Eczema

ECZEMA is a sensitive skin condition that can appear on any part of the body. It usually presents as a localized itching rash. The areas are red, scaling, and sometimes cracked. If the area has been rubbed, the skin may be thickened.

Cause: The exact cause is unknown. Research shows that involvement is multifactorial. The skin itself is more sensitive and easily traumatized. There is a predisposition for dry skin that may scale and crack. Contact rashes are common as the skin has a heightened sensitivity to allergens.

Atopic dermatitis, a variant of eczema, is characterized as a chronic skin sensitivity condition. This involves up to 1% of the American population. Its prevalence in children ranges from 5% to 10%. Typically, this condition starts in childhood and may involve the scalp, face, and arms. Many people have recurrent rashes and chronic allergies associated with this condition. Over 80% of atopic people have associated allergies.

Atopic dermatitis may have a genetic predisposition. The risk of a child getting atopic dermatitis is approximately 60% if one parent has involvement. If both parents have involvement, the risk is over 80%. In children, atopic dermatitis usually improves with age. Symptoms are less severe in adulthood.

Asthma is associated with atopic dermatitis. This is consistent with the overall heightened sensitivity of the skin and the immune system. Ichthyosis vulgaris is a chronic skin condition of dryness that is commonly seen in atopic people.

A rough "sandpaper-like" rash, keratosis pilaris, on the outer arms, thighs and/or upper back is seen in some atopic patients. In this condition, the upper cellular layers of skin, containing keratin, plug the follicles and produce a rough, sometimes irritated rash.

Pigment changes, called pityriasis alba, may accompany atopic dermatitis. This presents with lightening or darkening of the skin. This process is secondary to minor inflammation in the skin. The pigmentation is usually subtle but may be pronounced, especially with tanning.

The psychological impact of eczema cannot be overlooked in terms of lifestyle and relationships. Patients experience anger, frustration, anxiety and stress, which in turn can worsen the skin involvement. Unfortunately, this contributes to the itch-scratch cycle. When the psychological component is managed effectively, eczema usually calms down.

Diet: Whether or not diet contributes to, or exacerbates eczema is controversial. Systematic food elimination may be beneficial. However, elimination diets may be very restrictive, making compliance difficult. The most common inciting allergens include eggs, cow's milk, soy products, wheat, peanuts, and fish. Vitamin supplementation may be important to avoid malnutrition while on an elimination diet.

Allergies: Irritant or allergy involvement can be diffuse and variable. Skin tests can be valuable, but are not always reliable. Allergy shots, in general, are not beneficial for eczema. When eczema is chronic and relapsing, it is worthwhile to avoid dust, feather or kapok pillows, down comforters, and feather mattresses.
Wool and rough-fiber clothing may also irritate the skin. Some scientists feel that the dust mite, found in carpeting, is a common cause of household allergies. If this is a suspected source, the carpet should be cleaned, and pets should be kept outdoors.

Recommendations
Affected individuals must understand that they have a heightened skin sensitivity condition. Care and consideration must be taken to avoid skin -irritating situations. Cracks and fissures in the skin must be addressed as they may become infected. Topical anti-inflammatory creams or lotions are necessary if conservative measures are ineffective. The key to effective treatment is daily maintenance.

Bathing: Take brief lukewarm showers and not baths. Do not shower more than once a day. Hot water, long showers, and baths rid the skin of its natural protective oils. If you must take a bath, a lukewarm tub-bath is acceptable, particularly if you put bath oil in the water. Remember, a quick cool shower using no soap, is preferable to a long hot soapy one.

Cleansing: Deodorant soaps and detergents remove the natural skin protective oils leaving the skin dry and irritated. Clear water alone will remove dust, sweat, and grime that accumulates. If cleansing is necessary, use a mild moisturizing or glycerin soap. Use the soap only in the odor-bearing areas, for example, under the arms and in the groin area. Soap must be thoroughly rinsed from these areas as this too can cause irritation. Finally, avoid scrubbing with a washcloth or loofah as this will remove the natural protective oils and irritate the skin.

Lubrication: Immediately after showering and towel drying, while the skin is still damp, moisturizers should be applied. Ideally, moisturizers should be applied twice daily. Topical non-steroid anti-inflammatory or cortisone creams are used before the moisturizing cream or lotion. Generally speaking, the thicker the moisturizer, the more effective it is for irritated skin.

Moisturizing creams or lotions are preferred over oils to moisturize the skin. Lastly, avoid moisturizers with strong perfume smells, as this is a source of irritation in many people.

Anti-inflammatory agents: Conservative measures addressing bathing and lubrication should be attempted before anti-inflammatory treatment. Skin inflammation, however, is difficult to control without anti-inflammatory agents. Traditional cortisone creams and lotions are safe when used correctly. With inappropriate use, cortisone can cause local thinning of the skin. It can also be absorbed internally causing adverse side affects.

Mild over-the-counter hydrocortisone and prescription steroids should be used twice daily followed by a moisturizer until the inflammation has resolved.

Exacerbating Factors:

  • When in flare, avoid soaps, solvents, and other drying products. If the hands are involved, use soaps only after using the restroom or before meals. When showering, use soaps only in skin folds. Take brief, tepid showers and not baths.
  • Avoid woolen or stiff fabrics. Use cotton or cotton blend fabrics that are loose fitting and open-weave.
  • Avoid environmental conditions that irritate the skin. Windburn, over drying of the skin or sunburn irritates the skin and may precipitate eczema. In addition, the skin is sensitive to temperature fluctuations. Try to maintain your home temperature between 68° and 75°.
  • Exercise is encouraged, however, try to avoid sweating when in flare. Sweating irritates the skin.
  • Shower after swimming. The chlorine or bromine in the pool irritates the skin. Apply moisturizers immediately after showering.
  • Laundry detergents are generally not a cause; however, some people are sensitive to the residual detergent in clothing. It is helpful to add a second rinse to the wash cycle.

Additional Tips:

  • Avoid bubble baths.
  • Benadryl is very helpful at bedtime to decrease the itching and provide minor sedation to aid in sleep.
  • Cut fingernails or possibly wear gloves to bed to prevent scratching during the night. Individuals who scratch in their sleep are generally unaware of it.
  • Do not allow a furnace or car heater to blow directly onto the skin. The hot, dry air can make the condition worse.
  • If you live in a dry climate, consider a humidifier or vaporizer in the bedroom. If you have baseboard heating, try a large pan of water next to your bed.
  • Avoid applications of alcohol, astringents, drying lotions or powders to your skin. They can be over drying.
  • Avoid hot tubs or spas. The hot chlorinated water will strip every bit of natural oil from your skin. It may be soothing at the time, but can make the symptoms worse later.

Successful treatment of dry skin includes a thorough understanding of the causes and appropriate treatments. If your skin does not clear with conservative measures, you should consult your dermatologist.