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Childhood Eczema and Water Hardness - Information to Parents

Although not life threatening, eczema can be a miserable condition for children and their families, causing itching, sleep loss and distress. Eczema has probably been increasing over the last 20 years, and today it affects around 15 to 20% of British schoolchildren. Although hereditary factors are important, there are good reasons to suspect that the environment, too, may play an important role in eczema. Apart from allergies to things like house dust mite and possibly some foods, little is known about which things in the environment may be important in increasing the risk of eczema.

For a long time now, families of eczema sufferers and some doctors have claimed that living in a hard water area may make eczema worse, yet there has been no hard scientific evidence to back up these claims. Recently at the University of Nottingham, a team of researchers involving medical geographers, dermatologists, asthma specialists and statisticians, have found that eczema is around 50% commoner in primary schoolchildren living in hard water areas when compared with children in the soft water areas.

How the research at Nottingham was carried out

The research team studied 4,141 primary and 3499 secondary schoolchildren in the Nottingham area by asking them questions about symptoms of childhood eczema. Detailed information was then collected on water hardness for the survey area. The information on the frequency of eczema was then mapped onto the water data in such a way as to enable the researchers to say how common eczema was in the different water hardness zones.

What did the study show?

That primary school children living in the hardest water areas were 50% more likely to have had eczema in the last year when compared with the children living in the softest water areas.

That eczema is very common: 23% of primary schoolchildren in Nottinghamshire had suffered from eczema symptoms at some stage in their life.

That the link with water hardness and childhood eczema was not due to differences in the ages or social class background of the children studied.

That the link with hard water was not present for secondary schoolchildren

Do the study results mean that hard water causes eczema?

No, but it could a play a part in causing eczema flare-ups in some children. There is no single cause to childhood eczema - it is probably a mixture of hereditary and environmental factors. These environmental factors could be allergic (eg house dust mite) and non-allergic factors such as contact with soaps, hard water and drying winds.

All we have shown so far is a possible association between childhood eczema and hard water - this is not the same as saying that hard water causes eczema. It may be possible for instance that a 3rd factor which also increases with water hardness is responsible for our findings. This is why it is important to directly test whether water softeners actually improve eczema by doing an experiment or clinical trial in eczema sufferers.

If the results are true, why should hard water affect eczema?

If the research findings are indeed true, we need to try and explain them. 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.

What should you do as a parent?

It is most important that you do not go rushing out to buy an expensive water softener for your child, based only on the findings of this study. It is too early to say whether this action will benefit your child until more research is done. By all means avoid using soap on your child's skin if he/she has eczema - you can use a soap substitute like aqueous cream instead. Reducing house dust mite levels in your child's bedroom by frequent vacuuming and mattress covers might also be helpful in the long term, especially of your child suffers from asthma as well.

Remember that although there is no cure for eczema at the moment, most children grow out of it. The condition can be controlled in the majority of cases with simple treatment. You should discuss your child's eczema with your doctor, rather than experiment yourself.

What next?

The results of this study are exciting, because if it confirmed that hard water causes flare-ups in a significant number of eczema suffers, it may be possible to improve the lives of eczema sufferers by changing the water hardness.

It is important that other independent scientists confirm our findings, and that we follow up our study with another study to see whether softening the water of eczema sufferers will improve their condition. We are planning top do a pilot study of this later this year.

For further information about eczema

Please contact your doctor or write to:

National Eczema Society
Hill House
Highgate Hill
London
N19 5NA.

This research was sponsored by the British Skin Foundation and the University of Nottingham Professor Hywel Williams, August 14th 1998.