Skin Care World

The views expressed below are those of the author, and are not necessarily those of Mölnlycke Health Care.

The transition from primary to secondary school is a daunting prospect. Young people move from the relative comfort of a year group of 30 (or maybe 60) children – taught for the majority of the day by their class teacher, who has probably known them since they started the school – to a large sprawling high school with year groups of 100s of pupils. Not only a new form teacher but also a different teacher for each subject, and in a different classroom every lesson as well! Difficult enough when you don’t have a ‘hard to explain’ skin condition. How on earth are we to be sure that everyone the pupil comes into contact with understands their individual needs?

The teenage years are ordinarily a time of upheaval, both mentally and physically. Add to this the fact that puberty may actually cause eczema to become worse and we have a possible minefield of emotions. At this time the psychological effects of having lived with the condition throughout their lives, combined with the joy of puberty, can lead to extremely challenging behaviour. An added complication could be that the child who appears to have ‘grown out of it’ finds that their eczema reappears.

For young people with eczema, coping with the school day is problem enough. In more extreme cases, those with severe or infected eczema may miss school or be hospitalised frequently as part of their treatment. There can be real danger of the child not reaching the expected levels in SATS testing.

Eczema can affect a child’s performance across the whole of the National Curriculum. The ‘itch’ does not distinguish between the core subjects and the foundation subjects or appreciate attainment targets! However, flexibility within school practices can make a huge difference.

PRACTICAL GUIDELINES TO MAKE A DIFFERENCE!

Certain factors in a school environment can make the eczema worse. Alternatively, situations can be created that may make the youngster feel more comfortable. These factors will differ for each individual pupil and it is very useful if they or their parents are able to give the teachers details of situations to avoid and also of methods that are effective in helping the pupil to calm down and stop scratching. Many of these factors will have been tackled in primary school and if possible should still be considered.

Classroom

A pupil may break into a frenzied itch-scratch bout at any time, this will break their own – and their classmates’ – concentration. Arranging permission to quietly leave the classroom to calm down will cause as little disruption as possible for the teacher and the rest of the class. Some emollient cream, a glass of water, and a cool damp flannel may help. As a parent, be specific about your child’s needs and make sure all staff are aware of what works for the individual. If someone can sit and talk to the pupil, this and any other distraction can have a calming effect.

Itching increases with overheating – this can be avoided by seating away from sunny windows and radiators. A cotton pillowcase or towel to sit on minimises contact and possible irritation from plastic seats.

IRRITANTS

The list of possible irritants for young people with eczema is far too long to include here. The following list is not inclusive but will highlight areas that need extra vigilance:

• Woollen clothing, soap, detergents, washing-up liquids, paint, laundry powders, chemicals, metals;
• Pollen, dust and dusty conditions, certain foods (most common being dairy produce, eggs and citrus fruits), colourings and preservatives, pets (animal fur);
• Worry, over family problems, schoolwork, physical discomfort of eczema and its effects on lifestyle and appearance; and
• Cold weather, heat and sweating.

SUBJECT GUIDELINES

Consideration should be given so that youngsters with eczema can either participate fully, or be allowed to choose another activity if suitable provision cannot be made. Some examples are:

• Art and pottery – paint, glue, clay and water may irritate eczema on the hands. Gloves may be worn for art but they may have to miss out on pottery
• Craft design & technology – metals, chemicals, plastics and oils can cause problems. Gloves may be needed and an emollient applied before and after the lesson

Eczema does not distinguish between core subjects or foundation subjects, or appreciate attainment targets!

• Food technology – pupils with food allergies will need to avoid contact with the food in question, and those who find some foods an irritant (e.g. citrus fruits, onions) should avoid contact
• School trips, work and residential experiences – extra care may need to be taken in all these circumstances. However, no youngster should be excluded, and the school can be expected to make all reasonable provision to include them.

SPORTING ACTIVITIES

These should always be encouraged, but it must be taken into account that stiff, sore or infected eczema may prevent or restrict taking part. Teenagers are self-conscious to start with and pupils with eczema have the added embarrassment of exposing affected skin, which they may normally manage to hide at school. Cotton joggers or cotton-lined tracksuits can alleviate this. Pupils may need additional help to overcome this embarrassment or to deal with comments from classmates.

CONTACT WITH FOOD AND SCHOOL MEALS

If diet and exacerbation by certain foods is an important factor in the management of the individual in question, this area needs to be covered. Some pupils may find that certain foods tend to make their skin worse and a small number of pupils may also have severe anaphylactic reactions to foods.

Flexibility across the curriculum is important in these cases. For example, the cracking of eggs or even being in the same room as an egg may trigger a reaction, and everyone concerned needs to be aware of this.

If the pupil is using the school canteen the catering staff need to be aware of the pupil’s individual needs.

IMPORTANT INFORMATION FOR STAFF

Eczema is not in any way contagious, but the pupil with eczema is more likely to catch other people’s infections. It is absolutely vital to avoid contact with:

• Cold sores (herpes simplex) as this can lead to a very serious viral illness – eczema herpeticum
• Impetigo (a contagious pustular skin disease) as this can lead to development of infected eczema, which would need antibiotics to clear it

The problems of teenage eczema are very real. We need to help by encouraging them to work hard, develop hobbies, have a social life, keep fit and eat a healthy, balanced diet. By doing this we can help them to achieve their full potential and not make eczema the focus of their lives. Points to be aware of include:

• The pupil may need professional counselling
• The better informed the teenager and their peers are about eczema, the better he or she can cope with the difficulties and teasing that undoubtedly do exist
• Watch out for bullying and take necessary action
• Parents may feel they are fussing, as they have probably spent the whole of the child’s life explaining the situations that having an atopic child can cause and how to prevent it. As a member of staff, encourage them to take as much time as they need to cover all salient points.

At this stage of education it is still wise for parents to make a special appointment with the relevant teachers, taking a written note of medical and dietary needs. There is no legal or contractual duty on staff to administer medication, and most teenagers are by now responsible for their own medications, but these are areas that should be explained. It is useful to include:

• The use of emollients and topical steroids (what exactly topical steroids are – clear up the fact they are not the banned substances that athletes take)
• Bandaging
• Antihistamines (the fact that the child may be drowsy through taking them)
• Night sedation (many staff may not be aware that this can be a necessary treatment)
• Antibiotics
• Any other treatments and medication they may have for other atopic-related conditions – inhalers, Epipens™, etc.

ASSESSMENTS, EXAMS AND OPTIONS

Teenagers always need gentle pressure to keep up with their schoolwork! However, if a pupil has been absent frequently through their condition, teachers can help to ensure they don’t get behind with their work.

Unfortunately the crucial times during the school year fall during the hot summer months when eczema is already exacerbated. Most testing (Key Stage 3, GCSE and A levels) takes place at this time of year causing additional stress, which may aggravate the eczema. There is also the additional irritation from heightened pollen levels for those who also have asthma and/or hay fever.

Some ways to ease the situation at exam time are:
Allow the pupil to sit in a cool room
Always sit away from hot windows
Suggest using a cotton seat-cover for plastic chairs
Apply to the appropriate examination boards for dispensation which may include:
Extra time for pupils with writing difficulties due to eczema on their hands
Permission for the pupil to record answers on tape
Provision of an emanuensis (someone to write down answers under the pupil’s instruction)
Re-location to the special needs department
Re-location to a hospital ward.
If there is a sudden flare-up of eczema at the time of the exam and performance may have been affected by pain or lack of sleep, a doctor’s note can be submitted to the board.

When selecting options in Year 9, or considering work experience, it is important that the teenager gets early guidance on areas of work that may cause problems for someone who currently has (or has had in the past) severe eczema, especially on their hands. We need a balance – work experience is extremely beneficial, and putting obstacles up is not helpful to anyone. However they may do well to avoid careers where there is frequent hand washing, exposure to detergents or possible contact with irritant substances or chemicals. Further details can be found in our fact sheet, Working with eczema, and this whole area will also be covered in a main feature in a future Exchange.

LEGAL IMPLICATIONS

The Government is currently promoting inclusive education so that all children, where appropriate, are educated in mainstream. A child with severe eczema will only be regarded as having special educational needs if the condition affects their education. This is made clear in the Special Educational Needs Code of Practice 2001, which states:

‘A medical diagnosis or a disability does not necessarily imply Special Educational Needs (SEN). It may not be necessary for a child or young person with any particular diagnosis or medical condition to have a statement, or to need any form of additional educational provision at any phase of education. It is the child’s educational needs rather than a medical diagnosis that must be considered. Some pupils may not require statements or school-based SEN provision, but they may have medical conditions that – if not properly managed – could hinder their access to education (pg 88 7.64).

This came into force on 1st January 2002 and in the Code of Practice one of the definitions of disability is from the Disability Discrimination Act 1995 – ‘A person has a disability for the purposes of this Act if he has physical or mental impairment which has a substantial and long-term adverse effect on his ability to carry out normal day-to-day activities (Section 1(1))’

This new code of practice assumes that all teachers are, or will become, teachers of SEN and that the child gets the support through the graduated response in the Code of Practice. Any pupil who is identified as having SEN will be issued with an Individual Education Programme, an IEP (at School Action). This reflects the child’s individual needs, over and above what the school is expected to deliver through the National Curriculum. There are mechanisms within the Code of Practice (School Action and School Action Plus) that mean that the school receives money from the LEA to help them support the pupil’s needs. If the condition is severe enough, the child could be put forward for statutory assessment in order to produce a statement of SEN. To do this, the school has to show: evidence of the use of delegated budget; that they have liaised with all appropriate agencies (i.e. health service, counselling, educational psychologist), as appropriate; and that the condition is deemed lifelong. The statements for children with medical conditions tends to be under the umbrella of physical disability/medical condition.

An important point of contact at the school is the Special Educational Needs Coordinator (SENCO) who can facilitate whole-staff training/awareness of your child’s particular needs, i.e. Epipen™ training, need for extra time to shower, or being able to leave the room quietly to alleviate itch-scratch cycles.

Flexibility within school practices can make a huge difference.