Atopic Dermatitis in Children

Atopic Dermatitis: From the womb to early childhood

Eczema, and specifically atopic dermatitis, is an extremely common skin disease that can affect us at any age but is particularly prevalent in babies and young children. As a parent, or parent-to-be, we may feel helpless in preventing or treating atopic dermatitis in our children as there is no single, clear cause that has been established.

There is also concern about the potentially harmful side effects from conventional treatment options, such as topical corticosteroids. The causes of atopic dermatitis are complex and multifactorial including both the genetics and current environment of the child, as well as maternal conditions while the child is still in the womb or breastfeeding..

While much can be done during pregnancy, if you already have a young child and you want to prevent the disease, or treat existing dermatitis, it’s not too late!

Working one-on-one with a practitioner is key to make sure you get the support that is relevant to you or your child’s individual circumstances, but there is much that can be done at home, and on a daily basis, that will moderate the factors that are aggravating the condition or allowing it to progress. This is influenced by the environment in which your children sleep, household hygiene, how much and where they spend time outdoors, their diet, and the psychological stressors present. The mother’s diet is also a critical factor if they are still breastfeeding alongside their regular diet.

While it is important to work closely with a practitioner on complex diseases, this article will provide helpful information for anyone concerned about childhood atopic dermatitis treatment and give you an understanding of what you can do to start making improvements now! Let’s check it out.

Etiology: Why do children develop atopic dermatitis?

When our children are unwell, all we want sometimes is the cure, or the fastest way to make them feel better. Sometimes it feels like we don’t have the time or energy to figure out what is causing it in the first place.

When it comes to atopic dermatitis, understanding what leads to the development of this disease holds the key to its resolution, as there is no readily available cure. With a multifactorial disease such as this, we look at something called the exposome. This encompasses all things we are exposed to, both inside the body and outside, that influence us and our health. In this case, we are even including the environment an infant faces in the womb!

The development of atopic dermatitis can be intercepted before the child is born, in early infancy before they develop the disease, or in early childhood after it is already present. In order to do that, let’s look at all of the factors that contribute during each of these stages, keeping in mind the genetic factor that may or may not be present.

In utero:

Maternal exposure to airborne pollutants: This includes pollution from traffic, tobacco smoke, and even heavy metals. Pollutants may dysregulate the immune system leading to allergic type reactions like those in atopic eczema. Heavy metals can also get into the system through food, water, and herbs or supplements that haven’t been tested.
Phthalates, endocrine disruptors: These are found mostly in household products such as makeup, perfume, shampoo, topical creams, and household cleaning products. These interfere with lipid metabolism in the brain of the fetus and interfere with critical cellular proliferation and development, associated with skin diseases.
Low levels of vitamin D/ lack of sun exposure: Vitamin D is primarily gained through sun exposure and can become deficient if the mother has a lifestyle that prevents adequate sun exposure. Low levels of vitamin D in the mother transfer to low levels in the fetus and are associated with skin disease and disruption in immune function.
Pharmaceuticals: Some prescription and over-the-counter drugs (such as benzodiazepines, opiates, beta blockers and others) may cross the placental barrier and affect the fetus while in the womb.
Psychological stress: Several studies have shown an association with prenatal stress and atopic dermatitis in the child. The source of stress can be from jobs, relationships, physical environment, or anything that causes perceived stress in the mother, such as the pregnancy itself.
Diet and Consumption of allergenic foods: The appropriate maternal diet will ensure that adequate levels of micronutrients are transferred to the fetus in order to regulate the immune system. Deficiencies in prenatal nutrients often contribute to deficiencies in the infant. It is also proposed that when mothers consume foods that are commonly regarded as allergenic it may have a protective effect against allergic diseases in their child.
Folate levels: Low levels of maternal folate are associated with low levels in early childhood and with higher likelihood of developing allergic skin diseases. This may be due to the mother’s diet or with DNA methylation due to gene variants in MTHFR or other reasons for poor nutrient absorption.

Genetic predisposition:

Filaggrin protein mutation:

Atopic dermatitis development does not depend on having a genetic risk factor but studies have found that one gene mutation is very strongly identified with the disease. This is a mutation in what is called the Filaggrin protein, which is very important when it comes to maturation of keratinocytes and forming our skin’s epidermal layer. This is how we maintain an intact skin barrier, which is a major player in the effectiveness of our immune system and the development of allergic and inflammatory skin diseases. Having this gene mutation results in either a lack of or reduced amounts of this protein, which will cause skin barrier defects and the classic symptoms of atopic dermatitis.

This mutation is not only linked to atopic dermatitis but also to other allergic/atopic disorders such as asthma or allergic rhinitis. Developing atopic dermatitis with this gene mutation may be a sign that the other diseases are more likely to develop later, so it’s important to pay attention, for more than just the skin!

Neonatal/early childhood conditions:

Neonatal micronutrient deficiency (breast milk and diet): Micronutrient deficiencies are commonly seen in children who have atopic dermatitis and are often a result of the maternal diet and nutrient density of the breast milk. Immune resilience relies on appropriate levels of vitamin A, D, zinc, iron and the right amount of protein, fat, and carbs, as well as a diverse and well established microbiome. Micronutrient deficiencies can mimic an infection response in young children and generally lead to a weakened immune system.
Fast food, highly processed food: This may contribute to childhood eczema due to changes in the microbiome of the intestines and the resulting inflammation. A poor diet in general that is not varied in nutrients may lead to dysbiosis and skin diseases. If you want to learn more about the gut-skin connection, it’s all explained here.
Low levels vitamin D: This is linked to immune system inhibition. Vitamin D is partially gained through breast milk and early childhood diet, but the majority is through appropriate sun exposure.
Airborne pollutants: Children who live and play outside near roadways that are heavily trafficked are more likely to develop atopic illnesses. These pollutants can also aggravate an existing skin disease.
Household environment/toxins: The environment in the home is just as, if not more important, than outdoor air quality. There is a higher risk of AD when children are exposed to volatile organic compounds such as those off-gassed from building materials, paint, or furniture. Dust mites and pets in the house can also cause skin barrier impairment.
Hygiene, sleep hygiene: Kids are more likely to develop the disease when they sleep in bedrooms using electric space heaters, higher levels of humidity indoors, synthetic pillows and failure to air out bed clothing.
Screen time: Children who spend more time in front of screens, such as television, ipads, smart phones and computers, also have a higher risk of developing atopic dermatitis, perhaps due to less time spent outside with fresh air and sunshine, but potentially from other more direct factors of artificial light on their skin and circadian disruption.

Note on the link between autism and atopic dermatitis:

While these may seem like wildly independent issues in children, there is a surprisingly strong association between the two. Autism (or Autism Spectrum Disorder) and atopic dermatitis have similar risk factors and genetic predisposition, many overlapping maternal exposure risks and very similar clinical co-factors (such as asthma and allergic rhinitis mentioned above).
It seems that both may be the inflammatory result of the factors we have discussed thus far, but some children may only develop one or the other. It’s worth considering the close link if your child has either one, as the treatment and preventative measures you take may benefit both, or help mitigate further development of each disease.

Treatment: How do you treat atopic dermatitis in children?

Now that you know many of the factors that contribute to the cause and development of atopic dermatitis, you are likely already forming ideas about how to reduce exposure to certain items, either to yourself and fetus or to your already born child. If that’s the case, great job! If not, don’t worry, we’ll outline some practical measures that can be taken to ameliorate the condition at home.

Topical corticosteroids:

Many dermatitis sufferers express concern about using topical corticosteroids to alleviate their symptoms due to the risk of topical steroid withdrawal syndrome, which can be more devastating than the skin disease itself. Some studies show that it is potentially safe to use these at low/moderate strength and only short term. That said, while symptomatic relief is important, this is certainly not a cure, and after treatment is stopped, other measures will need to be pursued anyway.

Appropriate moisturization:

Moisturizers improve dermatitis on their own and should definitely be implemented alongside corticosteroids if those are used. Good moisturization will prevent water loss from the skin, which will improve elasticity and skin softness and reduce itch. This will also contribute to the integrity of the skin barrier which will further protect the skin from insult and additional inflammation.

Reduce problematic skin care products/materials:

This includes anything that is applied to the skin including creams, makeups, perfumes, shampoo, soap etc. It’s also important to consider what is used to wash dishes and clean clothes as these come into regular contact with the skin. The main issues to look out for are those we mentioned in the first section: phthalates, parabens, and fragrances.

Appropriate sun protection and sun exposure:

Sun exposure is controversial in general, but there is some data to suggest that it has a place in the treatment of atopic dermatitis. It is true that it is important not to overdo it as too much sun exposure can accelerate skin aging or lead to burning, both of which can compromise the skin barrier integrity. That said, we have mentioned a couple of times how important Vitamin D is for the immune system and skin health and how sun exposure is the main avenue in bringing up deficient vitamin D levels.

Wearing sunscreen may be a great way to protect your skin from overexposure, but keep the other points in mind. Make sure you pair it with a quality moisturizer and also watch out for ingredients in the sunscreen that may cause more harm than good. The best ones will not have any of the trigger chemicals, will be lightweight, non-comedogenic and hypoallergenic, mineral-based (titanium dioxide and zinc oxide), broad spectrum, and at least SPF30. If sunscreens trigger your child’s dermatitis, you may need to opt for using appropriate clothing, shade, and avoiding direct sun exposure too often. Getting some sun earlier in the day, and for short periods during the middle of the day, while protecting skin the rest of the time, may be a great recipe for optimizing Vitamin D and skin health!

Correction of micronutrient deficiencies- immune system support:

We have already addressed Vitamin D, but there are many other micronutrients that play an important role in our immune response and related skin diseases. If a child already has atopic dermatitis, it may be time to get a blood test to assess their nutrient levels. Even without testing, levels can be brought into better balance with an appropriate diet.

For example, the uptake of iron from heme-iron sources (such as meat and fish) is much higher than through non-heme sources (plants and grains). Vitamin A from animal food sources in the form of retinol is also more readily used. Zinc is more efficiently used when combined with proteins and citrates, and beta-carotene or supplemental Vitamin D is best combined with a fat/oil source. A varied, wholefood diet like the one listed below will likely hit a lot of these parameters.

Varied diet for varied microbiome:

While nutrient status is super important for the immune system, another reason that diet really matters is for the health of our gut microbiome! We know that when the balance of bacteria in our gut is off (called dysbiosis) it can lead directly to inflammation and disease of the skin. A diet that is rich in whole foods and contains a wide variety of fruits and vegetables, and fat and animal protein sources, will encourage healthy intestinal microbiota and contribute to a healthy immune system and skin barrier.

Household hygiene:

Your child likely spends most of their time at home! Do your best to remove tobacco smoke, don’t use toxic paints and furnishings, use an air filter and do regular vacuuming. Air out bed clothing, remove mold/damp and dust mites, and if you have the resources, opt for organic mattresses/pillows and keep your bedrooms well ventilated.

Reduction of exposure to airborne pollutants

Whether you are still pregnant or taking your little one out and about, avoid walks in high traffic areas and opt to get regular exposure to green/plant-rich areas (even if it’s a park in a city, or taking the backstreets rather than the busy roads). Exposure over time is what matters, so these little changes really add up.

Stress reduction:

Of course, stress reduction is not always so simple to incorporate in our lives. As mentioned above, maternal stress or stress in early childhood both contribute to the development of allergic skin diseases. While some stress is an important and natural part of life, excessive and chronic stress are potentially quite harmful. Some stressors are impossible or very difficult to change so just focus on what’s available to you. If big changes (such as necessary job change, house move, or therapy) are accessible to you, then go for it. If you don’t have the resources for those right now, just do your best to take care of your body and nurture your relationships. Make small changes like watching a comedy instead of a scary movie, making a phone call to a friend, going outside, finding small moments of fun or purpose and taking a moment each day to close your eyes and take a few slow breaths. Learn more about how stress influences our health here.

What do I do now?

Addressing childhood dermatitis with a professional

After everything we’ve covered, you will be equipped with quite a lot of actionable steps you can take in reducing the risk or severity of atopic dermatitis either during pregnancy or in early childhood. If you started some of these today, you’d be on a great path towards addressing the condition as well as improving the overall health of your child (and your entire household).

The next step in the treatment of atopic dermatitis is seeking out care from a professional. Because atopic skin diseases like atopic eczema and dermatitis are multifactorial, it’s important to address all of the factors you can at home, but also to work with a practitioner to get an appropriately tailored treatment plan with practitioner grade herbs and supplements, dietary protocols, and functional tests.

The unique combination of Functional Medicine and Traditional Chinese Medicine is particularly useful in treating skin disease. This combo offers the modern, technological advantages of functional testing using blood, urine, stool, saliva and hair plus high quality, third-party-tested supplements plus the traditional eastern approaches that consider our whole system and environment and treat underlying patterns through herbs and lifestyle. If this approach is of interest to you in treating atopic dermatitis and other skin diseases, get in touch here.

Dr. Jenny Bisset
Founder of The Bisset Method
JB Wellness
Chinese + Functional Medicine

Sources:

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