Case Study:

A concerned parent has brought in her 9 year old son who has raised, pink, scaly plaques on the inside of his elbows, back of his knees, and just behind his ears. In addition, a section of plaque is also present on both of his wrists – with the right-side including small blisters. According to his parent, this condition first appeared a couple of years ago and it has worsened over time. To date, they have treated his skin with over-the-counter creams, which seemed to work originally but now they do little to soothe his skin.

As a skin care professional, what solution do you propose to treat this case study?

Solutions:

Tara Templeton, aesthetician at Skintique Miami

“To protect myself from any liability, I would sensibly tell the mother that unfortunately, it’s beyond the scope of my license as an aesthetician to diagnose or treat a skin disorder without the consent of a doctor. I would suggest she make an appointment to see a dermatologist immediately. Then I would give her the following general suggestions to help soothe her son’s skin: bathe him in colloidal oatmeal; use a creamy wash rather than soap; apply moisturizer when skin is still damp after bathing; keep skin hydrated; drink plenty of water; avoid allergens and anything that may be irritating; take a mild antihistamine; and no picking. I wouldn’t write anything down for the mother, except a referral to a dermatologist. Eczema is a type of dermatitis, which can come from allergies, asthma and general skin irritants. Cases like the boy’s need to be treated by a doctor first.”

Courtney Griffin Freeman, licensed aesthetics instructor at Southeastern Esthetics Institute

“In the treatment room, aestheticians have a huge benefit to offer clients with eczema, with LED light therapy being one of the most acclaimed and documented treatments for aging, healing wounds, and improving disorders such as eczema. LED light therapy is a non-invasive procedure that delivers low-levels of pulsed light up to three times brighter than the sun by converting light energy already found in skin cells to promote healing and anti-aging. For this case study, I would develop a treatment using LED light. This particular therapy is essential for those dealing with eczema, as LED light stimulates our naturally occurring metabolic function and nutritional elements, decreases redness and skin degradation, and restores the skin’s natural collagen production.”

Ben Johnson, M.D., founder of Osmosis Pür Medical Skincare

“I believe that this condition stems from internal imbalances. Therefore topical products, while soothing, will be too cost prohibitive and only moderately effective over the long-term because none of them will fix the source. I prefer an internal/holistic approach which involves addressing the (likely) digestive source and allows the skin to heal itself. Topically I think that an extract of sweet wormwood would be the most soothing and may even clear a majority of the lesions... temporarily. I would also look at phosphatidylcholine because it does a nice job of restoring the barrier. However, the internal strategy should be the main focus.”

Howard Murad, M.D., founder of Murad®

“Eczema is a hereditary condition and is often associated with asthma, hay fever and allergies. Research also suggests that people who experience eczema tend to be overachievers and perfectionists. This can be a viscous cycle because perfectionists tend to stress more, which can exacerbate the symptoms. Although we tend to associate stress with adults, we are beginning to see it more in children. Kids are constantly pushed to succeed; from school to soccer practice to violin lessons, et cetera, leaving them little time to relax and unwind. One way to reduce the stress that exacerbates eczema is sleep. Almost every system in the body is affected by the quality and amount of sleep you get at night. Make sure the television is off one hour prior to sleeping and discourage stressful activities two hours prior to retiring to the bedroom. This can be hard for children whose activities fill up their entire day but maybe that just means cutting one out to make sure they have enough time to get rested and de-stressed. Topically, the main problem with eczema is dryness. Adding Omega-3 fatty acids in his diet like fish oil supplements will moisturize the skin from the inside out. I would also suggest taking fewer baths/showers and to just pat himself dry, followed by a nice body lotion that does not have perfumes, fragrance and those that are specifically for sensitive skin.”

Christian Jurist, M.D., medical director of global education for Pevonia International®

“Eczema is a chronic, multi-symptomatic inflammatory disease of the skin that can present itself in different forms. Because of its inflammatory nature, it is imperative to take action as quickly as possible. Steroids are a typical treatment for eczema due to their ability to quickly fight inflammation and bring relief. A steroid-based cream was most likely the over-the-counter product this child was receiving. Steroids tend to work great at first, but their benefits can be short-lived and therefore they may not be an appropriate long-term solution. That is why it might be necessary to try alternative treatments and leave the steroids for short-course use during acute flare-ups. In eczema, the skin barrier can be quite compromised and a natural ingredient such as grapeseed oil can do wonders to help restore, strengthen and protect it. This can be gently applied on the affected areas and their perimeters about two to three times a day on clean skin until it shows signs of improvement. Stop the use of harsh soaps and use body shower gels with natural oils like almond oil to help heal and prevent recurrence. A mild antibiotic ointment may be necessary in the case of broken blisters, but plant-based options such as tea tree oil and green tea can be safe choices as well. Also, topical products (preferably with filmogenic properties for extra hydration) containing aloe, green tea, allantoin, chamomile and/or its extracts, vitamin E, and licorice extracts can calm, soothe and help heal the skin. For large or multiple affected body areas, a water lily localized wrap can quickly bring relief and healing at the salon or spa.”