Eczema

Understanding Eczema

Millions of people worldwide suffer from the skin condition eczema. More than 15 million people in the United States alone have this condition. If you are one of them, you most likely have red, raised, itchy patches that sometime become infected or "weepy." Eczema tends to occur on the face, neck, upper back or chest, wrists, hands and in the folds behind the knee and elbows.

Let’s look at the causes, triggers and treatments of this inflammatory skin condition, which may also be called atopic eczema.This skin disorder is generally attributed to a malfunction in the body's immune system. You may have an increased level of IgE antibodies in your blood. Eczema tends to occur in people who have a family history of allergies. Many children who get this disease outgrow it at puberty, but later develop "dermatitis" or eczema as adults. Risk factors may include exposure to tobacco smoke, skin infections, changes in climate, irritating chemicals and food allergies.

Eczema is a hypersensitivity reaction. Here's kind of how it works: Your body is more "reactive," or sensitive to things, so anything that touches your skin, or affects it from inside or outside, will make you itch. That itch will make you scratch, though you may even be unaware that you are doing so. The scratch will bring out the eczema, and then you have a problem.

There are different sizes of red patches. There can be some scaly patches; they are most often very itchy and uncomfortable. Some people have small bumps that stick up, and some have bumps with fluid in it. In those who do a lot of scratching, the skin markings are thicker and you can see the skin much easier than in people who have had the condition on an acute basis. Identifying eczema may be tricky. (My husband has seen dermatologists who didn't even recognize that he had it!) You may see it on infants, too.

Other conditions often get confused with eczema, leading dermatologists to simply diagnose a case of "contact dermatitis." What is known is that certain triggers do seem to cause flare-ups. These include lower humidity, lower temperature and certain clothing, like wool. Stress can make any skin condition worse, whether it's eczema, psoriasis, acne, herpes or cold sores. Psoriasis sometimes resembles eczema, but the distribution will usually make it more obvious. A family history of eczema may be present; and sometimes a biopsy will be helpful. The best advice to give someone is to ward off a flareup if he can. Ask your parents if they have ever had the condition. See a dermatologist if it gets infected or if you are unsure it is eczema.

The first line of defense is usually administering something to keep the skin from being so dry. We use what are called emollient creams or lubricating creams or ointments. Traditionally, steroid creams or ointments were used for flareups, but they had side effects when used long-term. Often, hydrocortisone creams are used. I personally have not seen them to be very effective against very itchy eczema. Non-steroidal preparations offer a treatment that is not only effective but seems free of long-term side effects. This is the way to go if you can. There are also herbal treatments that may work for you. Acupuncture has been known to help eczema also.

Oral antihistamines (like Benadryl®) can be used to reduce itching, and can be very useful at night, when patients are unable to control their urge to scratch the skin. Ultraviolet light therapy also reduces itchiness in some people.

A new class of drugs for mild to moderately severe cases of eczema is that of the topical immunomodulators, or TIMS. Studies have shown that these drugs improve or completely clear symptoms in the vast majority of cases, and pose little or no safety concerns. Elidel (pimecrolimus) and Protopic (tacrolimus) are the only drugs in this class that are available thus far. Studies of Elidel have shown that application of TIMs at the first sign of itching can reduce severity and/or onset of flares.

Remission in eczema can last for a few weeks, or for months, or sometimes even years. Some people seem to outgrow it, but for many people, it remains a lifelong condition with no cure.



What To Do To When You Have Eczema

1. Avoid drying or irritating the skin.
2. Take no more than one shower or bath per day, and do not sit in a soapy bath.
3. Only use soap on your armpits, groin and feet.
4. Uses soaps that don’t dry out the skin, such as Aveeno, Neutrogena or Cetaphil.
5. Pat your skin dry after a shower or bath--do not rub it!
6. Before your skin is completely dry, cover it with an agent that helps hold in moisture, such as Eucerin, or mineral oil. (Avoid petroleum products.)
7. Avoid scratchy clothes (cotton is often the best).
8. Avoid foods that tend to trigger the condition. (Do test to determine which foods those may be. The most common are wheat and dairy products.) Only 30 percent of those affected have their condition worsened by eating certain foods.

Remember, there is no cure for this very annoying condition. But there are ways to manage it.