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Eczema

Allergic Condition Affecting the Skin

Eczema is an allergic condition that affects the skin. Another name for eczema is dermatitis. Dermatitis is inflammation of the skin. There are several different types of dermatitis, but the one people usually mean when they say eczema is atopic dermatitis. Atopic refers to a lifelong tendency to allergic conditions such as asthma and allergic rhinitis.

Eczema can be triggered by just about anything coming in contact with the skin. It occurs in atopic people, who are extra sensitive to skin irritation. Dry, flaky skin appears over red, inflamed areas, causing intense itching and burning.

Eczema

Causes

Many substances have been identified as itch "triggers" in patients with eczema, and triggers are not the same for every person. Many times it is difficult to identify the exact trigger that causes a flare-up. For some, it seems that rough or coarse materials coming into contact with the skin causes itchiness. For others, feeling too hot and/or sweating will cause an outbreak. Other people find that certain soaps, detergents, disinfectants, contact with juices from fresh fruits and meats, dust mites, and animal saliva and danders may trigger itching. Upper respiratory infections (caused by viruses) may also be triggers. Stress can also sometimes aggravate an existing flare-up.

Treatments

One of the most important components of an eczema treatment routine is to prevent scratching. Because eczema is usually dry and itchy, the most common treatment is the application of lotions or creams to keep the skin as moist as possible. These treatments are generally most effective when applied directly after bathing (within three minutes is a common recommendation) so that the moisture from the bath is "locked in." Cold compresses applied directly to itchy skin can also help relieve itching. If the condition persists, worsens, or does not improve satisfactorily, another effective treatment is the application of nonprescription corticosteroid creams and ointments to reduce inflammation.

Alternatives to nonprescription corticosteroids include more potent prescription corticosteroid creams and ointments, which are effective, but which may have some side effects. To prevent side effects such as skin thinning, your doctor may limit the length of treatment time and locations where you can apply treatment. For severe flare-ups, your doctor may prescribe oral corticosteroids, but be aware that side effects including new flare-ups can develop when treatment is discontinued (this treatment is not recommended for long-term use).

Skin affected by eczema may frequently become infected. If this happens to you, your doctor may prescribe topical or oral antibiotics to kill the bacteria causing the infection.

For severe itching, sedative antihistamines are sometimes used to reduce the itch and are available in both prescription and over-the-counter varieties. Because drowsiness is a common side effect, antihistamines are often used in the evening to help a person restless from eczema get to sleep. Because of the same sedative effect, though, persons taking these agents should not drive. Tar treatments and phototherapy are also used and can have positive effects; however, tar can be messy. Phototherapy requires special equipment (lights). Finally, in cases where eczema is resistant to therapy, your physician may prescribe the drug cyclosporine A, which modifies immune response; however, this is used only in extreme cases because of its association with serious side effects.

Prevention


  1. Room temperature should be kept as low was is consistent with comfort.
  2. Bathing should not be excessive (once every 1-2 days), and the bath water should be warm but not hot. Bath oils may be added (Alpha-Keri, Demol, Lubath). Pat dry.
  3. Excessive exposure to soap and water, solvents, or other drying compounds should be eliminated. It is the very mild irritants, often used casually and  without thinking, that cause the most trouble. Mechanical trauma from rough (often) or constricting clothing must be avoided.
  4. Frequent use of emollients should be encouraged. The lubricating agents may range from lotions (Keri, Lubriderm) and creams (Keri, Nivea) to thicker preparations (Aquaphor, Eucerin, hydrated petrolatum, petrolatum). They are best applied when the skin is moist.
  5. Choices of soaps include: Dove, Caress, Neutrogena, Aveeno, Cetaphil.
  6. Avoid Ivory soap or detergents with dyes or fragrances.

Contact Information

Allergy and Inflammation - Research
Department of Medicine
Beth Israel Deaconess Medical Center
Center for Life Science, 9th floor
330 Brookline Avenue
Boston, MA 02215
617-723-4110
617-735-4115