Eczema, or atopic dermatitis, is commonly found in people with a family history of eczema, hay fever, or asthma. As with asthma, a variety of conditions can aggravate eczema: infection, emotional stress, food allergy, and sweating.
The underlying problem is the inability of the skin to retain adequate amounts of water. The skin of people with eczema is consequently very dry, which causes the skin to itch. Most of the manifestations of eczema are a result of scratching. The scratching produces weeping, infected skin. Dried weepings lead to crusting. Sufficient scratching will produce a thickened, rough skin, which is characteristic of long-standing atopic dermatitis.
In young infants who can't scratch, the most common manifestation is red, dry, mildly scaling cheeks, caused when the child rubs them against the sheets. In infants eczema may also be found in the area where plastic pants meet the skin. The tightness of the elastic produces the characteristic red, scaling lesion. In older children it's very common for eczema to involve the area behind the knees and inside the elbows. Adults often have problems with their hands, especially if they're in frequent contact with water.
If there's a large amount of weeping or crusting, the eczema may be infected with bacteria, and a call to the doctor will most likely be required.
The course of eczema is quite variable. Some people will have only a brief, mild problem; others have mild to severe manifestations throughout life. Bouts of eczema are often related to emotional factors; identifying and dealing with such emotional triggers may be the key to successful therapy.
Therapy is based on good skin care and, if the eczema is allergic in nature, avoiding allergens.
Try to keep the skin from becoming too dry. Frequent bathing actually makes the skin drier. Although the person will feel comfortable in the bath, the itching will become more intense afterward. Avoid bathing with soap and water because these tend to dry the skin. Instead use "nonlipid" cleansers, such as those with cetyl alcohol (Cetaphil, etc.). Use rubber gloves to protect the hands when washing dishes or the car. Freshwater or pool swimming can aggravate eczema, but ocean swimming doesn't.
Sweating aggravates eczema. Avoid over-dressing. Light night clothing is important. Cotton clothing is suggested; contact with wool and silk seems to aggravate eczema and should be avoided. Avoid synthetic fabrics that don't "breathe."
Avoid all oil or grease preparations; they clog the skin, increasing sweat retention and itching. Keep nails trimmed short to minimize the effects of scratching, especially with children.
Itching is often worse at bedtime. Over-the-counter pain medications. and antihistamines may reduce itching.
Avoiding cow's milk is often suggested, particularly for children. Make sure this really works for your child before permanently changing to more expensive foods. When trying any milk-avoidance diet, make no other changes in food or other care for a full two weeks unless absolutely necessary, in order to see if it works.
What to Expect at the Doctor's Office
By gathering the patient's history and examination of the lesions, the doctor can determine whether the problem is eczema. If crusted or weeping lesions are present, bacterial infection is likely and an oral antibiotic will be prescribed. There has been no benefit demonstrated from either skin testing or hypo-sensitization (allergy shots).
If home treatment hasn't improved the problem, the doctor may prescribe corticosteroid creams and lotions. While these are effective, they aren't curative; eczema is characterized by repeated occurrences. Furthermore, because of their potential side effects, corticosteroid creams should be used only for a short period.
Sites of eczema rash
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