If your skin is more than dry, with red, scaly patches that itch like crazy, you may have a condition called Atopic Eczema, also known as Atopic Dermatitis or simply Eczema. Though it’s a chronic condition you may have to deal with indefinitely, there are ways to keep eczema symptoms under control and avoid future outbreaks.
Atopic eczema is the most common form of dermatitis, or skin inflammation, affecting as many as 10 to 20 percent of people around the world. It’s called atopic — meaning that it is allergy related — because certain types of exposure seem to cause the rash. The skin of people with atopic eczema seems to be sensitive to many substances that cause the eczema reaction, including wool fabrics, laundry detergent residues, and certain cosmetic ingredients. Although probably not the true cause of eczema, certain foods may make atopic eczema worse for some people, and eliminating them from the diet may help improve skin.
Atopic eczema can strike anyone from babies to the elderly, and most often appears for the first time at a very young age — generally before age 5 and often before age 1. It usually starts as an itchy, red patch of skin that may blister, ooze, and crust over. Finally, a thick patch of skin may appear where the rash has healed. Atopic eczema tends to run in families and it is most common in childhood. There is no cure but most cases can be controlled by applying various creams to rehydrate the skin. 60-70% of cases resolve by adolescence.
Eczema treatment can be complex and comprises of a maintenance skin care program to reduce the incidence of flares as well as treatment for the acute episodes. Treatments should focus on the repair and maintenance of the skin barrier, control of inflammation, reduction of allergen exposure and reducing itch. Dr. Wright is ideally qualified to discuss with you how to control your eczema in a totally safe manner which will not harm the skin as well as discuss with you the various treatment options and put this all in perspective for you.
Management is achieved by use of anti-histamines, barrier repair moisturizing creams (such as CeraVe®), and prescription anti-inflammatory corticosteroid creams and ointments. For severe cases, drugs such as cyclosporine A or Imuran may be recommended.
The Treatment Plan for Eczema consists of Three Parts:
- Avoiding irritants to the skin and other causes (triggers) wherever possible.
- Moisturizers (emollients) – used every day to help prevent inflammation developing.
- Topical steroid creams applied to the skin – mainly used when inflammation flares up.
Part 1 – Avoid Irritants and Triggers where possible
- Buy fragrance-free laundry detergents, fabric softeners, soaps, shampoos, etc. Don’t use fragranced, scent-free or unscented products, which may contain fragrances or masking scents.
- Purchase hypoallergenic mattress cover and pillowcase to protect from dust mites.
- Use comforters that contain wool from sheep that are pesticide-free, hypoallergenic, and resistant to mold, mildew, and dust mites.
- Vacuum all areas at least one to two times per week to decrease dust exposure.
- Consider buying a showerhead filter and placing filters in all faucets to remove excess minerals and chlorine from water.
- Keep a food diary to see if skin flares correlate with certain foods. If you suspect a link, try eliminating one product or food at a time and (re)introduce foods slowly over a couple of days.
- Avoid soaps, bubble baths, etc, when you wash. They can dry out the skin and make it more prone to irritation. Instead, use a soap substitute plus a bath/shower moisturizer (emollient).
- Try as much as possible not to scratch. To help with this, keep nails short and use anti-scratch mittens in babies. If you need to relieve an itch, rub with fingers rather than scratch with nails.
- Wear cotton clothes next to skin rather than irritating fabrics such as wool. However, it is probably the smoothness of the material rather than the type of the material which helps. Some smooth man-made fabrics are probably just as good as cotton.
- Avoid getting too hot or too cold as extremes of temperature can irritate the skin.
Part 2 – Apply Moisturizers (emollients)
- The regular use of emollients is the most important part of the day-to-day treatment for eczema. People with eczema have a tendency for their skin to become dry. Dry skin tends to flare up and become inflamed into patches of eczema. By keeping the skin supple and moist, you will help to protect the skin from irritants. This helps to prevent itch and helps to prevent or to reduce the number of eczema flare-ups. Dr. Wright can advise you on the various types and brands available and the ones which may suit you best.
- You should apply emollients daily and as often as needed. This may be twice a day, or several times a day if your skin becomes very dry. A common mistake is to stop using emollients when the skin appears good. Patches of inflammation, which may have been prevented, may then quickly flare up again. Dr. Wright recommends the use emollients with a ceramide to restore the skins natural moisture barrier.
- Apply emollients in the general direction of hair growth. If applied in the opposite direction the base of the hair shafts can get blocked, leading to possible infection.
- Emollients used for eczema tend to be bland and non-perfumed. Occasionally, some people become allergic (sensitized) to an ingredient in an emollient. This can make the skin worse rather than better. If you suspect this, see your doctor for advice. There are many different types of emollients with various ingredients. A switch to a different type will usually sort out this uncommon problem.
Part 3 – Apply steroid creams and ointments (topical steroids)
- Topical steroids work by reducing inflammation in the skin. (Steroid medicines that reduce inflammation are sometimes called corticosteroids. They are very different to the anabolic steroids which are used by some bodybuilders and athletes.)
- Topical steroids are grouped into four categories depending on their strength – mild, moderately potent, potent and very potent. There are various brands and types in each category. The greater the strength (potency), the more effect it has on reducing inflammation but the greater the risk of side-effects with continued use.
- Corticosteroid cream and ointment strength depends on the name and is not based on the percentage on the label. These should be used only as directed by your healthcare provider, as potential long-term side effects include skin thinning, acne, stretch marks, increased small vessel appearance and changes in skin color.
- As a rule, a course of topical steroid is used when one or more patches of eczema flare up. You should use topical steroids until the flare-up has completely gone and then stop them. In many cases, a course of treatment for 7-14 days is enough to clear a flare-up of eczema. In some cases, a longer course is needed. Many people with atopic eczema require a course of topical steroids every now and then to clear a flare-up. The frequency of flare-ups and the number of times a course of topical steroids is needed can vary greatly from person to person.