Understanding Eczema
Millions of people suffer from the skin condition eczema worldwide. 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 become “weepy”. Eczema tends to occur on the face, neck, upper back or chest, wrists, hands, in the folds behind the knee and elbows. Let’s look at the causes, triggers and treatments of this inflammatory skin condition. It 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 more sensitive to things, and so anything that touches your skin, affects it from inside or from outside, will make you itch. That itch will make you scratch, you may even be unaware that you are scratching it. The scratch will bring out the eczema, and then you have a problem.
There are different sizes of patches that can be red. There can be some scaly patches. The are most often very itchy and uncomfortable. Some people have little bumps that stick up and some have bumps with fluid in it. And those who do a lot of scratching, the skin markings are thicker and you can see the skin much easier than people who’ve had it on an acute basis. Identifying eczema may be tricky. (I know, my husband has had dermatologists who didn’t even recognize that he had eczema!) You may see it on infants too, they get it also. Here is a photo of an infant with a nasty cases of eczema.
Other conditions often get confused with eczema and then a dermatologist might just say it is “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, cold sores, etc. Psoriasis sometimes resembles eczema, but usually the distribution will 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 flare-up if you can! Ask your parents if they have ever had it if you do. See a dermatologist if it gets infected or if you are unsure if it is eczema.
The first line of defense usually is something to keep the skin from being this dry. So we use what we call emollient creams or lubricating creams or ointments. Traditionally, steroid creams or ointments were used for flare-ups, but they had side effects when used long term. Often hydrocortisone creams are used. I personally have not seen them to be very effective with very itchy eczema. Non-steroidal preparations offer a treatment that is not only effective but seems free of long term side effects. That 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, which 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 called 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 with 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 months. It can last for a years sometimes. Some people seem to outgrow it, but for many people it remains a lifelong condition with no cure.
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What To Do To When You Have Eczema?
- Avoid drying or irritating the skin
- No more than one shower or bath per day, and do not sit in a soapy bath
- Only use soap on armpits, groin, and feet
- Uses soaps that don’t dry out skin, such as Aveeno, Neutrogena, or Cetaphil.
- Pat skin dry after shower/bath — do not rub it!
- Before skin is completely dry, cover with an agent that helps hold in moisture, such as Eucerin, or mineral oil. (I say avoid petroleum products).
- Avoid scratchy clothes (often cotton is the best)
- Avoid foods that tend to trigger (do challenges to determine which ones may trigger — most common are wheat and dairy). Only 30% of those affected are worsened by certain foods.
- Remember, there is no cure for this very annoying condition, but ways to manage it!
- Decrease stress. Easy to say, harder to do. See Stress Skills , Stress Management and Tai Chi and Yoga.
- Psoriasis
Resources on the Web:
- National Eczema Association
- National Eczema Society in the UK
London — (Helpline): 0870 241 3604