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Tuesday, December 27, 2011

The Unrelenting Misery of Eczema

By Debra Jaliman MD

Eczema is a challenging skin condition for doctors and patients alike. For some patients with severe cases, it means recurring misery, sleepless nights as they fight the unrelenting urge to scratch, and unsightly skin that they try to hide with long sleeves and pants. For doctors, it can be frustrating to treat since it tends to recur.

Eczema is a catch-all term for inflamed, itchy, raw, cracked and peeling skin. Eczema is usually genetic – if one of your parents has it, chances are you and your children will, too. The list of triggers is very, very long:

-Prolonged or hot baths, since anything that dries the skin can set the inflammation process going. That includes hot tubs and saunas.

-Deodorant soaps, perfumed soaps and body washes.

- Anything abrasive, such as grainy body scrubs and even loofahs.

- Fragranced moisturizers, or anything that contains lactic acid, salicylic acid or glycolic acid.

- Wool clothes or elastics, because the pressure point can start the itch/scratch cycle.

- Detergents and fabric softeners.

- Food allergies or sensitivities – the most common are eggs, dairy, corn, grains, yeast, artificial sweeteners and soy. Food allergies and sensitivities are so associated with eczema that most dermatologists recommend allergy testing for their patients. Elimination diets are also useful.

- Airborne allergens such as dust and pollen

- Dry and heated environments. This is one reason why eczema is usually worse in winter.

- Cold, windy weather.

Babies and children suffer the most from eczema and should be seen by a doctor promptly. A baby with eczema is in constant discomfort and will cry and cry as a result. School children are not only miserable with the constant itch, they are cranky from lack of sleep and often do poorly in school. For babies and small children, the first step is washing with the mildest possible cleanser and making sure that baths are as quick as possible. Then, while the skin is still damp, moisturize it with a heavy, protective product. Steroids are the very last resort for small children, and I don’t like to use them at all in babies.

Some children are lucky enough to outgrow eczema, usually by the age of five. Others, unfortunately, will be lifelong sufferers. For adults, antihistamines can help, even the over-the-counter ones. Topical steroids will calm the itch and reduce the inflammation, but should be used with caution, since prolonged use can thin the skin permanently. Protopic and Elidel are the big guns, but not everybody tolerates them well and they have serious potential side effects.

For people with eczema it is crucial to avoid triggers and otherwise take precautions every day. Wear light, comfortable clothing made from cotton, silk or linen. Bedlinens should be 100% cotton or satin. When doing laundry, use only hypoallergenic detergent, put clothes through the rinse cycle twice to get rid of any trace of detergent, and use tennis balls in the dryer instead of dryer sheets.

It’s hard to avoid every trigger – after all, you can’t control the weather. Taking every precaution will lessen eczema outbreaks and make life easier for sufferers and their families, but will rarely eliminate it completely. The bottom line is that in most adults, eczema is a chronic condition that can be managed but not cured.

Posted by: Debra Jaliman, MD at 3:15 pm

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