In the intricate world of pediatric health, the skin often tells its own unique story. For parents navigating the challenges of pediatric dermatitis and eczema, understanding this narrative becomes crucial. The role of clothing, particularly everyday essentials like underwear, is more significant than it might seem at first glance. In this blog, we delve into the intimate connection between a child's wardrobe and their skin health. We'll explore how smart clothing choices, coupled with effective skincare strategies, can offer relief and comfort to little ones suffering from skin conditions.
We’ve consulted with Dr Emma Warner, a medical doctor working in General Practice in Hong Kong who will help us shed light on how parents can make informed decisions to manage these delicate skin conditions effectively.
What is the difference between contact dermatitis and eczema?
“Dermatitis” is a general term meaning inflammation of the skin. Generally, there are two main types of dermatitis that we encounter in little ones.
Eczema is a type of dermatitis called “atopic dermatitis”, which means that there is abnormal inflammation of the skin which is usually caused by an over-active immune system response to an allergen in the environment. Therefore, a lot of kiddies with atopic dermatitis/eczema will also have other allergy-mediated conditions like hayfever or asthma.
The other type of dermatitis we commonly see is “contact dermatitis” where something external in direct contact with the skin has caused irritation and breakdown of the skin’s protective barrier.
However, they can appear very similar, and many children with eczema also have contact dermatitis exacerbating their condition, whether this is from clothing or detergents, bath products or even sometimes topical medications used to treat it, so there is a lot of crossover sometimes!
Can you recommend a daily skincare routine for children with dermatitis?
The most important preventative measure with dermatitis is to avoid whatever it is that triggers it. Sometimes keeping a skin diary noting products used (e.g. brand of soap/detergent/anything new the child has done or been in contact with) around the time of flare ups can be helpful to identify what might be contributing to the problem.
The next most important thing for daily skincare for both atopic dermatitis/eczema and contact dermatitis is moisture, moisture, moisture! This helps to repair and strengthen the skin’s protective barrier and should be done daily even when the skin condition is good. Usually, I will recommend parents to buy any unscented moisturiser and often the less fancy, the better! Even the cheap, gloopy emollient creams you can buy in big tubs work well if you can cope with it being messy!
Depending on how dry the skin is and the type of dermatitis, we sometimes will use a combination of a bath emollient as well as moisturiser.
If your little one is having a particularly bad flare up of their skin, sometimes doctors will also recommend using steroid creams for a short while to help bring the inflammation down, although it is important to speak to your doctor first before using these over-the-counter, as if used incorrectly they can make the skin worse.
Dr. Warner, could you explain how certain types of clothing, particularly underwear, can affect children with dermatitis and eczema? What should parents be aware of when dressing their children?
Clothing can really make a difference to sensitive skin, and avoiding any fabrics like wool which are more likely to cause irritation and itching is important, as scratching can further damage the skin barrier and also runs the risk of introducing infection.
It is also important to choose fabrics that let the skin breathe, as whilst many parents will notice that their little ones’ skin is better in warmer, humid weather, overheating and sweating into non-breathable fabrics can cause further irritation to the skin barrier.
This is of course particularly important for any item of clothing that will be in direct contact with bare skin.
In your experience, what are the best types of fabrics for children with sensitive skin? Are there specific materials that parents should look for or avoid?
As mentioned previously, itchy fabrics like wool, or any clothing that has metallic threads sewn through them, for example, can cause irritation. It’s also important to think about t-shirts or underwear that have designs embroidered onto them, as sometimes the reverse side of the garment near the skin can have loose threads or glue which can scratch.
Fabrics that have a high polyester component are very common, as they are much cheaper to manufacture. However, they are much less breathable so not the best option for sensitive skin.
Generally, I recommend parents look for clothing made of 100% cotton, TENCEL™ or bamboo, as the fibres of these are much less irritating and are much lighter and more breathable.
100% silk (not satin, aka polyester!) is also a great choice in theory... Although this is quite an expensive choice for little ones who quickly grow out of things, and silk tends to stain quite badly from moisturisers too!
What are some preventive steps parents can take to minimize the risk of dermatitis flare-ups related to clothing? How important is the role of laundry detergents and fabric softeners?
In children with contact dermatitis, artificial fragrances in products are one of the most significant recognised triggers. Whilst these products are rigorously tested and are not harmful to humans per se, they do have the potential to irritate sensitive skin, so unscented options are often preferable. They still clean your clothes just as well even if they don’t have that nice fresh laundry smell!
Do not use more than the recommended amount of detergent, as this increases the risk of irritating residue on clothing, and don’t overload the washer, as this prevents clothes from rinsing properly. Sometimes even just adding an extra rinse to the end of the wash cycle can help reduce the amount of detergent or softener residue enough to make a difference.
Many also find improvement in eliminating fabric softeners or switching to a non-bio detergent option.
When a child does experience a dermatitis flare-up, what immediate actions can parents take? Additionally, how should they adjust their child’s clothing and skincare regimen during these times?
The most important thing is to firstly remove and keep away from any potential triggers and irritants, and secondly keep the skin well moisturised. Keeping children’s nails short, smooth and as clean as possible can also help minimise further skin barrier damage and infection risk from scratching.
Generally wearing a minimal amount of breathable and non-irritant fabrics helps prevent further exacerbation.
If the skin flare is particularly bad, or you notice any signs of infection, it is important to see a doctor for assessment as soon as possible.