Being a parent is one of the most difficult jobs in the world.  If in fact not the most difficult.  As a child gets older and enters into the school world a parent is frequently faced with the question of whether their child is well enough to go to school or not.

Is that runny nose and cough making them too miserable to be at school?  Is their conjunctivitis contagious?  Is that rash going to develop into measles?  Are they sick or have they just forgotten to finish their homework?

Without any medical expertise it is difficult for a parent to know the right answer.  We simply do what we think is right and what we feel is best for our child.

When you have a child with eczema it is a continuous, often daily battle to know whether your child is well enough for school.

So how do you know if your child should go to school or not?

Eczema is not contagious so there is no need to keep your child home from school to protect other children from their rash.

If your child is self conscious of their rash and afraid of the response of the other children talk to them about it and also the teacher so that your child can go to school and feel a part of the class without any feelings of being different.  The situation will not improve by keeping your child at home.

If your child needs eczema creams and emollients to be applied during the day to prevent itching and to keep them comfortable, discuss this with the teacher as she/he may be able to help so that your child is able to go to school.

If your child’s eczema is so severe that they will be unable to participate in activities it is probably wise to keep them at home.

If your child has open weeping eczema and you fear that they may be susceptible to infection by going to school they should probably be kept at home.

If your child has been unable to sleep all night due to the discomfort of their eczema they will most probably not be able to function properly at school.  Letting them sleep in and take it easy for a while is probably advisable. There is however no reason why they cannot be taken to school a little later.  The whole school day need not be lost.

It is important to remember that a child’s education is important and so is their socialization.  Being at school and learning to play and mix with other children is an important part of a child’s development.  It is however also important that a child’s health and well being not be put at risk by being at school.

Trust your instincts

I guess it still comes back to the parent and what they feel is the best for their child.  Most parents know how their child will cope at school and when their health is too poor for them to be able to cope.

Discuss your child’s health with the teacher and work as a partnership.  The teacher will be able to advise you on how your child generally copes at school and the effect that their eczema has on their days performance.

An understanding with the teacher that she/he will call you during the day if your child’s eczema becomes worse or if they appear too uncomfortable to be at school will also help to put your mind at ease.

Psoriasis comes in varying degrees and we so often hear of people referring to the condition as mild, moderate or severe.  But what is the severity of your psoriasis?  How do you know how severe is severe?

For some their psoriasis appears as a few small areas of affected skin or just the nail beds being involved whilst for others the entire torso or legs are involved.  At what point does the condition stop being mild and become moderate or severe?

It’s all in the palm of your hand

The severity of psoriasis is measured by the use of the palm of the hand.  One palm of the hand represents 1% of the skin involved.  Less than 3% of the skin being affected by psoriasis means the condition will be classified as mild.  Between 3 – 10% coverage is classed as moderate and anything over 10% is considered severe psoriasis.

The form of treatment selected to treat psoriasis is often based on the severity of the condition.  Mild psoriasis is usually treated with topical creams alone.  Severe psoriasis frequently uses a combination of topical treatments, systemic treatments and ultraviolet light therapy.

Biologic Drugs – New treatment available

In 2003 a new form of treatment became available when the FDA gave approval for the new biologic drugs to be used in the treatment of psoriasis.  Some of these biologic drugs were on the markets prior to 2003 but were only approved for the use in treating immune related disorders such as ulcerative colitis and rheumatoid arthritis.

Biologic drugs are only used for moderate and severe psoriasis.  It is believed that they are safer and more effective for long term treatment however a full evaluation of long term side effects is yet to be established as the drugs themselves are still relatively new.

Whilst the severity of psoriasis persists at least the treatment options are ever improving giving sufferers increased options and more hope of leading a comfortable life with reduced psoriasis symptoms.

A new discovery that may lead to long lasting therapies against psoriasis and assist in healing has been found. A new type of immune cell has been discovered that can be out of control in certain chronic inflammatory diseases, worsening the symptoms of conditions like psoriasis, atopic eczema and asthma.

German Research Scientists have recently discovered a new type of immune cell that plays a role in certain chronic inflammatory diseases such as psoriasis and asthma. The cell which has been named Th22, is a type of immune cell called a T helper cell.

T helper cells are white blood cells that help control inflammation in the body to help fight off infection. They also activate other immune cells when the body comes under attack by a pathogen, such as a virus or bacteria.

How Th22 cells work

In healthy cells the Th22 cells have a protective effect as they produce a signaling molecule that provides tissues with an advance warning that inflammation or infection is going to happen. This gives the tissues time to prepare to attack the invading pathogen or protect themselves against inflammation.

The protective nature of Th22 cells is ineffective in people with chronic inflammatory skin diseases like psoriasis and atopic eczema as there appears to be a malfunction within the Th22 cell. This leads to excessive inflammation and often a worsening of symptoms.

“These diseases can have a big impact on people’s lives, and patients can face a constant battle to keep their symptoms at bay. We are very excited about discovering this new subset of T-helper cells, as we believe it could provide a new target for the treatment of chronic inflammatory diseases in the future.” stated Dr Carsten Schmidt-Weber of the National Heart and Lung Institute of Imperial College London in the UK.

What this means for eczema and psoriasis

Studies of the Th22 cells are continuing in more detail as researchers are hoping to determine their role in inflammatory diseases as well as where the cells are produced in the body. With this determined it may be possible to control the cells before they start to cause problems by targeting new drugs directly at the Th22 cells.

How do you know what your rash is?

The answer is simple – you have to ask your doctor.  Only a doctor can give you a definite diagnosis.  However there are some typical characteristics that may help to give you a clue.

Eczema and Psoriasis are two rashes commonly confused

Eczema and Psoriasis are the most common rashes I get asked about and whilst they have many similarities they are distinctly different conditions.

Both eczema and psoriasis are chronic inflammatory skin conditions, ones that persist for a long period of time and they tend to run in families.  As with any chronic condition it is important to look at your lifestyle and understand how various aspects of it may affect your skin.  Unfortunately there is no known cure for psoriasis and eczema, but they can be managed.

Eczema, the itch that won’t go away

Eczema is most common in children but can affect any age group, both male and female. The most distinguishing feature of eczema is the unbearable itch.  Typically eczema skin is very dry and the lesion is red and scaly.  It usually appears on the face, neck and arm and leg folds but can appear on the whole body.

Eczema tends to run in families with the likelihood of a child developing eczema increasing significantly if one or both of the parents has ever suffered from eczema, asthma or hayfever.  Eczema is allergy based and it is these allergies that will trigger an eczema flare up.

The silvery scales of psoriasis

Psoriasis on the other hand is the result of an over production of skin cells.  The predisposition to develop psoriasis is passed on along the family line however it is environmental triggers that will result in an outbreak of the condition.

The psoriatic lesion is usually a discrete, bright red patch covered with silvery scales.  The lesions may be itchy but unlike eczema this is not a distinguishing feature.  Psoriasis usually affects the scalp, knees, trunk and elbows.

It is rare for a child to develop psoriasis.  The condition usually first appears in the late teen or early adult years.  Both males and females can be affected equally.

Whilst it is the itch in eczema and the silvery scales in psoriasis that are the distinguishing characteristics the only way to know for sure is to visit your doctor and have a proper medical diagnosis.

Eczema or Dermatitis

There is a good deal of confusion over the difference between eczema and dermatitis.  They both broadly mean skin inflammation.  Many doctors use the two terms interchangeably.

If you have atopic eczema, it is the same as having atopic dermatitis.  If you have irritant contact eczema it is the same as having irritant contact dermatitis. The condition is the same, therefore the treatment is the same.  It is just a matter of varying terminology being used by different medical practitioners.

Is it fungal?

Eczema and psoriasis are inflammatory skin conditions.  They are not fungal infections. Ringworm is a fungal condition characterised by itchy, red, scaly, inflamed circles that spread outwards leaving pale skin in the centre.  The appearance is not unlike the healing lesion of nummular (discoid) eczema.

Although similar in appearance the two conditions are not at all related.  It is important to establish if you have an inflammatory skin condition or a fungal condition before you start treatment as the treatment is quite different and eczema treatments may feed fungal infections making them worse.

Not fungal or inflammatory

Rosacea is a chronic condition affecting the blood vessels of the face.  The superficial facial blood vessels become enlarged and dilated resulting in the hot, inflamed rash that is common to this condition.  Rosacea is triggered by any condition that will cause the blood vessels to dilate.

It is important to remember that rosacea is not related to eczema or acne and the treatments normally used for these conditions may worsen rather than improve the symptoms.  Treatment is aimed at treating symptoms and avoiding trigger situations.

What to do

In order to prevent worsening of a skin condition it is important that any treatment options are selected for the condition that you have.  An accurate diagnosis of any rash can only be made by a medical practitioner.  If you are unsure of what your rash is consult your doctor before starting treatment.

20% of children in the United States are deficient in the Sunshine Vitamin – Vitamin D

These are the results of a nationally representative study out of the Children’s Hospital Boston carried out on 5000 United States children (1 – 11 year olds) between 2001 – 2006 that have just been released.

At this point in time there is some discrepancy as to exactly how much vitamin D children require.  Currently the American Academy of Pediatrics recommends children have vitamin D blood levels of at least 50 nmol/L.  However many pediatricians including the study author Jonathan Mansback believe safe levels of vitamin D may be as high as 75 nmol/L or even 100 nmol/L.

“If 75 nmol/L or higher is eventually demonstrated to be the healthy normal level of vitamin D, then there is much more vitamin D deficiency in the U.S. than people realize,”  Jonathan Mansbach, M.D., Children’s Hospital Boston, was quoted as saying.

Vitamin D deficiency causing eczema

Vitamin D is best known for ensuring strong bones in our children and preventing rickets.  Recent studies suggest that it may also prevent a host of common childhood illnesses including respiratory infections, childhood wheezing and winter-related eczema.

Who is deficient?

Changes in our living styles have possibly lead to the deficiency of vitamin D.  Children are now spending a large amount of time indoors away from the sun and parents are lathering their children in sunblock to protect them from sunburn and skin cancers.  Whilst pediatricians recommend wearing sunblock it is important to be aware that this actually blocks our skin’s ability to make vitamin D.

The children most at risk are those with darker skin.  The percentage of Hispanic children deficient in vitamin D is as high as 80% whilst as many as 92% of black children are deficient.  The reason for this is the darker the skin the greater the amount of melanin in the skin.  Melanin impedes vitamin D production so it will take significantly longer for someone with darker skin to produce adequate amounts of vitamin D.

What can we do about it?

Vitamin D is found in foods like liver and fatty fish however almost all children in the U.S. do not consume enough of these foods to match the level of vitamin D provided by sunshine.  Pediatricians are recommending that parents consider giving their children supplements that contain vitamin D especially during winter and in higher altitudes where the sunshine vitamin is most scarce.

How this affects your child’s eczema

Eczema is a difficult condition to control at the best of times and it is not uncommon for the flareups to occur in winter.  Whilst it is often not possible to remove all of the triggers that affect your child’s eczema is is worth considering alleviating the triggers or factors that you can.

If you live in an area where sunshine is limited or if your child does not spend a lot of time out of doors pediatricians believe that children prone to eczema are more likely to flareups due to a lack of vitamin D.  This can be rectified by taking vitamin D supplements.

If you have eczema or psoriasis you need to take special care of your skin.  The skin’s ability to protect you is reduced.  Healthy skin is designed to withstand external attack, but the skin of the eczema or psoriasis sufferer is more sensitive and vulnerable.

A proper medical diagnosis is important, and occasional medical checks especially during an outbreak may be necessary to bring the condition under control.  However most of the time the steps you will need to take to protect your skin you will be able to do yourself.

Keep your skin moisturized

The most fundamental measure you can take to protect your skin and keep it as healthy as possible is to moisturize your skin.  The skin’s ability to produce sebum is affected when you have eczema.  Since sebum is the natural moisturizing oil that keeps the skin supple, a lack of sebum will result in dry, fragile skin.

The natural oils need to be replaced with moisturizing products called emollients.  Emollients are oil or fat based moisturizers and softening agents.

Emollients work in two ways.  Firstly, they form a protective waterproof barrier over the skin which helps trap moisture in and prevents irritating substances contacting the skin.

Secondly, emollients will help to ‘stick’ the skin surface cells together similar to how the skin’s own natural oils do.  This will help to make the skin feel smoother and improve its appearance.  Emollients will also help to decrease the itch, thereby making the skin more comfortable.

Use your emollients regularly

Emollients are available in many different forms.  They include bath oils, shower gels, soap substitutes, lotions, creams and ointments.  Emollients are most effective when used on a regular basis.  A daily routine needs to be established.

However, choosing the right emollient can be difficult.  Unfortunately the best method really is a matter of trial and error.

Tips for Using Emollients

Regardless of the type of emollient you choose to use there are some common rules that if followed will enable you to gain the most benefit from your emollient.

•    To reduce the risk of infection always wash your hands before applying your emollient.
•    To prevent the skin drying out apply your emollient immediately after drying the skin.
•    To minimize skin irritation and increased itching always rub emollients in the direction of the hair growth.
•    To decrease the risk of cross infection, never share your emollient with other people.
•    To moisturize your skin overnight, apply an emollient to your whole body before going to bed.
•    To minimize skin irritation, apply moisturizing creams gently.