Eczema

Definition
Eczema (also known as atopic dermatitis) is a chronic skin condition characterized by itchy, red, scaling patches. A type of eczema, dyshidrotic eczema, is characterized by intensely itchy, tiny, clear, liquid-filled blisters. The blisters may ooze and form crusts. Often, the skin becomes thickened, dry and scaly from repetitive scratching of the skin.

Causes/associated factors
The exact cause of eczema is unknown, but it tends to run in families. People who have eczema appear to have a defect within their immune systems that makes them overreact to irritating substances. People who have eczema often have allergic conditions, including hay fever and asthma. Bathing, hand washing, lip licking, sweating or swimming can make eczema worse by drying out the skin when the moisture evaporates. Humidity and extreme heat or cold can aggravate the condition. Soaps, detergents and some cosmetics can also make it worse. For some people, an eczema flare-up may be traced to diet, excessive perspiration or emotional stress.
Eczema is not contagious or infectious. It commonly develops by age 5 and often improves by adulthood. In fact, many children outgrow the condition by their midteens or earlier. Some people live with eczema indefinitely, however, or develop it as an adult.


Signs/symptoms
Although the color, intensity and location of the rash vary, it always itches. The rash typically begins as itchy, red bumps or blisters, which may ooze and form crusts. The rash may also become dry, brownish-gray, scaly and thick. Symptoms periodically flare up, then go into remission. The cycle is difficult to predict.
For infants, eczema often appears on the cheeks, scalp, arms or legs. For teens and young adults, the condition typically affects the folds of the arms, backs of the knees, ankles, wrists, face, neck and upper chest. Nearly any area of the body can be affected, however, including the palms, backs of the hands, fingers and feet.


Diagnosis
If you suspect that you or your child has eczema, contact your doctor or dermatologist. Diagnosis is based on personal and family medical history and a skin exam. Food elimination diets and skin tests may be done to identify allergies that might be responsible for flare-ups of skin problems.

Treatment/prevention
Treatment varies for each person. The goal is to ease the itching, keep you comfortable, and control the factors that aggravate the rash. The primary treatment is with a topical steroid. Your doctor may prescribe other new topical medications known as immunomodulators, such as pimecrolimus cream (brand name Elidel) and tacrolimus ointment (Protopic). For severe cases, systemic steroids may be given orally (by mouth) or by intramuscular injection. Antihistamines may be prescribed to ease severe itching. Some cases of eczema respond to crude coal tar or prescription-strength moisturizers. If a secondary bacterial infection develops, your doctor may prescribe an antibiotic. Burow's solution may be used to treat weeping crusted areas. Phototherapy (controlled exposure of the skin to ultraviolet rays) can also be tried. A drug called psoralen may be used along with phototherapy. For severe cases in which conventional treatments have been unsuccessful, an immunosuppressant such as cyclosporine may help.
In addition to using any medication as recommended by your doctor, you may want to also try the following suggestions:

Avoid irritating substances such as household cleaners, fabric softeners, detergents, aftershave lotions, perfumed soap, gasoline, turpentine and other solvents. (People who have eczema are more likely to develop skin irritation after exposure to an irritating substance.)

Reduce house dust mites (many people are allergic, making eczema worse). Wash bed linens, pillows and blankets weekly. Replace mattress if old, and use a special mattress cover designed to reduce dust mites. Also wash stuffed toys on a regular basis.

Avoid occupations that require exposure to potentially irritating substances, such as food handling, health professions and janitorial work.

Wear gloves if you must work with water or irritating substances, but avoid the natural latex variety. Wearing cotton gloves beneath plastic gloves can absorb excess sweat. To prevent sweat from collecting inside the gloves, take them off periodically.

Wear 100-percent cotton clothing and avoid wool.

Use lukewarm water -- not hot or cold. Also, limit the amount of time you spend in the water. When drying yourself after bathing, pat your skin dry with a towel or let it air dry.

Use soap only on your armpits, groin and feet. Mild soaps without perfumes are best. You may want to use a soap substitute, available in your pharmacy.

After bathing, use a moisturizer while your skin is still damp to seal in the moisture. Avoid lotions that contain fragrances or numerous ingredients, however. You may want to try petroleum jelly. Your doctor may also be able to give you additional suggestions.

Avoid cigarette smoke and activities or situations that cause excessive perspiration or emotional stress.

Try not to rub or scratch itchy areas. Scratching may make the eczema worse. Scratching may also break open the blisters and lead to an infection. Keep your fingernails trimmed short to minimize the risk of injury in case you do scratch your skin.

Complications
Repeated scratching can worsen the eczema and lead to secondary skin infections. Chemicals and other harmful substances on the skin are more easily absorbed into the body through skin affected by eczema. Be sure to contact your doctor for any signs of infection, such as fever, pus, redness, or increased blistering, weeping, crusting or swelling.
The smallpox immunization is currently being offered to those that would respond in the event of an outbreak. Without a smallpox outbreak, however, it is not recommended that you receive the smallpox vaccine if you have eczema or have had it in the past due to potential serious side effects.


Pregnancy-specific information
The hormonal changes associated with pregnancy may affect eczema. If you're pregnant and notice an eczema flare-up, be sure to tell your doctor. Also make sure that any doctors treating you for eczema are aware that you're pregnant. Some medications may be harmful to your unborn baby.

Senior-specific information
Although eczema is most common in infants and young adults, it can affect older adults as well. Be sure to notify your doctor if you notice any changes in your skin.