The Basics: What Every Eczema Patient Should Know
The Facts
The word eczema is derived from a Greek word meaning “to boil over,” which is a good description for the red, inflamed, itching patches that occur during flare-ups of the disease. Eczema is a general term for any type of dermatitis or inflammation of the skin. There are different types of eczema. The most common is called atopic dermatitis (AD).
AD falls into a category of diseases called atopic, a term originally used to describe the allergic conditions asthma and hay fever. AD was included in the atopic category because it often affects people who either suffer from asthma and/or hay fever or have family members who do.
AD is not contagious. It almost always begins in childhood, usually during infancy. Its symptoms are dry, itchy, scaly skin, cracks behind the ears, and rashes on the cheeks, arms and legs. It alternately improves and worsens. During flare-ups, open weeping or crusted sores may develop from scratching or from infections.
AD is a common disease, present worldwide, though it is more common in urban areas and developed countries. An estimated 10 percent of all people are at some time affected by AD (this may not apply in the tropics). It affects men and women of all races equally.
AD falls into a category of diseases called atopic, a term originally used to describe the allergic conditions asthma and hay fever. AD was included in the atopic category because it often affects people who either suffer from asthma and/or hay fever or have family members who do.
AD is not contagious. It almost always begins in childhood, usually during infancy. Its symptoms are dry, itchy, scaly skin, cracks behind the ears, and rashes on the cheeks, arms and legs. It alternately improves and worsens. During flare-ups, open weeping or crusted sores may develop from scratching or from infections.
AD is a common disease, present worldwide, though it is more common in urban areas and developed countries. An estimated 10 percent of all people are at some time affected by AD (this may not apply in the tropics). It affects men and women of all races equally.
Types of Eczema
All types of eczemas cause itching and redness, and some will blister, weep, or peel. There are several skin diseases that are eczemas. A partial list includes:
Atopic dermatitis: the most severe and chronic (long-lasting) kind of eczema.
Contact dermatitis: a reaction that can occur when the skin comes in contact with certain substances, which can cause skin inflammation.
Dyshidrotic eczema: a blistering type of eczema, which is twice as common in women. It is limited to the fingers, palms and soles of the feet.
Nummular eczema: non-itchy round patches of dry skin often appearing in the winter months. It can affect any part of the body, particularly the lower leg.
Seborrheic dermatitis: a red, scaly, itchy rash that can appear in various locations on the body. The scalp, sides of the nose, eyebrows, eyelids, and skin behind the ears and on the middle of the chest are the most common areas affected.
Stasis dermatitis: a type of eczema that can develop in people when the veins in their lower legs don't properly return blood to their heart.
Genetic Factors
Researchers have found that some people with eczema have a genetic defect that causes a lack of filaggrin in the skin. Filaggrin is a type of protein that helps form the protective outer layer of our skin. This skin barrier protects the body from germs and other foreign substances. A lack of filaggrin dries out and weakens the skin barrier. This makes skin vulnerable to irritants such as soaps and detergents. A weak skin barrier also makes it easier for allergens, such as pollen, to enter the body. Scientists believe that this exposure may cause the sensitivity to allergens and even certain foods.
Triggers
Trigger factors may be different in different people. Most eczema patients can get worse when they have a cold or other infection. Some patients have worse problems in the winter, while others simply cannot stand the sweating during hot, humid summer weather. Common eczema triggers include
Dry skin - Wind, low humidity, cold temperature, excessive washing without use of moisturizers, and use of harsh, drying soaps can all cause dry skin and aggravate eczema.
Irritants - Irritants are any substances outside the body that can cause burning, redness, itching or dryness of the skin.
Allergens - Allergens are materials (such as pollen, pet dander, foods, or dust) that cause allergic responses and can increase eczema.
Stress - People with eczema often react to stress (frustration, anger, fear, embarrassment) by having red flushing and itching. Eczema itself, and its treatments, are also a source of stress. The challenge: Recognize stress and find stress reduction techniques that work for you.
Heat and sweating - Most people with atopic dermatitis notice that when they get hot, they itch. They have a type of prickly heat that doesn’t occur just in humid summertime but anytime they sweat.
Infections - Bacterial “staph” infections are the most common, especially on arms and legs. Such infections might be suspected if areas are weeping or crusted or if small “pus-bumps” are seen. If some lesions look different, ask your doctor.
Skin Care
The most important treatment for dry skin is to put water back into it. The goal of bathing and moisturizing is to help heal the skin. To repair the skin, it is necessary to decrease water loss. The best way to get water into your skin is to briefly soak in a bath or shower and to moisturize immediately afterward.
Use of an effective moisturizer several times every day improves skin hydration and barrier function. Moisturizer should be applied to the hands every time they are washed or come in contact with water.
Treatment
Once inflammation begins, prompt treatment as directed by a physician is needed. Bathing or wet compresses may ease the itch. Corticosteroids applied directly to the affected area are the mainstay of prescription therapy.
Tips for Using Topical Corticosteroids
Use the least potent corticosteroid possible to control the inflammation.
Only apply the corticosteroid to areas of skin affected by the disease.
It is most effective to apply corticosteroids immediately after bathing.
Only use the corticosteroid as often as prescribed by your doctor. Usage more than twice daily increases the risks but not the benefits of corticosteroids. And for many topical corticosteroids, once-a-day application is sufficient.
Do not use a topical corticosteroid as a moisturizer.
Wherever possible, avoid using large quantities of corticosteroids for long periods of time.
Be aware that certain areas of skin—the face, the genitals, raw skin, thin skin and areas of skin that rub together, such as beneath the breasts or between the buttocks or thighs absorb more corticosteroid than other areas.
Applying dressings over the area of skin treated with the corticosteroid increases the potency and absorption of corticosteroid into the skin. Only use dressings with topical corticosteroids if advised to do so by a physician.
Once the inflammation is under control, reduce or stop using the corticosteroid. Remember: a proper bathing and moisturizing practice helps prevent flare-ups.
Topical calcineurin inhibitors (TCIs) are a family of topical medications that work to inhibit the skin’s inflammatory response (which is what causes the redness and also contributes to itching). There are two FDA-approved nonsteroid drugs: tacrolimus and pimecrolimus. TCIs are not steroids and do not cause thinning of the skin, They can suppress the immune system in the skin, so the use of sun protection for anyone receiving this therapy is recommended.
Cortisone pills or shots are sometimes used but they are not safe for long-term use. Another treatment option is the use of ultraviolet light or sunlamps. Under a physician’s supervision, some AD sufferers find this treatment helps. Researchers are constantly seeking new and safer drugs to control the itch and inflammation.
Products Suitable for Eczema and Sensitive Skin: National Eczema Association Seal of Acceptance
Proper bathing and moisturizing of the skin is of utmost importance for eczema patients. Finding products that are soothing and non-irritating can be a challenge. The National Eczema Association Seal of Acceptance™ helps patients recognize products that are suitable for the care of eczema or sensitive skin.
Acceptance of a product means that the product has been evaluated to determine that it does not contain ingredients or contents that are known to be unsuitable for use by persons with eczema or sensitive skin conditions.
NEA’s Seal of Acceptance program includes an online Product Directory with product reviews. Learn more here: http://www.nationaleczema.org/seal-of-acceptance
Acceptance of a specific product does not represent an endorsement of that product. NEA makes no representation or warranty regarding any of the accepted products, including without limitation any implied warranties of merchantability or fitness for any particular purpose.
Resources: You are Not Alone and Expert Information is Available
The National Eczema Association offers eczema patients and caregivers accurate, up-to-date information and support to improve health and quality of life.
• Comprehensive skin care information
• Tips from leading eczema experts
• Research updates
• Support groups nationwide
• NEA website, searchable by topic: nationaleczema.org
• Facebook: facebook.nationaleczema.org
• Online support community (private and confidential): community.nationaleczema.org
• NEA Patient Conference
• Tips from leading eczema experts
• Research updates
• Support groups nationwide
• NEA website, searchable by topic: nationaleczema.org
• Facebook: facebook.nationaleczema.org
• Online support community (private and confidential): community.nationaleczema.org
• NEA Patient Conference
