What Is Eczema?
Eczema, also known as dermatitis or atopic
dermatitis, is a chronic, itchy inflammatory condition of the skin that is often
associated with asthma or hay fever. Eczema is an inability of the skin to
properly retain water. It can be made worse by irritating clothes or chemicals,
change in temperature or humidity, stress, and skin infections.
Causes of Eczema
Although dermatologists do not fully understand the exact cause of all
eczema, they have identified a variety of potential sources. Some people
may have a genetic predisposition because eczema tends to be more
common in people whose family members have allergies, asthma, or eczema.
In others, eczema may result from a variety of factors known to trigger
eczema flare-ups, which may include:
- Common household items such as detergents and disinfectants
- Health and beauty products such as medications, soaps, perfumes and makeup
- Chemicals such as industrial and household chemicals, smoke, latex rubber and metals
- Foods such as juices, eggs, peanuts, milk, wheat, fish and soy products
- Living organisms such as dust mites, pollen, molds, animal saliva, pet dander and plant saps
- Fabric such as abrasive clothing
- Environmental factors such as stress, low humidity, dry climates, rapid
heating and cooling, long periods of bathing and lack of moisture on the
If a patient's flare-ups are caused or aggravated by a
contact allergy, patch testing can be done to pinpoint the trigger.
Who Gets Eczema?
Eczema usually starts in early childhood. Children often get eczema
during their first year of life. If a child gets eczema during this
time, dry and scaly patches appear on the skin. These patches often
appear on the scalp, forehead, and face. These patches are very common
on the cheeks, as well. No matter where it appears, eczema is often very
itchy. Infants may rub their skin against bedding or carpeting to
relieve the itch and scratching can lead to a skin infection. Some
people grow out of it, but adults can continue to have eczema either
over their whole body, or more commonly on their hands.
Eczema, Dermatitis and Atopic Dermatitis Treatment Options (not limited to): +Avoid Irritants
Avoid harsh soap, wool clothes, and chemicals. Washing should be done with a mild soap (Dove, Cetaphil, Oil of Olay). For routine bathing, soap should be limited to the face, armpits, and groin. Washing other body parts with soap just removes the natural oils and dries out the skin, making atopic dermatitis worse. Body odor comes from sebum in the groin and armpits, so limiting soap use to these areas will not make you smell. You should try to avoid lanolin products. People with atopic dermatitis are frequently allergic to lanolin (wool oil). Lanolin is found in many moisturizers and skin care products.
Some physicians recommend limiting bathing for people with atopic dermatitis. This is not necessary, but several precautions should be noted. Hot water and prolonged exposure to water and soap will remove the natural oils from the skin and dry out the skin further. Daily bathing is acceptable as long as you keep the temperature warm (not hot), limit the amount of time spent in the water, towel dry, and apply a moisturizer immediately after coming out of the bath or shower.
Moisturizers should be used liberally and frequently to the entire body (2 to 3 times per day). They should be applied immediately after bathing or showering to "seal in" the water (within 2 to 3 minutes). Keeping the skin moist helps to prevent the dryness and prevent flares of atopic dermatitis. As a general rule, the greasier they are, the better they work. Examples of good moisturizers are Cetaphil Restoraderm lotion, Cerave cream, Vanicream, and plain Vaseline petroleum jelly.
Topical steroid creams and ointments are used cautiously only on red, itchy areas as prescribed by a dermatologist. They should not be used in place of a moisturizer. They can be used safely if you carefully follow a dermatologist's instructions, but can thin the skin, cause acne, and cause little blood vessels to become larger and more prominent. Use of very large amounts of topical steroids can even cause high blood pressure, thinning of the bones, and steroid dependence (adrenal suppression).
This is a class of non-steroid immunosuppressive agent. It often times works better than topical steroids and has none of the side effects of topical steroids. It can sting when it is initially applied for the first few days and is much more expensive than topical steroids. These take longer to take effect than topical steroids. They are often used for long term maintenance treatment, along with topical steroids for flare ups.
Oral Benadryl or prescription antihistamines (hydroxyzine, doxepin) can reduce the itching, but usually cause some drowsiness. They are most commonly used at bedtime. Over-the-counter non-sedating antihistamines such as Claritin, Allegra, and Zyrtec can be helpful for itching during the day.
Aveeno (oatmeal) or Cutar (tar) baths are sometimes recommended. Soak for 15 minutes, rinse off, towel dry, and immediately apply a moisturizer.
One of the main functions of the skin is to keep out bacteria. When a person has a bad case of atopic dermatitis and scratches the skin open, the areas can become secondarily infected. Staphylococcus Aureus (MSSA, MRSA) is the most common bacteria found and is usually treated with dicloxicillin or cephalexin – but other antibiotics can also be effective.
To minimize bacterial infection or colonization and to improve severe atopic dermatitis, our dermatologists may recommend bleach baths 2-3 times a week. For kids: ¼ cup bleach in ½ tub of luke-warm water. For adults: ½ cup of bleach in 1 tub of water. Soak for 5-10 minutes, and then shower off using a gentle soap. Blot dry. Then apply topical moisturizers and prescription steroid creams.