Eczema

The term eczema is broadly applied to a range of persistent skin conditions. Eczema is most common in infants. Many people outgrow it by early adulthood. The condition tends to run in families.

People with eczema often have a family history of allergic conditions such as asthma, hay fever, or eczema.

Symptoms

Symptoms may include:

  • Blisters with oozing and crusting
  • Raw areas of the skin from scratching
  • Skin coloring changes -- more or less coloring than the normal skin tone
  • Skin redness or inflammation around the blisters
  • Thickened or leather-like areas, called lichenification, which can occur after long-term irritation and scratching

Both the type of rash and where the rash appears can depend on the age of the patient.

In children younger than age 2, skin lesions begin on the face, scalp, hands, and feet. It is often a crusting, bubbling, or oozing rash.

In older children and adults, the rash is more commonly seen on the inside of the knees and elbows, as well as the neck, hands, and feet.

During a severe outbreak, rashes may occur anywhere on the body.

Itching, which is sometimes intense, almost always occurs. Itching may start even before the rash appears.

The following can make eczema symptoms worse:

  • Allergies to pollen, mold, dust mites, or animals
  • Colds or the flu
  • Contact with rough materials
  • Dry skin
  • Exposure to environmental irritants
  • Exposure to water
  • Feeling too hot or too cold
  • Fragrances or dyes added to skin lotions or soaps
  • Stress

Diagnosis

Diagnosis is primarily based on:

  • Appearance of the skin
  • Personal and family history

The health care provider should examine the lesions to rule out other possible causes.A skin lesion biopsy may be performed, but is not always needed to make the diagnosis.

Allergy skin testing may be helpful for people with:

  • Difficult-to-treat eczema
  • Other allergy symptoms

Treatment

Taking care of your skin at home may reduce the need for medications.

Avoid scratching the rash or skin if you can:

  • Relieve the itch by using a cold compress and taking antihistamines to reduce severe itching.
  • Keep your child's fingernails cut short. Consider light gloves if nighttime scratching is a problem.
  • Keep the skin moist (called lubricating or moisturizing the skin). Use ointments (such as petroleum jelly), creams, or lotions 2 - 3 times a day. Moisturizers should be free of alcohol, scents, dyes, fragrances, or other chemicals.

When washing or bathing:

  • Keep water contact as brief as possible and use less soap than usual. Short, cooler baths are better then long, hot baths.
  • Do not scrub or dry the skin too hard or for too long.
  • After bathing, it is important to apply lubricating creams, lotions, or ointment on the skin while it is damp. This will help trap moisture in the skin.

Medications

  • Antihistamines taken by mouth may help with itching or if you have allergies. Often you can buy them without a prescription.
  • Most causes of atopic eczema are treated with medications that are placed directly on the skin or scalp (called topical medicines).
  • At first, you will probably be prescribed a mild cortisone (or steroid) cream or ointment. If this doesn't work, you may need a stronger steroid medicine. You may need different strengths of steroids for different areas of skin.
  • Topical medicines called Immunomodulators (TIMs) may be prescribed for anyone over 2 years old. TIMs include Protopic and Elidel.
  • Creams or ointments that contain coal tar may be used for thickened areas.

Other medicines that may be used include:

  • Oral or injected corticosteroids when the eczema is severe
  • Antibiotic creams or pills if the skin is infected
  • Allergy shots (immunotherapy)

Expectations

Eczema is a chronic condition, but you can control it with treatment, by avoiding irritants, and by keeping the skin well-moisturized.

In children, it often clears beginning around age 5 - 6, but flare-ups will often occur. In adults, it is generally a long-term or recurring condition.

People with eczema tend to have dry skin that flares up more in the winter, when the air is cold and dry.

Complications

Complications may include:

  • Infections of the skin caused by bacteria, fungi, or viruses
  • Permanent scars

Prevention

Studies have shown that children who are breast-fed are less likely to get eczema. This is also true when the nursing mother has avoided cow's milk in her diet. Other dietary restrictions may include eggs, fish, peanuts, and soy.

Eczema tends to run in families. Controlling stress, nervousness, anxiety, and depression can help in some cases. Keeping the skin well-moisturized and avoiding irritants is important.

Contact your Dermatologist

Call for an appointment with your Dr. Tomi if:

  • Symptoms of eczema do not respond to moisturizers or avoiding allergens
  • Symptoms worsen or treatment is ineffective
  • You have signs of infection (such as fever, redness, pain)

Tips for eczema management

Moisturizer:
This is a very important aspect of skin care. Apply once daily especially after bath and/or shower when the skin is still damp. Clinderm cream, Nivea, plain vaseline, vaseline cream, Dermabase, Cetaphil cream, and Glaxal base. Avoid products containing Lanolin, Vitamin E, fragrance and colour.

Soaps:
Use to areas only as necessary. Dove unscented, Cetaphil cleanser, spectro gel, Trisan, Allenbury's soap, Neutragena oatmeal, or dry skin soap.

Detergents:
vory Snow and Tide Free are usually safe; add vinegar and water to rinse cycle. Avoid fabric softeners and dryer sheets.

Shampoo:
if recommended, restrict to Nuetragena or Clinderm shampoo and conditioner.

Bathing:
A shower or bath may be taken but keep it short and avoid extremely hot water. No bubble baths. Pat dry and apply moisturizer or prescription afterwards.

Clothing:
Wear cotton as much as possible. Avoid wools or mixed synthetic fabrics.

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