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Patient Education - Eczema (Atopic Dermatitis)

Eczema, or atopic dermatitis, is an inflammatory skin condition often associated with allergic diseases like allergic rhinitis (hay fever) or asthma. It can be worsened by exposure to inhaled allergens (dust mite, e.g.) or food. Eczema can range from being an annoyance to a severe, debilitating condition. Below are some tips that may prove helpful to sufferers.

Airborne Allergens: dust mites especially are thought to play a role in many patients with atopic dermatitis. Foods are thought be play a role in a smaller number of those with eczema, especially young children. Any food can be a problem, but milk, eggs, wheat, nuts, peanuts, soy, seafood and tomatoes are the most common factors. Foods become increasingly less important as one gets older. An allergy elimination diet may be necessary if skin testing, RAST testing, or the patient's history suggest a particular food.

SKIN CARE

Clothing: New articles are best washed before they are worn. Avoid fabric softeners and strong laundry soaps. Wash clothing and bed sheets in a mild detergent Put them through the rinse cycle two or three times. It is best to avoid wool, tight clothing, "rubberized" or elastic items, and polyester. Cotton clothing is recommended. Exposed stitching can also cause irritation.

Bathing: It is best to bathe before or after supper, or at least one hour before bedtime. The skin is too warm immediately after bathing to get into a warm bed; itching is more likely to happen. As some patients' itching is relieved by bathing, and some worsened, the frequency of bathing is up to the individual. Bath water should not be hot; it should be as tepid or cool as possible, and bathing in the tub is better than showering. More severe chronic cases should use "sudsing" agents, never commercial alkaline soaps. Anyone with eczema should avoid deodorant or perfumed soaps; Dove or Neutrogena might be better. Emulsified oil or oatmeal colloid can be added to bath water. Also, recent studies have shown that adding ¼ cup of bleach to a half filled bath twice a week may be helpful.

Bleach Baths: bathing for 20 minutes in a warm tub with 1/4 to 1/2 cup of bleach has recently been shown to be of great benefit. Consider doing this for a week straight, then twice a week afterwards.

Lubricants and Emollients: The best lubricant for any individual patient is found by trial and error. Some patients find something that works for a while, then have switch when it stops working. Creams are often beneficial, with ointments being better for thicker skin. Products containing ceramides (e.g. cerave) are thought to be very effective. Skin care should be done 2-4 times a day, including before bedtime, and after exercising and showering. Apply emollients to the entire skin surface when still wet after bathing to keep the skin moist. Try water-washable creams and ointments, Vaseline, vegetable oils (Crisco®), or those containing urea (including Moisturel, Lacticare, and Sarna). It is best to avoid lanolin- and paraben-containing medications. Read labels carefully.

Scratching: Pat or slap the skin gently if itchy. Do not scratch, as it destroys the skin and worsens the eczema. Use cool compresses or ice to relieve the itching. Avoid bath brushes. Avoid the "reflex" of "habit" scratching. Keep fingernails short. Even use mittens or socks on small children.

Tension: Try to avoid chronic stress, fatigue, and conflict. Train yourself to avoid situations that could possibly bring on itching or use medications and lubricants preventively. Avoid petsif you are allergic.

Sunlight: Sunlight is beneficial in some patients; however, sunburns are especially irritating to patients with eczema. Perspiration may also irritate. Carefully test sunscreen lotions on a small area of skin before applying generally.

Swimming: Swimming is usually beneficial. After swimming in a chlorinated pool, shower immediately, pat the skin dry and apply lubricants. Afterward, use a cotton robe.

Cosmetics: When considering items to be purchased, avoid perfumes, use non-perfumed lipsticks, use very simple shampoos, use hypoallergenic deodorants, and avoiding antibacterial deodorants.

MEDICATIONS

Antihistamines: These medications are taken by mouth may help control the itching of eczema (Zyrtec™ and Claritin™ are examples). These are helpful in reducing itching and perhaps helping protect the skin from the action of histamine. These medications are preferably not applied in ointments on the skin, as they can cause allergic reactions.

Antibiotics: Given by mouth, antibiotics are indicated when the eczema is infected (dark red or pus-like material oozing from the scratch marks, yellow crusting, pain, odor). These medications are not applied directly to the skin.

Cortisone-type medications: Topical steroid medications are prescribed by most physicians as creams, ointments, oils and foams to all areas of the skin. The stronger of these are typically avoided on the face, mucous membranes, and gentials. Many of the stronger products also have time limitations on their use - perhaps for 2-4 weeks.

Other Anti-Inflammatory Creams or Ointments: There are other prescription, non-steroid preparations that have anti-inflammatory properties (Elidel, Protopic). They are generally not quite as effective as the steroid preparations, but may be appropriate in certain situations, especially on the face and genital areas.

Oral Steroids: When eczema is so extensive or out of control that it is disabling, oral steroids (prednisone, for example) may be needed. Usually only a short course is necessary.

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