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Are Australian children too clean?

"In my day we used to throw the babies on the grass and let them get dirty. It's healthy."

If my dad said that to me one more time when my kids were little, I thought I'd scream. What would he know about raising babies?

Well, it turns out that he might be onto something after all.

A recent study has shown it's society's 'ultra-cleanliness' that is contributing to an increase in childhood allergies and eczema. The Institute of Child Health at Bristol University in the UK said children of parents with the highest standards of cleanliness are up to three times more likely to develop allergies and skin problems such as eczema. Children with eczema are the cleanest and most washed babies in the world.

Most babies will have peeling, flaking skin, redness and little 'milk rashes' around their mouths, but eczema is different. When a child develops eczema, the skin can become red, dry, itcy and scaly. When not managed correctly it can weep, bleed, crust over, become infected and cause extreme discomfort.

Families with a history of asthma and hay fever are more likely to produce children with the condition. Some never outgrow it.

Thirty per cent of Australian babies will now be affected by the condition and 10 per cent of adults.

10-year-old Kalli has suffered from eczema since birth

Kalli Hourn is 10 and has suffered from eczema her entire life. Her mum Roberta says it's been a struggle. “Your heart goes out to these kids. They want to tear their skin apart and somehow you’ve got to stop them."

“I hate this time of year because of how her skin flares up. It’s dry and itchy and you’ve really got to get on top of it quickly so the eczema doesn’t spin out of control.”

For her daughter Kalli she has had success using moisturiser. “Once I started with the intensive moisturisation my daughter’s eczema really settled but you really need to slather on that cream!” she said.

Sadly there is no cure, only treatments designed to alleviate the condition as much as possible.

This week is Eczema Awareness Week, supported by Cetaphil. Dr Ann-Maree Kurzydlo of eczema.org.au took the time to answer some questions for us:

Why is eczema increasing in Australian children?

One proposal is the “hygiene hypothesis”. According to this hypothesis, the decreasing incidence of childhood infections in developed countries has led to the increased incidence of both allergic and autoimmune conditions. This theory is based on the fact that our immune system needs to be exposed to bacteria or germs in order to develop in a balanced way. This is particularly important in the first year of life. It teaches our immune system to differentiate between harmful and harmless substances. An immune system that has not encountered germs, may start to see harmless items such as animal hair, as potentially dangerous. This can lead to allergies and eczema.

Some studies have shown children from homes where they are over-washed, along with their environment, may be three times more likely to develop eczema. Obviously genetic factors are still the main culprit, but over-bathing, including the use of anti-bacterial soaps and regular use of hand sanitizers may perhaps be doing more harm than good. These products also tend to cause irritation to the skin and are well known to worsen eczema.

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Can eczema in babies and children be prevented?

Eczema reflects a genetic tendency, so there is no prevention. However, environmental factors influence the severity of eczema, so modifying these may provide some control of skin symptoms.

Should all parents use or avoid certain products just in case of eczema?

No, it is not necessary to avoid products just in case of eczema. But in general, we should be using products containing as few chemicals as possible on babies and children. Choosing soap free and fragrance free products is a basic commonsense approach.

Does eczema necessarily mean the child will have asthma or food allergies?

Not necessarily. However asthma, eczema, allergic rhinitis and food allergies are all allergic conditions, which often cluster within families and individuals. Children with a genetic “atopic” or allergic makeup, as shown by having eczema, are therefore also more likely to have asthma, allergic rhinitis and allergies.

When does eczema in babies normally clear up?

Eczema tends to be more severe in infancy. With time, symptoms tend to improve and eczema may clear up later in childhood in some. Unfortunately this is not always the case and a minority of children continue to be troubled by eczema into teenage years and adulthood.

At what stage should parents seek doctor advice?

Medical advice should be sought if the parent is unable to control their child’s eczema with general skin care measures, including using soap free and fragrance free products and frequent liberal application of a good moisturiser. Prescription products, including topical corticosteroids may be required. If secondary infection is present, which may show as weeping and crusted skin, medical advice should immediately be sought.

Will eczema babies have more nappy rash?

Not usually. Eczema that occurs in the nappy area may be due to a product or substance getting on the skin causing an allergic or irritant reaction. The nappy area is otherwise moist and this seems to result in less eczema developing here.

Why do some kids get eczema and others don't?

The exact cause of eczema is unknown. It’s a condition that’s both genetic and affected by a number of factors in our environment. What we do know is the skin barrier is impaired in eczema, and as a result there is a loss of moisture from the skin, exposure to allergens and irritation develops. Some research shows patients with eczema may be deficient in natural moisturising factors known as fillagrin breakdown products. As a result, the skin tends to dry out and can be easily irritated.

Tips to prevent and manage eczema:

* Wash your baby once a day, max;

* Try to use to soap-free or fragrance-free product;

* Moisturise babies twice a day, especially in the winter when skin can be more sensitive and drier;

* Allow your child to be exposed to a reasonable amount of germs while playing;

* Use hand sanitisers when sick only. Try not to over-use;

* Stick to cotton products and never dress a baby in wool or lay them on a wool blanket. Even someone wearing wool who hugs your child can cause a skin irritation to occur;

* Wash baby clothes and bedding using gentle, natural laundry liquids.

Do you have a child who has suffered from eczema? Which products have worked for you?

Australian dermatologist Dr Ann-Maree Kurzydlo is working in conjunction with Eczema Awareness Week to raise awareness about the condition and give advice to parents. Eczema Awareness Week is sponsored by Cetaphil.

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