Starting From Scratch: Demystifying Eczema

There is no cure for eczema, but, in most cases, it is manageable. The word eczema comes from a Greek word that means to effervesce or bubble or boil over. It’s important to remember that many people have eczema. Over 30 million American may have it. There is no need to be embarrassed by your eczema. You are not alone.

Atopic Dermatitis (which is often called eczema) is an itchy, red rash. It can appear all over the body. Many people have it on their elbows or behind their knees. Babies often have eczema on the face, especially the cheeks and chin. They can also have it on the scalp, trunk (chest and back), and outer arms and legs. Children and adults tend to have eczema on the neck, wrists, and ankles, and in areas that bend, like the inner elbow and knee. People with eczema are usually diagnosed with it when they are babies or young children.

Eczema symptoms often become less severe as children grow into adults. For some people, eczema continues into adulthood. Less often, it can start in adulthood. The rash of eczema is different for each person. It may even look different or affect different parts of your body from time to time. It can be mild, moderate, or severe. Generally, people with eczema suffer from dry, sensitive skin. Eczema is also known for its intense itch. The itch may be so bad that you scratch your skin until it bleeds, which can make your rash even worse, leading to even more inflammation and itching. This is called the itch-scratch cycle.

RECOGNIZING ATOPIC DERMATITIS

Time of Onset

This type of eczema usually begins during the first year of life and almost always within the first five years. It’s seldom present at birth, but it often comes on during the first six weeks. Other rashes also can start at any time, but most rashes disappear within a few days to weeks. AD tends to persist. It may wax and wane, but it keeps coming back.

Itching

Atopic dermatitis is a very itchy rash. Much of the skin damage comes from scratching and rubbing that the child cannot control.

Location

The location of the rash can also help us recognize AD. In babies, the rash usually starts on the face or over elbows and knees, places that are easy to scratch and rub. It may spread to involve all areas of the body, although moisture in the diaper region protects the skin barrier. Later in childhood, the rash is typically in the elbow and knee folds. Sometimes it only affects the hands, and at least 70% of people with AD have hand eczema at some time in their life. Rashes on the feet, scalp or behind the ears are other clues that might point to AD. Be advised, though, that these symptoms may also indicate other conditions, such as seborrheic dermatitis.

Appearance

The appearance of the rash is probably the least helpful clue, because it may be very different from one person to another. Scratch marks are often seen, along with scaly dry skin. The skin may become infected and show yellow crusts or little, pinpoint, pus-containing bumps. The skin also may thicken from long-term scratching and rubbing.

Heredity

If other family members or relatives have AD, asthma or hay fever, the diagnosis of AD is more likely.

The Bottom Line

Be sure to get your child diagnosed by a physician before assuming that the condition is atopic dermatitis.

TRIGGER FACTORS

Trigger factors may be different in different people. Most children get worse when they get a cold or other infection. Most have worse problems in the winter; but others simply cannot stand the sweating during hot, humid summer weather.

TRIGGER FACTORS THAT SEEM TO AFFECT EVERY CHILD WITH AD

Dry Skin

The skin’s main function is to provide a barrier against dirt, germs and chemicals from the outside. We don’t notice this barrier unless it gets dry, and then it’s scaly rough and tight. Dry skin is brittle – moist skin is soft and flexible. People with AD have a defect in their skin so it won’t stay moist. It is especially bad in winter when the heat is on in the house and the humidity drops. Other things that dry the skin are too much bathing without proper moisturizing . The challenge: Prevent skin dryness.

Irritants

Irritants are any of the substances outside the body that can cause burning, redness, itching or dryness of the skin. The challenge: Avoid irritating substances.

Stress

Emotional stress comes from many situations. People with AD often react to stress by having red flushing and itching. Special problems for children with AD include frustration, anger or fear. And, of course, AD itself, and its treatments, are a source of stress! The challenge: Recognize stress and reduce it.

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. It can happen from exercise, from too many warm bedclothes, or rapid changes in temperature from cold to warm.

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. A common virus infection of children, Molluscum sp., tends to be more severe in children with AD. Molluscum infections look like small bumps, often with a central white core. Herpes infections (such as fever blisters or cold sores) and fungus (ringworm or athlete’s foot) can also trigger AD. If some lesions look different ask your doctor. If they turn out to be infected, they can be treated with antibiotics or other, effective medications. These are generally benign, superficial infections for AD patients and they do not seem to be especially contagious for other people. The challenge: Recognize and treat pustules or crusted lesions in consultation with a physician.

Allergens

Allergens are materials (such as pollen, pet dander, foods, or dust) that cause allergic responses. Allergic diseases such as asthma and hay fever, which flare quickly, are easy to tie to allergens. Allergic symptoms, such as itching and hives, appear soon after exposure to airborne allergens and last only briefly. But the slower, continuing, chronic eczema of AD may be difficult to tie to specific allergens. Food allergies can trigger flares, especially for children with moderate to severe AD. Pollens, dust mites, and pets can seldom be shown to trigger eczema in young children. Of the available tests for allergy, scratch tests and RAST tests are only brief reactions and do not diagnose allergen-triggered eczema. Patch tests, by contrast, can diagnose eczema response in some cases such as allergies to skin care products.

ARE THERE OTHER TRIGGER FACTORS?

Children with AD will be helped by reducing the major trigger factors described above. But individuals may be subject to other trigger factors, and it is important to be alert for these as well.

HOW CAN YOU AVOID TRIGGER FACTORS?

• Keep the skin barrier intact. MOISTURIZE!
• Wear soft clothes that “breathe.” Avoid fabrics of wool, nylon, or stiff material.
• If sweating causes itching, find ways to keep cooler: Reduce exertion, especially during times of flare. Layer clothing and adjust to temperature change. Don’t overheat rooms, especially the bedroom. Use light bedclothes.
• When itching from sweating, dust, pollen or other exposures, take a cooling shower or tub bath, and don’t forget to moisturize afterwards, within 3 minutes after the child has been gently toweled.
• Learn to recognize signs of infection and treat early.
• If you suspect food allergy, be systematic. Likely offenders are eggs, milk, peanuts, soy, wheat and seafood, but any food can do it. Can you exclude the most likely offender for a week? Keep a food diary. When the skin clears up, try the food. Watch for signs of itching or redness over the next two hours. Eliminate a food group if it causes hives or face swelling. Don’t exclude multiple food groups at the same time – it’s rare to have more than one or two food allergies that impact the eczema, and your child can get malnourished with prolonged avoidance of many foods.
• Always make sure that any food manipulation is performed with the advice of a physician.
• With allergy-prone kids furry animals are a risk. If you must have pets, keep them outside or at least off beds, rugs and furniture where the child plays. Dust mites collect in bedroom carpets and bedding. Simple control measures include coverings for pillows and mattresses, removing bedroom carpets and frequent washing of bedclothes in hot water.
• Think about stress-causing events and ways to cope with them. Review problems with your doctor or a mental health professional. Consider clinicians who specialize in approaches including mindfulness. Try to make AD treatments part of a daily, family routine. Encourage children with AD to do what they can on their own.

AD IS NOT CONTAGIOUS. PEOPLE WITH AD CANNOT “GIVE” IT TO SOMEONE ELSE.

AD inflammation results from too many reactive inflammatory cells in the skin.

Research is seeking the reason why these cells over-react. Patients with AD (asthma or hay fever) are born with these over-reactive cells. When something triggers them, they don’t turn off as they should. We try to control AD by controlling the trigger factors that “turn on” inflamed skin, or by “damping the flames” with anti-inflammatory therapies.

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Source: http://nationaleczema.org