Ooi SL Amy, See KS Kris, Osel Clinic, Osel Diagnostics
ABSTRACT
Eczema is not a single health condition but a recognizable reaction pattern seen in a number of skin disease. Eczema signs and symptom include tiny blisters (vesicles) that can weep and ooze, eventually producing crusted, thickened plaques of skin. It is almost quite itchy. In this case, a one year five months old child developed rashes (eczema) over bilateral cubital fossa and popliteal fossa after weaning breastfeeding. Same symptom occurred during the age of one month old which exclusive breastfeeding haven’t sustained. Symptom resolved completely after child was started exclusive breastfeeding. Breast milk provides the ideal nutrition for infants and also contains antibodies that help babies fight off viruses and bacteria. Breastfeeding will aid in the development of the baby’s immune system and decrease the chances of a baby developing allergies. Further study is needed to define the strategies for the prevention of adverse reaction after weaning breast milk.
INTRODUCTION
Dermatitis, also known as eczema, is a group of disease that results in inflammation of the skin. [1] These diseases are characterized by itchiness, red skin and a rash. [1] In case of short duration there may be small blister while in long-term cases the skin may become thickened. [1] The area of skin involved can vary from small to entire body. [1]
Eczema is not contagious. While the exact cause of eczema is unknown, researchers do know that people who develop eczema do so because of a combination of genes and environmental triggers. [2] There are several different types of eczema: atopic dermatitis, contact dermatitis, dyshidrotic eczema, nummular eczema, seborrheic eczema, stasis eczema. [2]
Dermatitis was estimated to affect 245 million people globally in 2015. [3] Atopic dermatitis is the most common type and generally starts in childhood. [1] [2] About 1 out of every 10 kids will develop eczema. Typically, symptoms appear within the first few months of life, and almost always before a child turn 5. [4]
Breast milk is the milk produced by the breasts (or mammary glands) of a human female to feed a child. Milk is the primary source of nutrition for newborns before they are able to eat and digest other foods. [5] The World Health Organization recommends exclusive breastfeeding for the first six months of life with solids gradually being introduced around this age when sign of readiness are shown. [6] Supplemented breastfeeding is recommended until at least age of two and then for as long as the mother and child wish. [6]
Case Presentation
Written informed consent was obtained from the patient’s parents (due to patient was under age) for publication of this case report.
A one year and five months old child with family history of atopy noted develop rashes eventually crusted and become thickened plaque of skin over bilateral cubital fossa and also bilateral popliteal fossa, it also associated with itchiness after stop breastfeeding around one month. Previously when the child was one month old noted some minimum rashes over left popliteal fossa, during that period, the child was given breast milk combination with formula milk due to inadequate breast milk supply. Symptom resolved with some hypo allergic lotion with hydrocortisone cream. Subsequently symptom never reoccurs after the child started on exclusive breastfeeding until the child was one year and five month old which breastfeeding was weaned down gradually.
While during the period of introducing solid food, with breastfeeding still going on, there was no reoccur of eczema reported.
Discussion
The World Health Organization currently recommends exclusive breastfeeding for the first six months and continuing to breastfeed, as well as introducing other foods, until two years of age. [6] The composition of Breast milk is the biologic norm for infant nutrition. Breast milk also contains many hundreds to thousands of distinct bioactive molecules that protect against infection and inflammation and contribute to immune maturation, organ development and healthy microbial colonization. [7] Breast milk contains compounds such as α-tocopherol, β-tocopheral, and prolactin – all help degrade inflammatory compounds, increase immune function and decrease sensitivity of infant. [8] In a meta-analysis of 18 prospective studies from 1966-2002, exclusive breastfeeding during the first 3 months of life was found to reduce the incidence of atopic dermatitis in children with family history of atopy (OR 0.58, CI 0.41 to 0.92) and in those without a family history of atopy (OR 0.84 for combined populations, CI 0.59 to 1.19). [9] In another study, more than 2700 infants in the Netherlands were enrolled in a KOALA (Child, Parent, Health, Focus on Lifestyle and Predisposition) birth cohort study, in which it was found that breastfeeding could prevent atopic eczema in children. [10]
Conclusions
Based on this case and a review of current literature, it would be advisable to promote breastfeeding globally. However, that the eczema reoccurs after weaning from breast milk seen in this case could be multifactorial, and that the potential of weather, lifestyle modification and should not be undermine. Hence, WHO recommends four and six months of exclusive breastfeeding to aid prevention of allergy and associated illness. [6] Further study is needed to define strategies for the prevention of adverse reaction after weaning breast milk.
REFERENCES
1. Nedorost, Susan T. (2012). Generalized Dermatitis in Clinical Practice. Springer Science & Business Media.
2. National Eczema Association (2017). An Overview of the Different Types of Eczema. www.nationaleczema.org
3. GDB 2015 Disease and Injury Incidence and Prevalence, Collaborators. (8 October 2016). “Global, regional and national incidence, prevalence and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015”. Lancet.
4. Patrice Hyde (June 2015). Eczema-Kids Health. www.kidshealth.org
5. Breast Milk. www.wikipedia.org
6. “The World health Organization’s infant feeding recommendation”.
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10. Snijders BE, Thijs C, Dagnelie PC, Stelma FF, mommers M, Kummeling I, et al. Breast-feeding duration and infant atopic manifestations, by maternal allergic status, in the first 2 years of life (KOALA study) J Pediatr. 2007; 151(4):347-51.351.el-2. Epud 2007 Jul 12. [PubMed]
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