‘Tis the Season…For Eczema
What is eczema? I normally tell my patients that eczema is dry skin with an attitude. It is often used as a catch-all word for atopic dermatitis, dyshidrotic eczema, nummular dermatitis, diaper dermatitis, allergic and irritant contact dermatitis.
Atopic dermatitis is usually diagnosed in infancy. The incidence has been increasing in developed countries. A child is more likely to develop atopic dermatitis if a parent also has a history of eczema. In many cases, atopic dermatitis is due to a genetic defect in a skin protein called filaggrin, which is responsible for maintaining the skin barrier. Mutations in the FLG gene is also associated with an increased risk of developing asthma.
The relationship between food allergies and atopic dermatitis is complicated to say the least. Often there is a concern that food allergies may induce an atopic skin flare. Approximately 1/3 of children with atopic dermatitis also have a food allergy. The most common food culprits include cow’s milk, wheat, soy, egg, tree nuts, peanuts, shellfish, and pollen associated foods. Clinical history is important in these cases. Allergy testing can assist in confirming a food allergy. If the child is exposed to a food and experiences a skin flare, then there may be a causal relationship. Avoidance of known triggers is the best prevention and treatment. In most cases, however, a food allergy cannot be directly blamed for an eczema eruption.
Those with eczema experience a scaling, itchy rash. Common areas include the cheeks, neck, arm folds, and behind the knees. In severe cases, the entire body can be involved. Other triggers include stress, viral and bacterial infections, pollen, and a change of season. Eczema is more likely to flare in the cold season due to dry winter air.
Treatment for eczema is multifaceted. Short lukewarm showers or baths are preferred as hot water dehydrates the skin. Moisturizing soap preparations by Dove, Aveeno, Cetaphil, Cerave, Basis, and Vanicream clean the skin without being too drying. Immediately after a bath or shower, apply a skin barrier cream to help the skin retain moisture. Over the counter barrier creams include Aveeno, Cerave and Cetaphil, Vanicream, Eucerin lotions/creams/ointments. Prescription barrier creams include Alevicyn, Epiceram, Atrapro, Neosalus, Hylatopic, and Ceracade to name a few. These barrier creams help to restore the skin barrier and are steroid free. Erupted areas of eczema may require a prescription topical steroid preparation. Topical immunomodulators, Protopic and Elidel, are steroid free and help to decrease eczema flares. When used, they are started in conjunction with a steroid cream. Steroid creams provide the initial and quick relief but should be used a maximum of two to three weeks in a given location. Protopic and Elidel have a delayed effect, are more beneficial in clearing the flare on the backend and then are responsible for reducing subsequent flares. Barrier creams should be used once or twice a day to keep the skin in a well hydrated state. Eczema prone skin should not be exposed to fragrance ridden detergents, fabric softeners, soaps, lotions, perfumes, etc. Stress management, meditation, and mindfulness also decreases body inflammation and is effective in controlling skin conditions. Currently clinical studies are researching the benefit of biologics in treating eczema.
Eczema can occur anytime in life. As the skin ages, the skin barrier is not as effective. Hormonal changes as experienced in menopause affects the skin’s ability to retain moisture. Dyshidrotic eczema involves dry skin of the hands and feet. This form of eczema is often triggered by stress. Water, soap, cleaning products, dish detergent, hand sanitizer, nickel, occupational chemicals can contribute to an eczema flare or cause an allergic/irritant contact dermatitis. Nummular eczema is a round area of dry skin that is usually treated with moisturizing the skin.
Skin health is important. When the skin is dry and itchy, one’s well-being is affected. Be deliberate in your skin care — use a moisturizing soap, moisturize the skin at least daily to help the skin retain its natural barrier, use a humidifier in the winter months, avoid known triggers, minimize stress, sugar, and processed foods.