Eczema

What is Eczema?

Eczema is a general term for any type of dermatitis or “itchy rash”. There are several skin diseases that are eczemas; a partial list of eczemas includes:

* atopic dermatitis
* contact dermatitis
* dyshidrotic eczema
* nummular eczema
* seborrheic dermatitis

All types of eczemas cause itching and redness and some will blister, weep or peel.

Atopic Dermatitis (AD)
Atopic dermatitis is the most severe and chronic (long-lasting) kind of eczema. Atopic dermatitis is a disease that causes itchy, inflamed skin. It almost always begins in childhood, usually during infancy. Physicians estimate that 65 percent of eczema patients are diagnosed in the first year of life and 90 percent of patients experience it before age five. Often the symptoms fade during childhood, though “most” will have AD for life. It is estimated that atopic dermatitis affects over 30 million Americans. It typically affects the insides of the elbows, backs of the knees, and the face but can cover most of the body. Atopic dermatitis falls into a category of diseases called atopy, a term originally used to describe other allergic conditions such as asthma and hay fever. Physicians often refer to these three diseases as the “atopy triad” and AD may be first to appear in what has been called the “allergic march”, the progressive manifestation of allergic conditions from infancy to adult. Although many patients with atopic dermatitis will test postive to several foods on allergy tests, less than 30% of patients with AD will improve when those food are elliminatted. It is safe to say, therefore, that atopic dermatitis is directly related to the conditon of allergy but not necessarily to any one allergic trigger.

Contact Dermatitis (Allergic or Irritant)
Contact dermatitis is a reaction that can occur when the skin comes in contact with certain substances which can cause skin inflammation. Irritants are substances that cause burning, itching or redness in all people if the exposure dose or duration is long enough. Common irritants include solvents, industrial chemicals, detergents, fumes, tobacco smoke, paints, bleach, woolen fabrics, acidic foods, astringents and other alcohol (excluding cetyl alcohol) containing skin care products, and some soaps and fragrances. Allergens are specific substaces, typcially proteins from foods, mold, pollen, or pets, that only sensitized individuals will react to. Contact dermatitis is considered a type of delayed hypersensitivity reaction because it may take 24-48 hrs after contact before the eczmea developes.

Dyshidrotic Dermatitis (Pompholyx)
This is a blistering type of eczema, which is twice as common in women. It is limited to the fingers, palms, and soles of the feet. The hands may have small,tense, fluid filled blisters, scaly patches of skin that flake constantly or become red cracked and painful. Itching is usually severe.

Seborrheic Dermatitis
Red, scaly, itchy rash in various locations on the body. The scalp, sides of the nose, eyebrows, eyelids, and the skin behind the ears and middle of the chest are the most common areas affected. Dandruff (as seborrheic, is caused by a fungal infection) appears as scaling on the scalp without redness. Seborrhea is oiliness of the skin, especially of the scalp and face, without redness or scaling. Seborrheic Dermatitis has both redness and scaling.

Treatment of Eczema

Prescription drugs vs over the counter medications?

Over-the-counter (OTC) medications are available without a prescription because they contain the lowest potency of active ingredients. They are not designed to treat the causes of a disease, but to give some relief of symptoms. Many good moisturizers are available as OTC products. They are important in terms of prevention and maintenance to reduce eczema’s impact. Regular use of these products may reduce the frequency of flare-ups. Prescription medicines, by contrast, are usually much more powerful in providing some relief of the symptoms. They are closely regulated in the U.S. by the Food and Drug Administration (FDA), and are approved for use in treating a specific disease only after they have demonstrated effectiveness and safety. No prescription drug is free of side effects, and FDA approval is given to drugs with the understanding that they must be used with caution to avoid the negative effects which could result in something worse than the disease itself. Consequently, these drugs must be administered under the watchful eye of a licensed prescriber-a doctor, or in some states, a nurse practitioner.

What are FDA approved prescription therapies?

Topical steroids have been the standard treatment for eczema, with oral steroids being prescribed only for severe flare-ups. Recently, however, the FDA has approved a new class of drugs called Topical Immunomodulators (TIMs). At this time there are two FDA approved non-steroid drugs: tacrolimus and pimecrolimus. Topical anesthetics, antibiotics, antihistamines, antibacterial, antifungal and anti-inflammatory drugs are available in creams, gels, ointments, lotions and solutions. Most of these classes of drugs can also be administered orally.

What about alternative or complimentary medication?

Alternative medications also have ingredients that may have irritating or allergenic effects for some people, as with any treatments. It is important to discuss with your physician any alternative medication that you may purchase at a health food store as it may have an adverse reaction to your eczema or another medication you may be taking.

Are there plants and vegetables to avoid?

Everyone knows about obvious culprits like poison ivy, poison oak and stinging nettles, but for people with eczema trying to avoid any plants with fuzzy leaves and stems is a good idea.
Alliums, which include garlic, onions, chives, and leeks, tend to contain allergens that are more irritant than allergen. Citric fruits like lemons, limes and oranges may cause phototoxicity problems. You can get a severe rash from contact with a mango rind. The saps of certain trees are also phototoxic. Daisies (member of a family which includes dandelions, artichokes, chrysanthemum, sunflowers and yarrow) contain a variety of the allergens called sesquiterpene lactones in their stems, leaves, and flowers. If handled, they can produce a localized rash, and they (particularly dried ragweed) may also cause airborne contact dermatitis. Tulips contain an allergen called tuliposideA that often causes a fissured, fingertip dermatitis called “tulip fingers”. Poinsettias are also very irritating mostly because of a sticky sap it exudes. Handle all plants diligently (or with latex free gloves).