Eczema

1.    What is Eczema?

Eczema is a very common, inflammatory reaction of the skin to any of a wide number of causative agents.  Atopic dermatitis, the most common form of eczema,is a skin disorder involving an overly sensitive immune system reacting to otherwise normal substances that the skin or body contacts. Eczema may involve swelling, redness, itching, blistering, “weeping” clear fluid, crusting, formation of pustules, dryness, peeling, or allergic-like reactions of the involved area.  While some cases of eczema are shorter lasting, others may continue for months or even years at a time. 

2.    What Does Eczema Look Like?

Eczema may display a variety of characteristics.  Eczema in its mildest form may appear as dry, itching, and flaking skin.  In addition, eczema may appear as red bumps forming entire plaques with indistinct borders, as well as dryness, itching, peeling and scabbing throughout the affected region.  Secondary bacterial infection can cause tenderness.  Chronic cases involve dull red, extremely itchy, cracking, thickened and leathery skin.  Eczema tends to occur in the flexural regions (backside of elbows, knees), neck, wrists, ankles, creases of the body, face and scalp (in infants).

3.    Who Does Eczema Affect?

Eczema is very common and affects many different types of individuals.  The prevalence of eczema is estimated at 15-20% among children, and 2-10% of all adults, with males slightly more affected than females.  Children of individuals with eczema have a 60% chance of being affected.  Eczema usually begins in infancy and may persist through childhood and into adult life.  Certain factors may elicit a response in children, such as certain protein-containing foods, dust mites, or microbial agents.  Other contributing factors include skin dehydration, pregnancy, menstruation, cold climates, irritating clothing, and most significantly, emotional stress.

4.    What Causes Eczema?

Eczema is caused by the immune system’s over-sensitive reaction to unidentifiable substances either foreign or regularly contacting the skin.  These “triggering” events often lead to a chronic cycle of exacerbations and remissions in the affected areas.  With each new exposure, the irritating or causative agent stimulates certain antibodies to cause an amplified release of inflammatory agents from immune system cells.  These agents promote the formation small red bumps, itching, swelling, and flaking of the skin.  The end result is a chronic inflammation of the skin, as well as a perpetual migration of blood cells and immune system cells to the affected location.  An eczema flare may often trigger other allergic-like reactions in individuals such as hay-fever, sinusitis and congestion.

5.    What Triggers Eczema?

Certain factors may trigger an eczema response, especially in children.  These include protein-containing foods such as eggs, milk, peanuts, soy products, fish, and wheat, as well as dust mites, airborne allergens, or microbial agents.  Other exacerbating factors include skin dehydration, pregnancy, menstruation, cold climates, wool and other irritating clothing, and of especially great importance, emotional stress.  Exposure to adverse climatic conditions may also trigger or worsen an eczema response.  In all cases of eczema, rubbing and scratching are behaviors that worsen the condition by introducing secondary bacterial infections to the involved areas.

6.    How Can My Eczema Be Treated?

Although childhood eczema frequently subsides before adulthood, adult eczema often lasts years at a time and requires special management. Topical anti-itch lotions may be given to control excessive itching and rubbing.  Topical steroid creams and newer non-steroid products such as Elidel, Protopic, Mimyx, Eletone, and Atopiclair may help reduce inflammation. Topical anti-bacterial lotions or oral antibiotics may be given to decrease secondary bacterial infections.  Laser treatments may also be used to treat small areas.  The Excimer laser  has been extremely successful in treating small patches of eczema.  This laser uses a carefully focused beam of narrow-band UVB light delivered through a sophisticated fiber optic device, and allows higher doses of narrow-band UVB light with minimal exposure of nearby, healthy skin.  Hydration using unscented moisturizing lotions is important in preventing dryness, and non-liquid soaps should be avoided.  Finally, identification and reduction of emotional stress factors may help prevent unnecessary eczema flares.  Eczema can be a difficult, frustrating condition. The natural human desire to scratch or rub an itchy rash just makes the condition worse, and treatments can be slow and are not always completely effective.  For more information on available treatments for eczema, or to schedule a visit, please call and speak with a representative at the Berman Skin Institute.