Eczema

Overview

Not just a childhood itch

Eczema, or atopic dermatitis is a chronic, itchy, blistered rash that can make its first appearance in infancy (sometimes called infantile eczema). About 5% of children have eczema. This condition is believed to be an immune system abnormality, and occurs most commonly in children who have asthma, hay fever, rhinitis, hives, or chronic sinus problems, or have relatives with these conditions. It generally appears in specific places such as the upper arms, in front of the elbows, and behind the knees. A child may have flare-ups of eczema throughout childhood, however, 90% of eczema sufferers see the condition clear up by the onset of puberty.

Acute atopic eczema is characterized by a red, bumpy, swollen rash that itches intensely. Persistent scratching can cause oozing and crusted lesions. The lesions can develop secondary infections.

Detailed Description

Atopic eczema is quite itchy and scratching only makes it worse. It follows a fairly predictable pattern of appearance on the body as a child grows, starting with the face, abdomen, diaper area, lower back, and calves of infants. Later, the pattern shifts, starting on the fronts of elbows, thighs, shins, back of ankles, backs of knees, and backs of upper arms.

If that weren't bad enough, scratching can lead to secondary infections and permanent damage to the skin.

Allergies and eczema are often related, so you might find that certain foods or conditions cause flare-ups. A good part of eczema treatment is prevention, including learning to identify which foods or conditions precipitate a flare-up and avoiding them. Stress and changes in temperature and humidity are important factors.

There are two other common types of atopic dermatitis:

• Nummular or discoid eczema is mainly an adult disorder. This persistent, itchy rash may come and go without any apparent reason, although many experts believe it is particularly reactive to changes in the environment. Small, round lesions marked by tiny blisters, scabs, and scales may ooze and form crusts. It is most commonly seen on the arms, legs, and buttocks, but it may also appear on the torso.
• Steatotic eczema occurs mainly in elderly people. This condition causes the skin to become very dry and scaly.

How Common Is Eczema?

Eczema can affect people of all ages but is more common in infants and young adults. It affects about 10% of infants and close to 15% of the U.S. population overall. The condition usually improves in childhood or sometime before age 25. In teens and young adults, eczema most commonly affects the elbows, knee folds, ankles, and wrists. It generally improves by puberty and eventually localizes to the hands.

About 60% of people with eczema have skin problems throughout life. About 80% of people with eczema have family members with similar skin problems.

What to Expect

Atopic eczema is a chronic disease that flares and subsides periodically. The overwhelming majority — 90% — of patients see the disease spontaneously clear itself before the onset of puberty. Throughout the course of the illness, it can be managed with conscientious treatment.

Conventional Treatment

Goals of Treatment

Atopic eczema cannot be cured, but it can be treated effectively. Before the onset of puberty, 90% of patients experience spontaneously healing of the disease.

Mild cases of atopic eczema can be treated quite easily with over-the-counter creams, ointments, antihistamines, and bath preparations. More serious cases require persistent, diligent treatment to keep symptoms under control and may require oral corticosteroids and antibiotics.

The goal of treatment is to relieve itching, inflammation, and other discomforts, to return skin to its normal appearance, and to restore the barrier function of the skin.

Treatment Overview

Most treatments designed to treat atopic eczema are rooted in moisturizing the skin, while soothing the skin and controlling itching. These therapies include therapeutic baths.

In addition, mild corticosteroid creams or ointments, even an antihistamine at bedtime, may control itching. Severe atopic eczema may be treated with prescription corticosteroid tablets. For adults, ultraviolet light treatments plus oral doses of psoralen — a drug that intensifies the effects of ultraviolet light — may help.

There are also general measures that will make living with atopic eczema easier:

• Avoid stress. Stress can exacerbate or cause a flare-up.
• Take lukewarm baths or showers — avoid very hot water, and keep them short.
• Wash new clothes before wearing them. Rinse laundry twice.
• Wear cotton-lined rubber gloves when cleaning.
• Bathe every other day, and use super-fatted soaps.
• Use hypoallergenic, total-body moisturizers, bath oil, etc.
• Avoid strenuous exercise and sweating. Sweating will only worsen your condition.
• Avoid substances that may exacerbate a flare-up (wool, detergents, perfumes, perfumed soaps, etc.).
• Brief exposure to the sun (but not sunburn) may be helpful.
• Humidify your house.

Drug Therapy

Drugs most commonly prescribed
Drugs of choice involve the use of medications including: Topical corticosteroids of varying strength Oral antihistamines to relieve itching Oatmeal lotions and baths Barrier creams
Erythromycin
Second choices
If alternatives are needed, systemic steroids, like prednisone, may be taken over short periods of time. Usually, these cases are severe. For stubborn eczema, intralesional steroids may be administered.
buy Prednisone
Imuran

Appropriate Health Setting

The appropriate healthcare is outpatient from a family physician, pediatrician, dermatologist, or internist, and self-care after diagnosis.

Possible Complications

Possible complications arising from eczema include:

• Skin infections
• Greater risk of later developing cataracts
• Atrophy of face and skin folds due to corticosteroid use
• Systemic absorption of steroids with cushingoid condition
• Irritation due to contact with substances such as wool (lanolin), nickel compounds, etc.

Activity and Diet Recommendations

Those with outbreaks of atopic eczema should avoid any activity that causes sweating or overheating. Avoid stressful activities, which can exacerbate the outbreak.

When eczema carries into adulthood, it is usually unrelated to food allergies. Some studies show, however, that children with atopic eczema can have sensitivities to certain foods. Identify the foods that spark a reaction, and avoid them. Some foods cause allergic reactions more frequently than others do: milk, dairy products, eggs, shellfish, wheat, soy, peanuts, tomatoes, and citrus fruits.

Considerations for Children and Adolescents

Children with very severe atopic eczema should not be vaccinated against smallpox. Such vaccinations can cause eczema herpeticum, a serious illness requiring hospitalization. Check with your doctor about the appropriate timing of vaccinations.

Atopic eczema is generally a disease of childhood. Take special care that children's fingernails are clipped short and their hands are kept clean. Scratching with dirty fingernails can cause serious secondary infections.