Eczema

Eczema is a heterogeneous group of different non-infectious skin diseases. Eczema occurs in both children and adults, but usually appears during infancy.

Causes of Eczema

No one really knows what causes eczema (atopic dermatitis), however, we do know of certain things that can cause eczema to "flare-up", or get worse. A flare-up occurs when the immune system in people's skin overreacts to environmental or emotional triggers and causes symptoms such as an itchy rash to appear.

People with eczema may have a unique set of causes, or triggers, that produce a skin rash. Some of the more common causes of eczema flare-ups include:

• Changes in temperature or humidity
• Chemical irritants, such as pesticides, paint strippers, alcohol, astringents, perfumes, harsh soaps, detergents, and household cleaners
• Physical irritants, such as clothes made of rough or scratchy fabrics, like wool
• Allergies (to dust, pollen, mold, animal dander, etc.)
• Intense emotion or stress
• Infections of any kind

People with eczema should work closely with their healthcare providers to determine what triggers their eczema flare-ups. They can then take steps to avoid these triggers and minimize the onset of a skin rash.

How can eczema be prevented?

Eczema outbreaks can usually be avoided with some simple precautions. The following suggestions may help to reduce the severity and frequency of flare-ups:

• Moisturize frequently
• Avoid sudden changes in temperature or humidity
• Avoid sweating or overheating
• Reduce stress
• Avoid scratchy materials (e.g., wool or other irritants)
• Avoid harsh soaps, detergents, and solvents
• Avoid environmental factors that trigger allergies (e.g., pollens, molds, mites, and animal dander)
• Be aware of any foods that may cause an outbreak and avoid those foods

How can eczema be treated?

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.

Two topical medications, tacrolimus and pimecrolimus, have been approval by the U.S. Food and Drug Administration (FDA) to treat atopic dermatitis. These medications belong to a class of drugs called calcineurin inhibitors and work by modulating the immune response. Pimecrolimus and tacrolimus are a much-welcomed addition because they have not produced some of the side effects associated with long-term topical corticosteroid use, such as thinning skin and loss of effectiveness.