Emollients and sensory differences

Question

My five-year-old son has always been very sensitive and has recently been diagnosed with autistic spectrum disorder (ASD). He has atopic eczema and very dry skin but he has increasingly found the feel and smell of emollients difficult to cope with. He is starting to refuse all emollients, which is gradually making his skin drier and, in turn, flaring his eczema. We’re finding it a real struggle – any suggestions?

Answer

Julie Van Onselen, Dermatology Nurse Adviser to NES, says: For people on the autistic spectrum or with sensory processing issues, managing eczema can be a real challenge. It is not uncommon for children and adults alike to have heightened or reduced sensitivity to sights, sounds, taste, smells, textures and touch. Adults with sensory issues have said that even a gentle touch can feel like fire or barbed wire, so it’s important to find the best solution.

As emollients are usually applied to the body with touch, this can cause problems. The result of not applying enough emollients can also alter sensation, with the feel of dry and scaly skin. Practically, to try and prevent itch and stop your son’s eczema from flaring, it is important to try and find an emollient he can tolerate. Emollients come in different formulations and have different textures, including greasy ointments, oily creams, lighter gels and even sprays. So, do try a variety – sprays can work well for people who don’t like being touched or dislike the texture of emollient on their skin.

Bath oils are not often prescribed, but this is one situation where a bath oil could really help restore the skin barrier without physical touch. Once your son is comfortable in an emollient bath, you could introduce a leave-on emollient as a soap substitute. This may be a good option for a formulation with a comfortable texture for your son. Over time, you might help him get into a routine of applying his own emollients – perhaps with a reward system if he finds this motivating.

When you do apply products, warn your son you are about to touch him and approach him from the front. Gradually introduce different textures to touch (for example, have a box of small pots of
different emollients that he can try). If clothing causes him sensitivity too, remove any tags or labels, turn clothes inside out so there is no seam touching his skin and (as for all children with eczema) opt for natural fibres.

If your son has a flare, he may be prescribed a short burst of topical steroids too. These are only applied once daily, so you could try and do this when he is asleep. However, sleep can be a challenge for children on the autistic spectrum, too, so if this causes problems do talk to your GP or dermatologist. If the problems are ongoing, an occupational therapist could provide strategies to help your son.

Find out more from the National Autistic Society at autism.org.uk/advice-and-guidance/topics/sensory-differences/sensory-differences.