Skin Care

Skin Care

Most children with  WAS have eczema at some time in their lives.  They are also prone to infections with bacteria such as with streptococcus and staphylococcus, viral skin infections such as molluscum, warts and recurrent herpes.  These infections can be severe and difficult to treat.  Chicken pox can be severe in these children.   Many of these children are prone to autoimmune disorders which affect the skin such as vasculitis and recurrent hives.  This section just focuses on eczema. 

Eczema is a chronic recurring skin disorder that results in dry, easily irritated, itchy skin.  The skin is dry because the outer layer is unable to retain water.  Unfortunately there is no cure for eczema and it has to be controlled with good skin care.   The skin is the largest organ in the body.  It provides a barrier against infection and anything that affects the skin can affect the rest of your body.  It is therefore important to take good care of the skin.  The goals of controlling eczema are three fold:

1.  Avoid triggers that cause flare ups of eczema.  Some food, and several chemicals can irritate the skin.  Find products that do not irritate the skin and stick with them.  These irritants could be harsh soaps, detergents, household cleaners, lotions etc  In general keep away from perfumed products as they tend to irritate the skin.   Using half the recommended amount of a hypoallergenic detergent and double rinsing the clothes can help reduce eczema.  Wash all new clothes before wearing them.  Avoid the use of fabric softeners. Wear cotton clothes.  It breathes, absorbs moisture, feels better and irritates the skin less.  Wool can very often irritate the skin of these children.  Cold temperatures, especially when combined with low humidity during winters in a heated home, wind, heat, sweat,  and excessive bathing can worsen eczema.  Stress can cause flare ups.  It is important to help children find effective ways of coping with and managing stress.

2.  Moisturize the skin by means of baths and retain the moisture by frequently applying moisturizers.

3.  Use of medications to control the eczema and the itching.


Medications to control the eczema and Itching

1.  Topical Corticosteroids(Steroids):  These medications come in the form of ointments and creams and are often the only medicines that can help eczema.  They come in various strengths, from mild to very potent.  Steroids are potent medicines and must be used with care.  Always use  as directed by the physician.  A thin layer  of medication should be applied to the affected parts only.  Applying moisturizer over the medication increases the effectiveness of the medicine, but also increases absorption and should be done under the direction of the physician.  A mild steroid such as hydrocortisone 1% which is available over the counter is relatively safe.  However, the more potent steroids can cause thinning of the skin, stretch marks, growth retardation or suppression of the adrenal gland if used in the same areas for a long period of time1.  Children should be supervised if they use steroids.Listed are the topical steroids  that are used and their potency.  Use the lowest potency steroid that is effective for your child.

2.  Infections can happen more frequently than normal as the skin is not intact and allows bacteria to enter more easily.  Routine use of soap and water helps reduce the infection.  If there are signs of infection such as redness, pain, swelling, etc. this may require topical or oral antibiotics.   Patients with WAS are more susceptible to severe  infection with chicken pox, molluscum (a viral infection) and warts.  More details on these infections are in the section on infections.

3.  Tar creams can help in milder cases of eczema.  Once used widely, tar preparations are used less frequently nowadays. 

4.  Topical Immunomodulators (they alter the immune system):  These are newer medications which control the redness and itching associated with eczema.  Tacrolimus andPimecrolimus are FDA approved for patients over the age of 2 years.  They work by stopping the immune system from producing factors that cause eczema.  Some experts(verbal communication- Dr. Buckley) feel that it is best to avoid the use of these medications in children with WAS if possible.  It should not be used under the age of 2 years and is not meant for long term use.  Patients below age 16 can only use the 0.03% cream and not the 0.1% cream.  It is very important to follow the doctors advise exactly when using this medication.  A few cases of lymphoma and skin cancer have been reported with the use of these mediccations and patients who are post transplant may be more vulnerable2  When using this medication, please read the instructions and follow them thoroughly.  The area where the medication has been applied should be protected from natural and artificial sunlight.  Use normal, loose fitting clothing to cover the area to protect it.  Use sunscreen on the area only if the doctor advises it.

5.  Itching is part of the eczema process and persistent itching worsens the eczema  and can cause bleeding.  Itching can be disruptive to sleep, school and cause social problems.  It also predisposes the patient to infections.  Good skin care and the routine use of moisturizers and oatmeal baths can help control the itching.  Keep nails short and filed.  Encourage routine washing of hands prior to applying topical medications.  Medications such as benadryl or atarax, especially at night  can help control itching and break the itch-scratch cycle.  All topical products should be kept using good hygiene practices to avoid their contamination with agents that can cause skin infections. 

Back to top                                                                                                                       > Next Section: School & WAS



1.  National Eczema Association.

2.  Tacrolimus Topical.