive, if at least keep the dog out of the, boys room or, just avoid contact and things like that that just need to be that could be addressed earlier rather than later.

 

00;14;38;07 – 00;14;45;18

Dr. Mona

And if they do come to you, obviously. What is it you mentioned in briefly about the workup? What does that workup look like or entail?

 

00;14;45;21 – 00;15;23;04

Dr. Shreya Patel

Okay. So, if a patient comes to me in their history, physical, everything is consistent with eczema. So the first thing I do is I usually assess the severity because really how severe the eczema guides, how I’m going to treat them and what kind of workup I’m going to do. So based on, again, the severity I make recommendations for like skin moisturizers, prescription topical medications, I usually evaluate for whether there’s an infection and then again, how to kind of how we already mentioned whether there’s a possible inhalant environmental food allergy or something like that that could be triggering the eczema to decide that I can actually skin test right in my office, and

 

00;15;23;04 – 00;15;47;19

Dr. Shreya Patel

we can have results for same day to suspected triggers, but I only go to testing if I cannot get the eczema under control. With a good skincare regimen. So I usually try that first. Now, the exception to that is the patient that we just described where they’re coming in, telling me that it’s the eye, or telling me that it’s the dog, and then I can consider testing, sooner rather than, you know, waiting to try the topical stuff first.

 

00;15;47;19 – 00;16;07;12

Dr. Shreya Patel

But we can start it sooner. That way we can prevent the flares. And I’m just going to stress this point because this is so, so important. I do not do blanket skin testing for all of my eczema patients. Okay. Food allergy has been implicated in about a third of patients with eczema. And testing usually consists of some sort of skin prick testing.

 

00;16;07;18 – 00;16;25;22

Dr. Shreya Patel

It should really just be to a small panel of foods that I usually pick based on the current diet. This is a team decision between myself and the family. I sit down with them. I talk about what is currently in the child’s diet. What are they eating regularly again? Is there something that you know that’s triggering it, like the egg?

 

00;16;25;22 – 00;16;49;09

Dr. Shreya Patel

Right? Based on that conversation, we decide how to proceed the testing. And I always say, and this is something really good for pediatricians and primary care providers to to tell their patients as well. Is this a good idea for families from the very beginning to come prepared with like a food diary or something that helps them zone in a potential trigger so that by the time they get to the specialist, they can open up that diary and say, look, these are the things that we’ve noticed over the last few weeks.

 

00;16;49;16 – 00;17;07;06

Dr. Shreya Patel

These are the things we’re concerned about. So I still get asked that question, though. But why don’t you just test for everything, doctor Patel, please? Like just do the full panel of food allergies. The reason I don’t do this is because there really are a high rate of false positives. Okay, so our skin tests unfortunately, they’re not perfect.

 

00;17;07;06 – 00;17;31;23

Dr. Shreya Patel

Even though people think that this is going to be gospel when they get the results, they’re really not perfect and they lead to a lot of unnecessary large elimination diets that can result in nutritional deficiencies. And actually, if you eliminate foods early on that a child’s not actually allergic to, you can actually create sensitivity down the road because their body is not seeing it enough now and then later when they see it, it’s deemed foreign.

 

00;17;31;23 – 00;17;52;15

Dr. Shreya Patel

The food is, you know, thought of as something foreign and they might actually develop the allergy. So I don’t like to do these, you know, panel food testings. Instead, I just like to have the conversation test based on certain, potential specific triggers. So I can also do skin testing to environmental triggers. So like we talked about dust pads, pollen.

 

00;17;52;15 – 00;18;14;00

Dr. Shreya Patel

That also was done on a very individualized basis. But it can be part of the workup when it’s appropriate. If, I find that a child’s skin is too inflamed for the skin test, we can always do a blood test. But again, with that, I’m very careful about sending unnecessary testing in the blood. Same thing. We can have lots of false positive results here too, especially if you’re dealing with that really allergic kid.

 

00;18;14;02 – 00;18;35;29

Dr. Shreya Patel

Probably has a lot of that general IgG floating around the body. It is an allergic antibody that anybody who’s an allergic person just has a lot of this floating around in their blood. It’s just a general marker of that. So if they have a lot of the general IgG floating around, then they can have a false elevated specific IgG to like milk, egg or peanut.

 

00;18;36;02 – 00;18;56;24

Dr. Shreya Patel

And it’s not truly that they’re allergic to that food, but they just have a lot of IgG floating around. And so that’s why I don’t like to do a lot of, you know, a lot of blood testing either unnecessarily. And then lastly, one of the things that can be part of my workup is if a parent is pediatrician is concerned about a potential contact allergy, and then we can discuss patch testing.

 

00;18;56;24 – 00;19;10;20

Dr. Shreya Patel

So this will be two things are chemicals fragrances, preservatives things that you might find in the child’s laundry detergent, in a child’s products that they’re using, even dyes in their clothes. So these are things that a patch test can, can tell us.

 

00;19;10;25 – 00;19;19;08

Dr. Mona

And so you mentioned between the blood and skin testing is one more I know you said there’s false positives for both but is one more accurate than the other.

 

00;19;19;10 – 00;19;35;20

Dr. Shreya Patel

No it’s not that one is. No, it’s not one more accurate than the other people usually choose skin tests because it’s a little bit easier of a test. They don’t need to go through a needle stick. They can have results the same day within 20 minutes versus like going, getting your blood drawn, waiting a week to get the results.

 

00;19;36;00 – 00;19;47;24

Dr. Shreya Patel

Skin tests are usually more sensitive. Tests and blood testing are usually more specific. And so each one kind of has their strengths. But, skin test is generally what’s preferred.

 

00;19;47;26 – 00;20;11;11

Dr. Mona

I’m so glad you brought up testing because as a, you know, in my office, I commonly get families. And this is we should have a whole conversation about testing. And we could we could talk for hours about testing, but, families will come in and they, you know, their child is is sneezing or their child has one little spot and they want the whole, like you said, the whole panel of allergy testing.

 

00;20;11;11 – 00;20;30;00

Dr. Mona

And I’m happy you brought it up because one, it’s very expensive to use, like you said, it has a lot of false positives. And three if symptoms are mild and we’re able to manage it well with just say it’s eczema, we’re managing it well with, ointments and steroid creams or whatever may be. You don’t need that because it’s being managed.

 

00;20;30;00 – 00;20;56;19

Dr. Mona

It’s not going to change the management anyway. So I love that you brought that up, because I really want the listeners to know that the testing, well, the clinical exam will always trump testing. You know, it’s more important to look at the at the kid. And I love skin testing because the skin testing can kind of get you an idea of, okay, well, obviously we need to avoid these certain foods that are flaring, flaring up, but to just go in and many times even for food allergies, I want to just be tested for everything.

 

00;20;56;19 – 00;21;14;25

Dr. Mona

Even before I introduce food, I’m like, well, that’s not really how it goes, but not always all the time. But we should we can absolutely talk about testing and, you know, food allergies at a later time because I do get that. Could that comment a lot? Do you, what are your basic like going into like management?

 

00;21;14;25 – 00;21;22;10

Dr. Mona

What are your basic skincare tips for a family who’s, you know, obviously taking care of a child with eczema.

 

00;21;22;12 – 00;21;42;29

Dr. Shreya Patel

Okay, so that’s another great question because in my opinion, the most important and first step in the treatment of eczema is creating an eczema action plan, which lists out what you should use, how you should use it, and when you should use it. So every single one of my eczema patients walks out of my office and they have an eczema action plan in their hands.

 

00;21;43;02 – 00;22;05;21

Dr. Shreya Patel

And treatment is really multi-pronged. So you have to think about skin hydration, topical anti-inflammatory medications when needed. Antiparasitic therapy because breaking the so called itch scratch cycle is also very important. Some patients might need antibacterial measures if they have like an overlying bacterial infection. And then of course, eliminating the exacerbating factors right in the diet in the environment.

 

00;22;05;21 – 00;22;37;21

Dr. Shreya Patel

So there’s a lot of things that go into it. So basic skin care tips though in terms of what I recommend. So remember again and I sound like a broken record, but remember again that eczema is characterized by a reduced skin barrier function. So this leads to enhance water loss as well as dry skin. So I usually recommend hydration with warm soaking baths daily with an unscented hypoallergenic soap such as dove at least ten minutes daily, like I said, followed by application of a really good moisturizer.

 

00;22;37;24 – 00;22;58;17

Dr. Shreya Patel

Moisturizers, really are the first line therapy. I prefer the thicker emollients like Aquaphor. These contain less water, more oil than creams or lotions. They also burn less because people who have those like open eczema lesions, they always complain the children as soon as they put their cream on, you know, they were screaming that it was burning. So things like Aquaphor usually burn less.

 

00;22;58;23 – 00;23;17;29

Dr. Shreya Patel

They also act as both a barrier as well as a moisturizer. So Aquaphor is going to be something, you know, that’s clear versus like those white creams. That’s kind of the main difference between those other, moisturizers that sometimes I’ll recommend. Basic skin skincare tips would be like surveys of anti cream. Those are, good, always good products to use as well.

 

00;23;18;04 – 00;23;31;20

Dr. Shreya Patel

But again, I’m still a big fan of the hack before and then when eczema becomes more severe, that’s when you’re going to come in and start discussing the anti-inflammatory topical medications. With, I don’t think a pediatrician for myself.

 

00;23;31;28 – 00;23;37;26

Dr. Mona

What about Vaseline? Is that an emotion that you like, or would you say Aquaphor? Vanney cream are a little better?

 

00;23;37;28 – 00;23;59;01

Dr. Shreya Patel

So I used to love Vaseline, and I still have found that most of my patients do pretty well with Vaseline. But from from my experience, from reading some, you know, different articles and stuff. One thing I’ve learned it the main difference between Aquaphor and Vaseline is that Vaseline is still more of a barrier, and Aquaphor acts as a barrier and a moisturizer.

 

00;23;59;01 – 00;24;16;07

Dr. Shreya Patel

So that’s why I like Aquaphor a little bit better. But I have seen a lot of patients who may not necessarily want to pay a lot of money for the offer. And so they go for the Vaseline, which is totally understandable and appropriate, and they do great with that. And so, you know, it just depends. It’s it’s definitely, okay to try it.

 

00;24;16;09 – 00;24;37;15

Dr. Mona

And, you know, in terms of that, that next level commonly as, you know, gentle patricians, we prescribe like topical which means like ointments, steroids. What what’s your feeling on that? A lot of times obviously families are worried about the steroid. And you know, I reassure them that, you know, how we use them. It’s safe for the child. But in your opinion, are they are they safe to use?

 

00;24;37;21 – 00;24;41;06

Dr. Mona

And how often would a family end up having to use it.

 

00;24;41;08 – 00;25;01;09

Dr. Shreya Patel

Yeah. So you’re absolutely right. Parents have the same concerns with me as well. You know, they as soon as they hear steroid, you know, so I think that the answer to this question is it it can be safe if it’s used appropriately for short periods of time. So by appropriate I mean, again, short period of time, as well as choosing the correct policy or the strength of the steroid.

 

00;25;01;21 – 00;25;24;17

Dr. Shreya Patel

So the use and the potency of the steroids usually again, all individualized based on the severity of the eczema, the location of the affected skin, the surface area. So how much of the skin is affected and the age of the patient. So for example, I’ll use milder steroids for say, younger patients and those with involvement of the sensitive areas like the face, neck and the groin versus like the rest of the body, the arms in the legs.

 

00;25;24;17 – 00;25;44;02

Dr. Shreya Patel

You can usually use a little bit of a stronger steroid. If a child’s eczema is not controlled by moisturizers alone, then I would typically recommend a topical steroid. And it’s safe to use in the in, you know, short periods of time. The moisturizers again target the skin barrier issue. But the topical steroids are really what works at targeting the underlying inflammation that’s present in eczema.

 

00;25;44;05 – 00;26;00;21

Dr. Shreya Patel

And if you don’t get rid of that inflammation, sometimes you can repair that skin barrier as much as you want. It’s going to be very difficult to control the eczema if you don’t get rid of that inflammation. I avoid use of the higher potency steroids as much as possible, and only recommend short bursts of the higher potency ones.

 

00;26;01;03 – 00;26;23;05

Dr. Shreya Patel

And again, only for like really severe flares. And I save those for areas that are not as sensitive on the body. If you have more prolonged use, that’s when you’re going to probably see the longer term side effects, like the skin thinning, the stretch marks, really systemic adverse effects of type blisters are pretty rare as long as you use them properly and under proper, you know, supervision of your physician.

 

00;26;23;08 – 00;26;43;18

Dr. Shreya Patel

And then and, you know, this brings us back to the question again, of the importance of finding out why a child’s eczema keeps getting exacerbated. Because if you eliminate those specific triggers, then you can prevent overuse of topical steroids. But that being said, you know, some children, it’s just this allergy, this sensitive skin that’s coming from within. It’s hard to identify specific triggers.

 

00;26;43;22 – 00;26;48;13

Dr. Shreya Patel

And again, for them, short bursts of the topical steroids is absolutely appropriate.

 

00;26;48;15 – 00;27;02;08

Dr. Mona

So it sounds as if the best course of action is a family when they either see their pediatrician or if they end up going to an allergist, is coming up with an action plan based on the severity and obviously that particular situation.

 

00;27;02;08 – 00;27;23;27

Dr. Shreya Patel

Right? Yes, absolutely. And then I wanted to bring up to you, Chris, is something like a newer medication such as a non-steroidal anti-inflammatory topical agent. So I’ll recommend that for my patients with mild to moderate eczema, especially ones who have these frequent flares. But they’re, you know, they’re not severe. So they need more prolonged use of some sort of anti-inflammatory agent.

 

00;27;24;03 – 00;27;31;13

Dr. Shreya Patel

And we want to avoid such, you know, prolong use. A posterior is a new Chris, is an option for that. So luckily there are different options out there.

 

00;27;31;15 – 00;27;49;28

Dr. Mona

So is there you know, in terms of we talked about that, you know, moisturizing and steroids. And obviously you Chris, as an option if that’s needed in terms of detergents, are there certain detergents that you would recommend the family using? Should they use fabric softener or should they not? What is the recommendation for clothing and washing the clothes?

 

00;27;50;02 – 00;28;09;03

Dr. Shreya Patel

Yeah, so I would definitely avoid any use of fabric softeners or anything that’s going to really make your your clothes smell really good. I mean, that’s the reason that you get that fragrance is you’re getting that at the added chemicals. It’s literally something called fragrance mix. And we test for that on a patch test. So that’s what’s added to these things to make them smells like that.

 

00;28;09;03 – 00;28;32;27

Dr. Shreya Patel

So I would avoid most fabric softeners, usually the detergents that I would recommend would be the all clear, all free and clear as well as drift. Those are usually the two that that I find works the best, but there’s a lot of honestly hypoallergenic brands out there nowadays. As long as it’s unscented and, you know, you don’t notice that specifically, it’s triggering your child’s eczema, then they’re okay.

 

00;28;32;29 – 00;28;52;00

Dr. Mona

No, this is great because, you know, like I said earlier, so many questions and I really, really appreciate you going through pretty much all those common, common questions I get asked in my office. Is there anything else you would want to add in terms of, you know, final points that a parent should take home in terms of treating their child’s eczema, or anything along those lines?

 

00;28;52;03 – 00;29;10;00

Dr. Shreya Patel

Yeah, I’d love to add a couple things, actually. So, first of all, I wanted to remind people that eczema is usually the first manifestation of HB in many patients who will then later get on go on to develop, you know, the allergic rhinitis, the hay fever, the asthma, or potentially both. This is called, you know, the atopic march.

 

00;29;10;05 – 00;29;28;15

Dr. Shreya Patel

So it’s something to keep in mind in the child who has at least severe eczema, mild eczema they can grow out of. And you know, it’s not necessary. They’ll develop something else along the line. But it’s how they might have more moderate to severe eczema. Keep a lookout for other things, like it’s not uncommon for them to then grow up and also develop the seasonal allergies and asthma, and other things to consider.

 

00;29;28;15 – 00;29;46;12

Dr. Shreya Patel

So that’s something that I wanted to bring up. Another thing I wanted to bring up, and we briefly touched on this before, is that although eczema commonly presents in childhood, it can persist into adulthood and it can actually present in adulthood as well. So it’s important really to control it early on to prevent those chronic changes that you can see in the skin.

 

00;29;46;17 – 00;30;11;02

Dr. Shreya Patel

So this is going to be like that. Hyperpigmentation, the skin discoloring the thickening of the skin. These are reasons that I use when I have especially my teenage patients. I say take responsibility for your skin. You know, it should not be your parents who are forcing you to moisturize your skin. Take responsibility early on so that you can prevent these long term or chronic changes to your skin.

 

00;30;11;16 – 00;30;35;10

Dr. Shreya Patel

And then another thing is sunscreen. Sunscreen, sunscreen, guys, it’s still very, very important. I live in Florida. Okay. So I talk about sunscreen all day, every day with my patients. So you have to still apply sunscreen even when you have sensitive skin. And if anything, it’s more important in children with eczema to apply that sunscreen. What I usually recommend for sunscreens would be those physical blockers instead of the chemical counterparts.

 

00;30;35;10 – 00;30;53;23

Dr. Shreya Patel

So these are going to be like your zinc oxide based sunscreens. These are like the white ones, you know, so so people will love them, but they’ll protect your skin by completely blocking the UV rays as opposed to just absorbing them with the chemical counterparts. And they’ll also, prevent your eggs, even from being flared too.

 

00;30;53;23 – 00;31;15;19

Dr. Shreya Patel

So that’s good. And then lastly, but probably I think the most important takeaway point that I have is that, as I mentioned earlier, eczema really has a significant effect on the patient and the family quality of life. And children have an increased risk for these psychological distress. Unfortunately, I often have patients who are bullied and I see it too much in my office and this has to stop.

 

00;31;15;29 – 00;31;42;13

Dr. Shreya Patel

Sleep can also be affected in this children, which will then affect, you know, their concentration in school. So I just like to discuss this with parents ahead of time. Just be on the lookout for these kinds of signs. If you have a child with severe eczema that’s potentially causing, you know, issues on their skin, like the hyperpigmentation and the thickening, just talk to them about it and make sure that they know that if there are any issues or any reasons, you know, to be concerned that they can talk to you about it.

 

00;31;42;16 – 00;32;07;03

Dr. Mona

Yeah. Of all those common, you know, skin conditions we see in pediatric medicine, I agree with you. Eczema is very tough, even from my end when we’re trying to get that child on a good regimen. And I see how uncomfortable they are. And I have one last question for you before you go, because you talked about that, that itch, that breaking of that itch scratch cycle, what can a family do in terms of, you know, helping reduce that itch?

 

00;32;07;03 – 00;32;19;12

Dr. Mona

Are there certain medicines that, you know, you would prescribe or the pediatrician would prescribe cutting nails, like, what can we do to kind of help them when they’re just scratching, scratching, scratching. And you’re trying to get that regimen under control?

 

00;32;19;14 – 00;32;38;09

Dr. Shreya Patel

Yeah. So there’s a couple things that can be done actually. So this is where the antihistamines come into play. Now the studies are pretty mixed on this. And they don’t actually show that antihistamines can directly, you know, reduce the itch. But but I find that it helps, at least if you use a stronger antihistamines that are drowsy.

 

00;32;38;15 – 00;32;55;16

Dr. Shreya Patel

If anything, it helps the child sleep sometimes. And so then that will prevent them from at night just constantly scratching their skin. Right. And so that helps prevent that itch scratch cycle as well. Other things that can be done or when you have those really raw open areas, the child just keeps opening up, keeps opening up or keeps scratching.

 

00;32;55;22 – 00;33;13;04

Dr. Shreya Patel

You can actually do the Aquaphor with, wet wraps. So this is going to be like, you put the aquifer on, you cover it with one layer of damp gauze and then one layer of, dry gauze. And you can do that in certain areas to prevent them from constantly scratching those areas. So those are kind of like the basic things that we do.

 

00;33;13;08 – 00;33;32;22

Dr. Shreya Patel

And then, you know, just in general a moisturizing, anti-inflammatory, all those things work. Everything is multi prong. Everything works together to really reduce that, that sensation of itch. And then it’s, you know, if we can get the child to reduce the sensation of itch, then hopefully they reduce scratching and it will slowly break the cycle.

 

00;33;32;25 – 00;33;56;07

Dr. Mona

And for all of you obviously out there antihistamines like Benadryl, things like that. But before you start any of that, you have to make sure you talk to your doctor or your allergist or someone like that. I have to I have to add that disclaimer because I know we are talking about management, but yes, I, I agree, these, these, these when they’re in my office and they’re just going at their skin, I’m just and they’re, you know, whatever age they are.

 

00;33;56;07 – 00;34;16;15

Dr. Mona

But I’m like, oh my gosh. Like I feel so sad. And I really appreciate you bringing up the the quality of life and the bullying component, because people forget that this is a chronic medical condition and it’s something that hopefully will go, you know, obviously go away as they become an adult, but it can really impact their childhood years for sure.

 

00;34;16;20 – 00;34;29;02

Dr. Shreya Patel

Absolutely. And it’s something that unfortunately they wear on their skin quite literally. You know, it’s not a chronic condition that they can hide. And so this is why I think a lot of children with eczema, they do suffer from bullying. And so that just needs to stop.

 

00;34;29;10 – 00;34;44;04

Dr. Mona

Yeah. Well thank you so much for joining us today. I had such a great time talking to you. And we could go on and on about so many different things in allergy and immunology. Definitely food allergies. We need to do a whole episode on that at a future time.

 

00;34;44;04 – 00;34;48;12

Dr. Shreya Patel

Yes, definitely, I totally agree. Thank you so much for having me.

 

00;34;48;14 – 00;35;09;06

Dr. Mona

So everyone, please follow Shreya Patel, MD. I’m going to be attaching it on our show notes and you know we will try to do other episodes. I personally have a huge interest in allergy, allergy and immunology. I know that and pediatric GI are my two favorite little niches in, pediatric medicine. So thank you so much Shreya.

 

00;35;09;08 – 00;35;10;16

Dr. Shreya Patel

You’re welcome.

 

00;35;10;18 – 00;35;29;09

Dr. Mona

Thank you for tuning in for this week’s episode. I hope you guys enjoyed it. As always, please leave a review, share it with a friend, comment on my social media and if you’re not already, follow me at PedsDocTalk on Instagram. I love doing this for all of you. Have a great rest of your week. Take care.

 

00;35;29;10 – 00;35;30;05

Dr. Mona

Talk to you soon!