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Article on childhood eczema & hard water.

Published in the Healthy Times Oct/Nov 98
Published by Alliance UniChem Plc, Cox Lane, Chessington, Surrey. KT9 1SN

A recent study has found a link between hard water and childhood eczema. Healthy Times explores the health issues behind the headlines. Eczema affects around one in eight children in the UK. In its mildest form, the condition causes a few patches of dry skin, but in severe cases, it can affect the whole body, causing persistent itching and extreme discomfort. Frequent washing is an essential part of the daily management of eczema, as it keeps infections at bay. But scientists at Nottingham University have discovered that in some cases, washing can actually aggravate the condition. A recent study, which was published in the medical journal The Lancet, found that children who live in homes with hard tap water are more likely to suffer from eczema than those Living in homes with soft water. Although this doesn't mean that hard water causes eczema, it may mean that it plays a role in aggravating eczema flare-ups.

The hardness or softness of your domestic water supply depends on where you live and the original source of the water. At present, hard water is supplied to around 60% of households in England and Wales. Hard water contains higher concentrations of calcium and magnesium than soft water. It forms scale that clogs up pipes, blocks shower fittings and reduces the life expectancy of household machines, such as dishwashers. The scum produced by hard water leaves tidemarks that are difficult to wash off baths and basins, and makes it difficult to obtain a lather, so more soap or shampoo is needed for washing.

Families of eczema sufferers and some doctors have claimed for some time that living in a hard water area can make eczema worse, but it's only now that there is scientific evidence to back up these claims. It is thought that calcium and magnesium may directly irritate the skin, or may modify the effects of other chemicals such as soap. ''There are at least two possible ways in which hard water can make eczema worse. First, the salts in hard water could be deposited on the skin causing dryness and irritation. Second, it is possible that using hard water simply means that we use more soaps and shampoos, which we know can irritate the skin of eczema sufferers,'' explains Professor Hywel Williams of Queen's Medical Centre in Nottingham, who co-authored the study. In the study, primary school children aged between 4 and 11 years - were more likely to be affected than secondary school children, suggesting that the link is age-related. It is possible that younger children have greater exposure to hard water during supervised bathing, under the watchful eye of parents, or that older children are not as exposed because they spend less time at home or have less sensitive skin.

It is possible to artificially change the hardness of your domestic water supply. Water softeners alter the chemical structure of water by exchanging calcium and magnesium ions for sodium. Physical conditioners are scale reducers only and do not affect calcium and magnesium levels. According to British Water, it is estimated that an ion-exchange water softener could save over 200 a year for an average family of four through the amount of shampoo, soap and water that you save with a softener.

However, water softeners vary in price and efficiency, so seek advice before you buy. According to Peter Evans, British Water's Quality Water Group's deputy chairman: "It is absolutely vital for any parent of a childhood eczema sufferer who is considering softening their water to deal with a reputable supplier who will provide them with detailed information and advice on the various products available.'

It's too early to say whether water softeners will benefit the health of children with eczema, although some dermatologists do recommend them to their parents. 'It is important that other independent scientists confirm our findings, and that we follow up our study to see whether softening the water of eczema sufferers will improve their condition,' says Professor Williams.

If you do install a water softener, place it downstream to the kitchen tap, as softened water isn't good for you in large amounts and shouldn't be used in cooking or in drinks. There is some statistical (but not clinical) evidence to show that softened water is associated with an increased risk of heart disease. The reason for this is unclear, despite much research. One theory is that the higher Levels of sodium cause an increase in blood pressure - softened water isn't suitable for babies or for people on a Low-sodium (low-salt) diet.

Because water itself has a drying effect on skin, washing with softened water may also aggravate eczema in some people. But it's still important to wash frequently -just apply moisturising emollient products when you do. "Washing keeps the skin's surface germs down, reducing the risk of infection," explains Dr Sue Lewis-Jones, consultant dermatologist at the Wrexham-Maelor Hospital in North Wales. Flare-ups have been linked to a build-up of Staphylococcus aureus bacteria, which are present in a higher density than usual on areas of skin affected by severe or inflamed eczema. To reduce the drying effect of water, eczema sufferers should apply emollients to all affected areas after bathing, or use a specially-formulated product in the bath itself. "If you wash with a bath oil, aqueous cream or soap substitute, you stop the water drying out your skin. Emollients act as an inert barrier, stopping germs getting through, and also pass into skin cells, where they restore the natural oils,' stresses Dr Sue Lews Jones.

Using emollients can be very time-consuming, as the products need to be applied regularly -every few hours if possible. This causes a lot of distress to young sufferers and places a strain on the whole family. In a study published in the British Journal of Dermatology, researchers found that in families where at least one child suffers from severe eczema, 66% of parents said that they did not lead a 'normal' family life. Over 60% felt frustrated or exhausted as a result of attending a child who delayed sleeping or woke at night with itching or scratching. Over 60% of siblings were losing steep too.

Now that researchers have found evidence of a strong link between hard water and eczema, it may be possible to prevent a lot of this distress. "The results of this study are exciting, because if it is confirmed that hard water causes flare-ups in a significant number of eczema sufferers, it may be possible to improve the lives of eczema sufferers by changing the water hardness," concludes Professor Williams.