How to Live With Eczema

Symptoms: Unbearable Itching

The first symptoms of eczema are very dry, flaky, red rash-covered, intensely itchy skin. If left untreated, eczema can become infected and develop into crusty scabs and blisters that are itchy, painful, and oozing. This happens when people scratch the rash-covered skin, leaving it raw and open to bacterial (usually staphylococcal), and less commonly viral (usually herpes) infection.

Although eczema can develop anywhere on the body, the most common areas affected are the face, scalp, hands, and areas where the skin folds, such as behind the knees, and in the creases of the elbows.

Triggers: Learn What to Avoid

While the cause of eczema is not known, the triggers for the condition are. For virtually all who suffer with eczema, one or more of the following will trigger and/or worsen the condition:

• Soaps and body cleansers, especially those that are strong and/or highly scented
• Harsh laundry detergents
• Irritating clothing, especially wool and acrylics
• Very cold, dry conditions and very hot, humid conditions
• Hot water
• Sunburn

In addition, the following may also trigger an eczema outbreak:

• Animal hair and dander (especially cats—and to a lesser degree—dogs)
• Dust
• Cleaning solvents
• Emotional stress

Dr. Jeffrey Dover, associate chairman of the Department of Dermatology at Boston's Beth Israel Deaconess Medical Center points out that "In most patients, limited exposure to the sun will make their eczema better. However, in about 10% of patients, exposure to the sun will cause their eczema to flare up."

Finally, in rare cases, some people with eczema (especially young children) may react to one or more of certain foods, including milk, citrus fruits, wheat, eggs, fish, shellfish and/or peanuts.

Prevention: Avoid Your Triggers

While there is no known cure for eczema, the symptoms can be greatly minimized by taking a number of preventive measures. The most important is to avoid circumstances and materials that trigger the condition. Here are some examples on how to avoid triggers:

• Washing clothes in mild, hypoallergenic detergents.
• Washing and showering with lukewarm water, and using milder, unscented soaps or body cleansers sparingly. These products are usually prominently labeled as "soft" or "mild."
• Showering with lukewarm—not hot—water, and no more than once a day.
• Applying emollients to keep the skin moist and well lubricated throughout the day, but especially after washing, bathing, or swimming. Products should be applied immediately after drying off, while the skin moist. Patting dry is much better than rubbing with a towel.
• Wearing looser-fitting cotton or other non-irritating clothing next to the skin.
• Keeping the living environment as clean and dust free as possible.
• Avoiding or minimizing contact with pets and other animals.
• Avoiding emotional stress.
• Avoiding any foods that trigger the symptoms. However, food allergies tend to be rare and assessing individual food triggers can be very difficult. Methods for identification include avoidance of a suspected food trigger for two to three weeks to see if the condition improves, and/or having an allergist administer a skin test known as a radioallergosorbent test (RAST). However, very often there is no good clinical correlation between a positive RAST test and eczema. Because growing children have critical nutrient needs, avoiding possible food triggers is not recommended unless the exact food trigger has been solidly identified and you've discussed this with your child's health care provider.
• Wear gloves when cleaning with solvents and when exposed to the cold. Consider wearing light gloves at night to reduce scratching.

Treatment: There Is Relief

Along with avoiding as many triggers as possible, there are a number of treatments for eczema. In addition to lubricating the skin with fragrance-free moisturizing ointments, creams and lotions to help prevent outbreaks and bathing with oatmeal-based products will help keep initial stage eczema from flaring to its more serious stage. If, however, the condition does become more severe, numerous other treatments can be prescribed. These include the following:

Corticosteroids—Topical (applied on the skin) steroid ointments and creams are often very effective at clearing up or reducing severe eczema. The lower strength varieties (now sold over-the-counter) are believed to be safe to use for months at a time.

In some instances, higher strength topical steroids may be prescribed by a primary care physician or dermatologist. These are generally prescribed only for short periods of time (a few days to a couple of weeks at a time), since they can cause side effects, including thinning of the skin.

"High strength topical corticosteroids should never be used on the face except under the direct supervision of a dermatologist, since they can cause glaucoma [in addition to] thinning of the facial skin," Dr. Dover cautions.

Immunomodulators (calcineurin inhibitors): Topical tacrolimus (Protopic) and pimecrolimus (Elidel) are effective for mild to moderate eczema. These are especially useful on the face as they do not thin out the skin or cause glaucoma. Although safety concerns with regard to risk of lymphoma have been raised from animal experiments, to date there is no evidence to support these concerns in humans.

Immunosuppressants—Oral cyclosporine may be used in extremely severe outbreaks of eczema.

Antihistamines—Oral antihistamines (either over-the-counter or prescription strength) may be prescribed to ease the itching, make the patient more comfortable, and thus prevent (or at least lessen) the scratching that further inflames the eczema.

Oral steroids—In extremely severe cases, oral steroids may be prescribed for a brief (one to four week) period to bring the eczema under control.

Antibiotics—In those instances where eczema becomes complicated by a staphylococcal infection, topical or oral antibiotics may be prescribed to kill the bacteria and clear the infection and inflammation.

Phototherapy—Phototherapy can also be an important treatment for people with severe eczema. It involves the use of UVA and/or UVB exposure in people over age 12. Photochemotherapy (also referred to as PUVA), is a type of ultraviolet radiation treatment used for both eczema and psoriasis when phototherapy alone does not work. It is a combination treatment that consists of psoralens (plant compounds) and exposing skin to long wave ultraviolet radiation (UVA). The risks of this treatment are premature wrinkling and increased chances of skin cancer. Narrow band UVB (nbUVB) is similar to PUVA, but anpsoralen is not needed since the effect of the lamp is strong enough. The source for the nbUVB light are special fluorecent lamps. nbUVB carries a much lower risk of skin cancer.