by Gary Waddington, M.D.
Eczema in the allergy-prone patient is most likely related to a condition called atopic dermatitis. This type of skin rash is frequent in people with hay fever or asthma and may present in infancy, childhood, or adulthood. Eczema is merely a descriptive term and may refer to moist, weeping dermatitis or dry, scaly, thickened skin.
The most striking symptom is atopic eczema is the severe itching that results in scratching both day and night. It is this scratching that results in many of the changes seen in the skin. It is, therefore, imperative to attempt to control the itch in order to prevent scratching to manage the eczema seen in allergy patients.
Itching in atopic eczema often becomes more severe at bedtime or with a change in temperature which may occur after bathing or merely removing clothes. It is also Worsened by psychological stimuli such as anxiety, anger, frustration, or embarrassment, and therefore, is often referred to as neurodermatitis.
People with atopic or allergy-related eczema generally have dry skin which is often more pronounced in winter months when the humidity is lower, dry heat is used to warm our homes, and hot baths or showers are the norm. Dry skin is made worse by the use of lipid solvents, soaps, detergents, and cleansers, which remove natural oils from the skin. This dry skin then is more susceptible to irritation by intense toweling, wool, silk, nylon, furs, and other rough fabrics and materials. Cotton is the safest material one can put next to the skin. Activities which increase sweating commonly increase itching as well.
Treating atopic eczema requires continued vigilance to avoid activities and materials which further dry and irritate the skin, which then causes increased itching and consequently scratching. It is necessary to control the environment as much as possible and supplement that with topical or systemic medications.
It is imperative to avoid overbathing with hot water and avoid the excess use of soaps. It is acceptable to bathe or shower daily using a comfortable, tepid temperature of water and limiting soap to the underarms, genital-rectal area, and feet between the toes. These are the perspiration and malodorous areas of the body and the only areas requiring soap. The scalp and face have more oil glands and are more resistant to excessive drying. A bath with unscented bath oils is acceptable.
After bathing, one should pat dry without vigorous rubbing, and within three to five minutes apply a good moisturizer without perfumes. Ointments and creams are more effective than lotions and tend to trap water in the skin to rehydrate as well as moisturize the skin.
Attempt to control the home environment to maintain as close to constant humidity as possible. Avoid overheating or cooling and use dehumidifiers in the hot, humid summer months and humidifiers in the cold, dry winter months.
Topical medications such as cortisone creams and ointments, as well as systemic medications such as antihistamines, antibiotics, and cortisone, are commonly quite effective and should be used only with the recommendation and surveillance of a physician. Again, topical medications such as cortisone applied shortly after bathing or contact with water makes them much more effective.
Eczema in the allergy-prone patient can be viewed as hay fever of the skin. Just as hay fever and asthma cannot be cured, it can be managed in order to provide acceptable relief and comfort to the patient. Treating eczema should be viewed as a way of life and requires diligent care.
Posted in: Eczema