Overview:
Eczema (atopic dermatitis) is a very common skin condition. The skin is red, itchy and dry. With a flare the skin may look “weepy” with fluid leaking and yellow crusting. Active lesion site can get infected with bacterium (especially Staphylococcus aureus), virus (such as herpes or molluscum) or fungus (candida,etc).
Eczema usually starts early in life. In infants, eczema often appears on the face, trunk and extensor surface, but usually skips the diaper area. Children are prone to have eczema at the bends of the elbow, behind the knees and the ears. Adults may also have persistent eczema on hands and feet. Eczema is often concurrent with asthma, allergic rhinitis, and food allergy. Genetics plays an important role in developing eczema. Mutation of a gene called Filaggrin in the skin leads to severe disease.
Common triggers for eczema include environmental allergies (dust mite, animal danders, pollens, etc), food allergies (egg, milk, etc), over-drying, irritations (rough clothes texture, laundry detergent, soap, heat and sweat) and stress.
Management:
The most effective way to treat eczema is skin care. Soaking bath in lukewarm water for 20-30 minutes can keep skin cool and well hydrated. On the contrary, quick bath in hot water takes away fluid from skin via vaporization. Pat dry. Within 3 minutes, apply moisturizer while the skin is still wet, so that the moisturizer can seal water inside the skin. Good moisturizers are hypoallergenic, may contain ceramides to supplement what the eczematous skin lacks. In terms of the power of moisturizing, ointment formula is stronger than cream, and further stronger than lotion.
The main stay medical treatment for flares is topical steroids, which ease inflammation and help skin heal. Topical steroids have different strength for different disease severity. Some patients are concerned of the side effects of steroid, especially on growth. The amount of steroid absorbed through the skin usually is limited. And it is always a balance between risk and benefit. Correct use of topical steroids can treat flares and prevent flares, to restrain the disease at minimum and improve life quality, while keeping the dose of steroid as low as possible. In some cases, for example, severe disease on the face when strong steroid cannot be used, another class of topical medication, calcineurin inhibitors that curbs immune cell functions, can be considered.
Antihistamine can be used to reduce itchiness. Itchiness, if not controlled, leads to scratching for relief. Scratching itself further activates mast cells in the skin to release histamine, which is the culprit for itchiness, thus starting a vicious cycle. The more you scratch, the itchier you get. This is particularly important at night to remedy sleep disruption.
Skin infection, especially from staph, can be a complication of a flare. On the other hand, it also worsens eczematous condition. Antibiotics, both oral and topical, may be prescribed depending on the severity of the condition. Bleach bath is also effective to get rid of colonized bacteria.
If allergy is concerned as a trigger for eczema, allergy evaluation should be performed, and allergens should be avoided. However, this sometimes can be tricky, as the skin usually is “ready to fire” and may give false positive reactions to the allergens skin-tested, and the serum IgE to the allergens can be falsely elevated. So the interpretation should be cautious with careful scrutiny of the history. This is especially true to food allergies. As the natural history of eczema usually runs a wax and waning course, the exact relationship between eczema flares and ingestion of certain foods can be difficult to define, resulting in many confusions and unnecessary removal of foods. In fact, only 1/3 of people with moderate to severe diseases have food allergies.
A few more things you can do to take care of yourself or your children:
- Trim the nails to reduce scratching.
- Use mild soap and detergent.
- Wear loose comfortable clothes, preferably cotton or silk.
- Avoid overdrying. Keep room humidity ~35% (higher humidity may foster the growth of dust mite or molds)
- Avoid getting over heated or sweating. Shower after workout.
- For young children with facial and neck eczema, apply barrier cream (such as Vaseline) to avoid irritations from food and saliva.