Atopic Eczema: Dinuki's story and a doctor's note

As a doctor, part of my daily life is meeting patients, listening to their questions, and prescribing treatments. But there is a big difference between going through that journey alone and helping someone close to me go through that experience. This story is very close to me – both as Dr. Priya and as Priya’s friend.

A friend's call and my role

One morning, a friend of mine, Shalini, called me. Her voice was filled with worry and exhaustion. Her little daughter, Dinuki, had been suffering from a red, flaky rash on her cheeks and hands for weeks. The condition was at its worst at night. Little Dinuki would scratch herself, scratching until she cried. Shalini and her husband couldn't sleep at night, watching their child suffer. As a mother, Shalini was exhausted and worried. As a friend, I could relate to that feeling.

We agreed to meet at Shalinila's house that same evening. I promised to help her with this problem not only as a doctor, but also as a friend. And so we began our journey with Dinuki's atopic eczema . This is a common skin disease that usually affects about 5% of young children.

What exactly is Atopic Eczema?

Sitting on the sofa in Shalini's living room, Dinuki in her arms, we started the conversation from the beginning. I explained to Shalini simply that Atopic Eczema is a chronic skin condition that causes the skin to become red, dry, and itchy. This is a very uncomfortable condition for a small child like Dinuki.

Atopic eczema is often a genetic condition. This means that if someone in the family has asthma , hay fever, or other allergies, the child is at higher risk of developing eczema. As soon as I said that, Shalini remembered, “Oh yes, Priya, I have asthma!” Then she understood to some extent what could be causing Dinuki to develop this condition.

But I emphasized that this is no one's fault. Maybe no one in the family has it, but anyone can develop eczema through a combination of genes and environment.

Let's identify the symptoms.

The symptoms on Dinuki's body showed a very typical form of atopic eczema.

• The skin looked red and swollen.
• The skin was very dry and seemed to be peeling in some places.
• There were red patches, especially on the cheeks, inside the elbows, and behind the knees.
• The main thing was the intense itching . Because of that itching, Dinuki scratched those areas, causing the skin to break out and form small blisters.
• This itching gets worse at night. One reason for this may be that even though you may be distracted during the day, such as while playing, you may feel the itching more at night when it is quiet. Changes in body temperature, such as sweating , can also increase itching at night.

Atopic eczema is not just a skin problem. The biggest challenge is the discomfort and sleep disturbance that it brings, and the resulting stress for both the child and the parents.

I explained to Shalini that eczema in babies usually starts on the face and scalp. It then spreads to the folds of the body (elbows, behind the knees). But the good news is that as most children get older, especially after 1-2 years, this eczema condition largely subsides or disappears completely.

Triggers that aggravate eczema

As we talked, I took out my book and told Shalini about the triggers that could make Dinuki's eczema worse or worse. The list is quite long.

• Dry skin: Dry skin itches easily and can aggravate eczema.
• Irritants: Harsh soaps, some detergents, perfumes, and some fabrics (such as wool).
• Allergens :
  • Dust mites (found in house dust).
  • Animal fur, saliva (Pet dander).
  • Pollen .
  • Some foods (Food allergens – young children can be allergic to things like eggs, milk, peanuts, and soy, but not all children with eczema have food allergies).
• Other: sweating, extreme cold or heat, dry weather, some infections, stress.

I mentioned that sand, especially sand from playgrounds, is very bad for eczema-prone skin. And when I mentioned pet dander, Shalini's face turned a little pale. Their 2-year-old golden retriever is one of Dinuki's best friends.

“That doesn’t mean they can’t be around, Shalini,” I said slowly. “What we need to do is reduce our exposure to allergens as much as possible. Things like bathing the dog regularly, vacuuming the house thoroughly, and washing our hands after playing with the dog.”

Together, we made a list of practical things that would help Dinuki manage her eczema:

• Keeping Dinuki as far away from the sand dunes as possible.
• Using hypoallergenic and fragrance-free soaps and laundry detergents.
• Avoid using perfumes and scented lotions.
• Wear soft clothes like cotton and avoid rough clothes made of wool or synthetics.
• Vacuuming the house frequently to reduce dust.

I also said that stress can also worsen eczema. Even small children can feel the stress at home. So it's important to maintain a peaceful environment at home.

Developing a treatment plan

I reminded her that this battle was not something Shalini had to fight alone. I suggested that we work together to create a treatment plan that would work for Dinuki. The first and most important step in any eczema treatment is to take good care of the child's sensitive skin.

First Steps in Skincare

• Bathing: It is good to bathe in lukewarm water (not hot water) for about 10-15 minutes every day or every other day. I recommend adding a fragrance-free bath oil or an emollient cleanser / soap substitute to the water. Avoid using harsh soaps, as they dry out the skin even more. After bathing, gently pat dry your skin without rubbing it with a towel.
• Using Moisturizers: This is the most important thing. Within 3 minutes of showering, while your skin is still damp, apply a good thick moisturizer (emollient) all over your body. This will help lock in moisture. Apply moisturizer at least twice a day (morning and night) or as needed. We chose a good brand that is fragrance-free and colorant-free, and is suitable for eczema-prone skin.

When Basic Care Isn't Enough?

Sometimes, no matter how well we do this basic skin care, eczema can be difficult to control. Itchiness and redness increase (flare-ups). At such times, you may need to seek further help from a doctor .

• Topical Corticosteroid Creams: These are prescription creams that reduce skin inflammation and swelling. They come in different strengths. Your doctor will prescribe one that is appropriate for your child's age and the severity of their eczema. They are very safe and effective when used correctly, for the right amount of time, and in the right amount. There is no need to worry.
• Antihistamines: If your child is having trouble sleeping at night due to excessive itching, the doctor may prescribe a short-term, sleep-inducing antihistamine to reduce itching.

I told Shalini again not to be shy about asking for help if she needs it. Living with eczema is not easy. Our main goal should be to make Dinuki feel as comfortable and happy as possible.

A safe environment for Dinuki

We next talked about how to make the home environment more conducive for Dinuki.

• We talked about things like vacuuming the house frequently to reduce dust and washing bed linens in hot water.
• She said it's also a good idea to be aware of food allergens that Dinuki may be allergic to (but not all children with eczema have food allergies).
• I also told Shalini that she also needed to think about her mental well-being. She didn't want to suffer along with the child, and reminded her to seek help if needed.

Change over time

A few months later, I went to see Shalini and Dinuki again. Shalini was very relaxed that day. As we discussed that day, Dinuki’s eczema condition had been greatly controlled with the changes they had made. Applying moisturizer regularly had become a part of their daily routine. “We now call it Dinuki’s special massage time,” Shalini said with a big smile.

As a doctor and a friend

That day, I realized that my role as a doctor is not limited to prescribing medication. It extends to listening to a mother's concerns, finding practical solutions for them, and helping them navigate this journey with them.

Shalini's story is just one example. How many parents face similar challenges? Sleepless nights, crying, itching, medications, new advice – it's not easy to balance life with all this. But I wish every mother, father, and child the strength they need to make it through this journey.

Living with Eczema

Living with atopic eczema is a challenge. But it can be managed. It takes patience, experimentation (finding what works for your child), and consistent skincare. As a parent, as a doctor, our responsibility is to help your child be as comfortable and happy as possible.

Remember, every little thing counts. Good skin care, loving touch, and sharing the right knowledge can all bring great relief to the child and the entire family.