Eczema

Dec 18, 2013
2014 / January 2014

Eczema is a general term for dermatitis or inflammation of the skin. The most common types are atopic dermatitis and seborrheic dermatitis. Eczema is not contagious.

Atopic dermatitis affects 30 million Americans. Although it is not an allergic reaction, it is common among people with a family history of seasonal allergies and asthma. Atopic eczema is common in infants and may start as early as 2–6 months. Most people get AD before age 5, and many outgrow it. It rarely starts in adulthood.

Symptoms include blisters with oozing and crusting, dry skin all over the body, bumpy skin on the back of the arms and front of the thighs, ear discharge or bleeding, and raw areas from scratching. There may be skin coloration changes, redness and inflammation around the blisters and thickened or leather-like areas from long-term irritation and scratching. Intense itching is common and may start before the rash appears.

AD can be made worse by allergies to pollen, mold, dust mites or animals; cold, and dry air in winter; colds or the flu; contact with irritants and chemicals; and contact with rough materials such as wool. Other triggers include emotional stress, dry skin from too many baths and showers or swimming too often, sudden changes in temperature, getting too hot or too cold, and lotions or soaps containing perfumes and dyes. A dermatologist can examine your skin, take a medical history and may take a skin biopsy or scraping.

Daily skin care may reduce the need for medications. Avoid scratching; keep fingernails cut short and wear light cotton gloves during sleep if nighttime scratching is a problem. Keep skin moist with lotions, topical steroid creams or prescribed medications that are free of alcohol, scents, dyes and other chemicals; apply two to three times a day. A humidifier helps. Expose your skin to water as little as possible; take short, cooler baths and showers and use gentle body washes instead of soap. Do not scrub or dry the skin too hard or too long. Apply lubricating skin products while the skin is still damp to help trap moisture.

To help with itching, take over-the-counter antihistamines or apply topical corticosteroids to inflamed areas. A stronger steroid cream may be ordered; use only as prescribed. Other treatments include antibiotic creams if the skin is infected, drugs that suppress the immune system, phototherapy to expose skin to ultraviolet light, and short-term systemic steroids.

Seborrheic dermatitis affects areas of the skin that are oily or greasy such as the scalp, eyebrows, eyelids, creases of the nose, lips, behind the ears, the outer ear and middle of the chest. SD, which seems to run in families, is thought to be due to over-production of skin oil and irritation from malassezia yeast, a part of normal skin composition. SD causes lesions, plaques, greasy or oily areas, scales that look like dandruff, itching, mild redness and hair loss. Risk factors include stress, fatigue, weather extremes, oily skin, infrequent shampooing or skin cleaning, use of lotions containing alcohol, acne and obesity. Seborrheic dermatitis has been associated with neurologic conditions including Parkinson’s disease, head injury and stroke as well as HIV. SD often has extended inactive periods followed by flare-ups, which are common in cold and dry weather.

Infants often develop a form of SD called cradle cap, a harmless, temporary condition in which thick, crusty, yellow or brown scales form over the scalp and may also be present on the eyelids, the ears, around the nose and in the groin. Cradle cap can be seen in newborns and in children up to age 3. It is not dangerous or contagious and is not caused by allergies or poor hygiene. If it itches, excessive scratching may cause additional inflammation and mild infections or bleeding.

A diagnosis of seborrheic dermatitis is based on your medical history and a physical exam by a dermatologist or your health care provider. Treatment includes using over-the-counter dandruff or medicated shampoos. Wash your hair vigorously and frequently, daily at first; loosen the scales with your fingers, wash for five minutes and rinse thoroughly. These shampoos include active ingredients such as coal tar, salicylic acid, zinc, selenium resorcin or ketoconazole.

Prescription-strength shampoos and lotions containing the same ingredients may be ordered for severe cases. Follow your dermatologist’s directions for application. If you have blond, gray or white hair, do not use a shampoo that contains coal tar, since it can discolor your hair. Prescription-strength lotions are usually applied to the skin twice a day. Topical prescription-strength cortisone is helpful for short-term use. Recently, the FDA approved a new class of drugs called topical immunomodulators for the treatment of mild to moderate eczema.

Be prepared for an eczema flare-up when traveling. Research the food you will encounter in a different culture, checking for eczema-triggering ingredients in popular local dishes. Pack plenty of your favorite body washes, lotions, shampoos and medications. Drink plenty of fluids to keep your system less stressed. Pack an anti-allergen travel bed sheet to avoid exposure to harsh detergents or bleach.

The content of this article is for informational purposes only. It is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition.

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