East Central Indiana
06/28/2017
Medical Dermatology

Eczema

  • Eczema
    Eczema presents itself with dry, itching skin. The skin will likely be red and cracked as well. It may look like a bumpy rash.

About

Eczema

Atopic Dermatitis (Eczema) results from an inherited tendency for sensitive, itchy and often dry skin. The exact cause is still unknown. It is not contagious. Eczema leaves the skin dry and irritated, causing it to crack and sometimes bleed.

Causes

While doctors are unsure of the exact cause of eczema, it is known that it can be a sign of being allergic to certain foods, plants, or soaps. It is also known that eczema is hereditary. Changes in weather can also affect eczema at times.

Although allergic conditions, such as asthma, hay fever and hives often may be found in patients with eczema and in their families, allergy is not the cause of the skin inflammation. Therefore, a search for specific allergies is not usually indicated. Extremes of heat or cold, vigorous exercising and excessive perspiration can aggravate this condition. Try to keep the temperature and humidity in your house fairly constant. Use your air-conditioner during the summer and a cool-mist humidifier in the winter, keeping the indoor humidity (measured with a hygrometer) at 40-45%.

Risk Factors

While children are more at risk for eczema, people of any age may have it. For some who have it as children, it may go away as they grow up and return again in later years. Those with asthma, hay fever, and certain allergies are more prone to it than others. Someone who has a family member with eczema is also likely to have it.

Symptoms

The skin is often very itchy, which leads to scratching. Scratching makes the rash worse, and stimulates more itching, leading to more scratching and the development of a vicious cycle. Part of the goal of therapy is to break this "itch-scratch" cycle. The skin will likely be red and cracked as well. It may look like a bumpy rash. Eczema also can cause fluid to come out from the cracks left in the skin. If an increased amount of oozing, crust formation or pus is noted or if small pustules (yellowish pimples) develop, call our office. You may need a course of antibiotics.

Diagnosis

To be have a confirmed diagnosis of eczema, a doctor will examine the irritated skin. The doctor can then try to determine if the eczema is allergy related. If it is, the patient could be sent to an allergist to pinpoint the allergen that is causing the eczema.

Dishidrotic Eczema

Dyshidrotic eczema is a condition in which small itchy blisters develop on the hands and feet. The condition may recur at certain times of the year andthe cause is unknown.

The blistering type of eczema is more common in women than in men. People are more likely to develop dyshidrotic eczema when they are under stress, have allergies, have moist hands, are in the water often or do work which exposes them to certain chemicals or components.

Symptoms may include fluid filled blisters on the fingers, hands and feet. The blisters cause severe itching and scaly areas on the skin which may also become red, cracked and painful.

At times a skin biopsy or scraping may be needed to diagnose this condition or rule out other causes such as a fungal infection. If your condition is due to an allergic reaction allergy testing may be done.

Scratching may worsen the condition and prolong healing time, therefore, anti-itch medications, such as Benadryl or Claritin, may be recommended to take at bedtime. Topical medications may also be prescribed for this condition.

Treatment includes topical steroids, sometimes steroid pills (Prednisone) and often, a steroid shot (Kenalog). Treatment is usually very successful, however, the problem may recur later.

Treatment

Treatment

Unfortunately, there is no "magic cure" that will permanently eliminate this skin problem. However, it is usually possible for us to place you on a treatment regimen that lets you keep your eczema under control. If your condition worsens and you can't control it, please make an appointment so that we may make appropriate adjustments in your treatment program. Treatment consists of relieving the itching, decreasing this skin eruption, and treating the dry skin. Antibiotics may sometimes be used. If certain irritants in the patient’s clothes are causing the eczema, they may have to start wearing a different fabric, such as cotton, to treat the eczema.

Prevention

If the eczema is hereditary, there is not much a person can do it prevent it. However, a patient can lessen the severity of their symptoms by avoiding the allergens that cause the irritations to their skin. Changing the fabric they wear, the foods they eat, and the soaps and detergents they use can all have a huge effect on eczema.

Instructions for Patients with Atopic Dermatitis (Eczema)

1. Try to limit bathing to once every other day with a mild soap, such as Dove, or a non-soap cleanser such as Cetaphil or CeraVe. Aveeno may also be used. Avoid harsh or heavily scented soaps. A bath oil may be used if desired, but be careful because oil will make the tub slippery.

2. Lubricate your skin TWICE a day with a moisturizing lotion or cream such as Aveeno, Cetaphil or CeraVe. This is best applied over damp skin, such as after bathing or showering. This traps moisture on your skin, instead of merely oiling it.

3. Apply the prescription medicated cream two (2) times a day to all areas of rash. Use a TINY amount; rub it in gently and well.

4. Avoid rubbing and scratching your skin, as this will aggravate and perpetuate the eruption. A medication may be prescribed to relieve itching. Take it as directed.

5. Avoid wool, harsh clothing, bubble baths, deodorant soaps and other skin irritants. 6. If necessary for secondary infection, an antibiotic may be prescribed. Take it as directed.

*Source:

National Eczema SocietyAmerican Academy of Allergy, Asthma, and Immunology

FAQs

Is there a cure for eczema?

Unfortunately at present there is no cure for eczema but it can be well managed.

What are the main treatments for managing eczema?

There are a number of ways to manage eczema, all of which begin with an effective skin care routine. The following are main treatments used to help manage eczema.

Emollient is the medical term for a non-cosmetic moisturizer. Emollients are required to reduce water loss from skin, preventing the dryness that is typically associated with eczema. By providing a seal or barrier, the skin is less dry, itchy and more comfortable.

Emollients are safe to use as often as is necessary and are available as lotions, creams, gels and ointments. Ointments are preferable for very dry skin, creams and lotions are lighter and suitable for mild to moderate eczema, and are particularly suitable for ‘weeping eczema’.

Gels are heavier than creams but not as thick as ointments.

Topical SteroidsWhen the eczema is under control the continued use of emollients are all that is needed. However, when the eczema flares up and the skin becomes inflamed, a steroid cream or ointment may be required.

Topical steroids act by reducing inflammation and are used in most types of eczema and should not be confused with the steroids used by body-builders. Topical steroids come in four different potencies, mild, moderate, potent and very potent and are also available in different strengths.

The strength and potency of steroid cream/ointment that a doctor or nurse prescribes depends on the age of the patient, the severity of the condition, the part of the body to be treated and the size of the area of eczema to be treated.

The doctor/nurse will also take into account any other medication being taken. Topical steroids are applied to the affected area, as directed by the prescribing doctor/nurse.

Many people have concerns regarding the use of topical steroids and their side effects. As long as steroids are used appropriately and as directed by your doctor/nurse, the likelihood of side effects is very rare. Reported side effects have been largely due to the use of very potent steroid preparations over long periods of time.

Why is cotton recommended for people with eczema, and what other fabrics are suitable for wearing next to the skin?

Many people with eczema find cotton clothing and bedding preferable, as it is more comfortable than wool or synthetic fibres. Cotton is smooth and cool, as it allows the skin to breathe and prevents overheating.

Most people prefer 100% cotton, but some can tolerate a mixture of cotton and another material. Many people with eczema can also wear silk, linen or soft acrylic next to their skin.

Always pre-wash coloured cotton to remove potential irritants such as loose dyes. Cheaper products can cause problems as they may have been finished with an irritant chemical called formaldehyde, which can trigger a flare-up in some people.

Be wary of 100% cotton that can only be washed at low temperatures, as this may have also been coated with a chemical finish.

Look out for rough seams or edges on cotton clothing and bedding. Washing labels can be cut out of clothing if they cause irritation.

How can I reduce the Itching?

Itching is one of the worst symptoms of eczema. There are many methods of reducing the itchiness of the skin and minimising the damage of scratching. Cotton clothing and bedding keep the skin cool and allow it to breathe, whereas synthetic fabrics and wool can irritate.

The use of a non-biological washing powder and avoidance of fabric conditioner can also help to reduce the itchiness of the skin. Nails should be kept short and the skin moist by frequent application of emollients. At night time, a cool bedroom temperature can be helpful as heat can trigger itching.

For children in particular, the itchiness of eczema can be very distressing. Distraction is often the best way of reducing scratching. Cotton mittens or all in one sleep suits can be helpful in reducing the damage to the skin occurring during sleep.

How can I tell if my eczema is infected? What are the signs?

If you think that an infection is present, you should see your doctor as early as possible so that it can be treated accordingly. Infection should be suspected if:

  • the skin has blisters, pustules or dry crusts;
  • the skin is weeping a clear or yellow fluid;
  • there is reddening, itching, soreness and sudden worsening of the eczema;
  • yellow pus spots appear;
  • there are small, red spots around the body hairs;
  • you have a raised temperature, and flu-like symptoms; or
  • you have swollen glands in the neck, armpit or groin

The possibility of infection should always be considered in eczema that is getting worse or not responding to emollient and topical steroid treatment.

I find that winter makes my eczema worse. What can I do to keep it under better control?

Many people find that the cold winter months can exacerbate their eczema. Here are some measures you can take to reduce the impact.

  • Wear cotton gloves when you are outside, underneath your ordinary gloves or mittens
  • If you want to wear a woolly jumper, try wearing cotton or silk clothing underneath so that the jumper does not come into direct contact with your skin. Avoid woolly scarves around your neck as they can make you itch.
  • Wear loose, thin layers of clothing so that items can be added or removed according to temperature.
  • Apply emollient ointment or Vaseline to lips to stop them from drying out.
  • Apply your preferred emollient, especially to exposed areas such as your face, neck and hands, before going outside.
  • If you find that your skin is drier in winter, you could change your emollient cream to an ointment.
  • Avoid extremes of temperatures, such as getting out of a bath and going into a cold room.
  • Do not have your central heating on too high, as sweating can aggravate eczema.

Is there a mosquito repellent suitable for people with eczema?

Unfortunately, all mosquito repellents applied to the skin can cause some irritation. This is especially true of liquid repellents, which are alcohol-based and can sting. Test any repellent on your own forearm first and wait 24 hours to see if you have a reaction.

Some people have found that ankle and wrist bands, which are impregnated with DEET, cause fewer problems. However, long cotton sleeve tops, trousers and socks, especially at night, will provide the most protection.

A mosquito net at night or a repellent that you plug into an electrical socket are also beneficial in warding off the mosquito.

Will my child grow out of their eczema?

Unfortunately, there are no guarantees that a child will grow out of eczema. However, research has shown that 65% of children will be free of eczema by the time they are 7 years old, and 74% by the time they reach 16 years of age.

My child is starting school - have you any advice?

School or nursery should not present problems for a child with eczema if time is taken to ensure that the teachers and nursery staff have eczema explained to them and are given written information about it.

Well before the child’s first term, approach the school/nursery and speak to the teacher or staff. Explain that your child has eczema and what things can be done to manage her skin during the day. Tell the school if the child has to take antihistamines as sometimes they can make a child a little drowsy first thing in the morning.

Provide the school or nursery with a pump dispenser of her emollient. In the classroom ask the teacher if your child can have a desk away from direct sunlight or a radiator as this will help prevent the child getting too hot and itchy.

Can changing mine or my child’s diet help?

Dietary changes can be quite helpful in babies and young children, where the emollients and topical steroids have failed to control the eczema. Children under 5 are at the greatest risk of having their symptoms worsened by food allergies.

It is thought that in about 30% of children with eczema, food may be one of the causes, but a much smaller group than this (about 10%) will have food as their main or only trigger. This means that only a small number of children will be helped by changes in their diet. In other words, it is rarely diet alone that triggers eczema.

The evidence for changing diet in older children and adults is inconclusive and only a small number of adults are helped by diet and because they eat a much wider range of foods than children, finding the trigger is like looking for a needle in a haystack.

In children, dietary changes should not be made without the advice of a GP, nurse or state registered dietician.

*Source:

National Eczema Society

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