Category Archives: Eczema

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Prescribing roles for health professionals other than doctors

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Vitamin C for preventing and treating the common cold

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Early skin-to-skin contact for mothers and their healthy newborn infants

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Vaccines to prevent influenza in healthy adults

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Gabapentin for chronic neuropathic pain and fibromyalgia in adults

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Bronchodilators for bronchiolitis for infants with first-time wheezing

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Vitamin E supplementation in pregnancy

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Corticosteroids for bacterial meningitis

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Weaning from mechanical ventilation using pressure support or a T-tube for a spontaneous breathing trial

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Intravenous infusion of lidocaine starting at the time of surgery for reduction of pain and improvement of recovery after surgery

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Magnesium sulfate for treating exacerbations of acute asthma in the emergency department

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Amitriptyline for neuropathic pain in adults

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Loop diuretics for patients receiving blood transfusions

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Treatments for delusional disorder

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Acupuncture for preventing migraine attacks

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Two different laparoscopic techniques for repairing a hernia in the groin

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T-tube drainage versus no T-tube drainage after open common bile duct exploration

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Oral dextrose gel for treatment of newborn infants with low blood glucose levels

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Routine abdominal drainage versus no drainage for patients undergoing uncomplicated laparoscopic cholecystectomy

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Oral misoprostol for induction of labour

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Air pollution is the pollution of air by smoke and harmful gases, mainly oxides of carbon, sulfur, and nitrogen.

Many of the world's large cities today have bad air quality.[1] Even 2,000 years ago, the Romans were complaining about the bad air in their cities. At that time, the air was thick with smoke from fires and the smell of sewers.[1] Air pollution has been a danger to human health and Earth's many ecosystems for a long time.

It has many pollutants (things that pollute the air) from natural sources. These pollutants include dust, sea salt, volcanic ashes and gases, smoke from forest fires, pollen, and many other materials.[1] In fact, there are many more natural pollutants than pollutants that humans make.[1] However, humans have adapted to most of these natural pollutants.[1]

Air pollution may be personal, occupational or community air pollution.

Air pollution is usually described as either primary pollutants or secondary pollutants. Primary pollutants are pollutants that are put directly into the air by humans or natural sources. Examples of primary pollutants are exhaust fumes (gas) from cars, soot from smoke, dust storms and ash from volcanic eruptions (as seen in the picture on the left).[1]

Secondary pollutants are pollutants that are made from chemical reactions when pollutants mix with other primary pollutants or natural substances like water vapor.[1] Many secondary pollutants are made when a primary pollutant reacts with sunlight. Ozone and smog are secondary pollutants. Ozone is a gas that stops harmful ultraviolet rays from the sun. When it is near the ground, though, it can poison people and other organisms.[1]

Human-made air pollution comes from many things. Most air pollution made by humans today is because of transportation. Cars, for instance, make about 60% of the human-made air pollution. The gases inside car exhaust, like nitrogen oxide, make smog and acid rain.

Human-made air pollution is also caused when humans set their farmlands or forest on wildfires producing soot ( a black powder composed mainly of carbon, produced when coal, grasses, wood etc. is burned ) from smoke, that can affect people and other living when exposed to the atmosphere.

Many industrial power plants burn fossil fuels to get their energy. However, burning fossil fuels can make a lot of oxides (chemical compounds that have oxygen and other elements inside). In fact, the burning of fossil fuels makes 96% of the sulfur oxides in the atmosphere. Some industries also make chemicals that make poisonous fumes (smoke).

Air pollution is not only on the outside. Homes, schools, and buildings can also have air pollution. Sometimes the air inside a building is even worse than the air outside.[1] Many things which humans use every day can pollute the air. Compounds inside carpets, paints, building materials and furniture also pollute the air, especially when they are new.

In buildings where the windows are tightly shut to stop air leaks, the air inside can be polluted more than the air outside.[1]

Acid precipitation is precipitation, like rain, sleet, or snow, that contains acids from air pollution. When fossil fuels are burned, they let out oxides into the air. When these oxides mix with water in the atmosphere, they make acid, which fall as precipitation.[1] Acid precipitation can kill living things like fish and trees, by making the place where they live too acidic. Acid rain can also damage buildings made of limestone and concrete.

A global concern is the greenhouse gases and the hole in the ozone layer in the stratosphere. The Earth's ozone layer protects life from the Sun's harmful ultraviolet rays, but in the 1970s, scientists found out that some chemicals let out into the atmosphere makes the ozone turn into oxygen. This lets more ultraviolet rays reach the Earth. During the 1980s, scientists found that the ozone layer above the South Pole had thinned by 50 to 98 percent.

On March 17, 1992, in Mexico City, all children under the age of 14 could not go to school because of air pollution. This does not often happen, but being exposed to air pollution every day can make people have many health problems. Children, elderly (old) people, and people with allergies especially, can have a lot of problems because of air pollution. Studies from the University of Birmingham showed that deaths because of pneumonia and air pollution from motor vehicles like cars are related.[2]

The World Health Organization said that 2.4 million people died because of the direct problems of air pollution.[3][4] Some of the problems include:[1]

In India in 2014, it was reported that air pollution had cut crop yields in the most affected areas by almost half in 2010 when compared to 1980 levels. There can also be increased yield of crops due to some air quality conditions.

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What are eczema symptoms and signs?

Almost all patients with eczema complain of itching. Since the appearance of most types of eczema is similar, the distribution of the eruption can be of great help in distinguishing one type from another. For example, stasis dermatitis occurs most often on the lower leg while atopic dermatitis occurs in the front of the elbow and behind the knee.

An accurate diagnosis requires an examination of the entire skin surface and a careful history. It is important to rule out curable conditions caused by infectious organisms. Occasionally, a sample of skin (biopsy) may be sent for examination in a laboratory.

The treatment of acute eczema requires repeated cycles of application of dilute aqueous solutions followed by evaporation. This is most often conveniently performed by placing the affected body part in front of a fan after the compress. Once the acute weeping has diminished, then topical steroids (such as triamcinolone cream) application can be an effective treatment. In extensive disease, systemic steroids may need to be utilized either orally or by an injection (shot).

Mild eczema may respond to compresses composed of tepid water followed by room air evaporation. Chronic eczema can be improved by applying water followed by an emollient (moisturizing cream or lotion).

Medically Reviewed by a Doctor on 2/24/2016

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Eczema Symptoms, Causes, Treatment - MedicineNet

Dermatitis, also known as eczema, is a group of diseases that results in inflammation of the skin.[1] These diseases are characterized by itchiness, red skin, and a rash.[1] In cases of short duration there may be small blisters while in long term cases the skin may become thickened.[1] The area of skin involved can vary from small to the entire body.[1][2]

Dermatitis is a group of skin conditions that includes atopic dermatitis, allergic contact dermatitis, irritant contact dermatitis, and stasis dermatitis.[1][2] The exact cause of dermatitis is often unclear.[2] Cases are believed to often involve a combination of irritation, allergy, and poor venous return. The type of dermatitis is generally determined by the person's history and the location of the rash. For example, irritant dermatitis often occurs on the hands of people who frequently get them wet. Allergic contact dermatitis; however, can occur following brief exposures to specific substances to which a person is sensitive.[1]

Treatment of atopic dermatitis is typically with moisturizers and steroid creams.[3] The steroid creams should generally be of mid to high strength and used for less than two weeks at a time as side effects can occur.[4]Antibiotics may be required if there are signs of skin infection.[2] Contact dermatitis is typically treated by avoiding the allergen or irritant.[5][6]Antihistamines may be used to help with sleep and to decrease nighttime scratching.[2]

Dermatitis was estimated to affect 334 million people globally in 2013.[7] Atopic dermatitis is the most common type and generally starts in childhood.[1][2] In the United States it affects about 10-30% of people.[2] Contact dermatitis is two times more common in females than males.[8] Allergic contact dermatitis affects about 7% of people at some point in time.[9] Irritant contact dermatitis is common, especially among people who do certain jobs, however exact rates are unclear.[10]

Dermatitis symptoms vary with all different forms of the condition. They range from skin rashes to bumpy rashes or including blisters. Although every type of dermatitis has different symptoms, there are certain signs that are common for all of them, including redness of the skin, swelling, itching and skin lesions with sometimes oozing and scarring. Also, the area of the skin on which the symptoms appear tends to be different with every type of dermatitis, whether on the neck, wrist, forearm, thigh or ankle. Although the location may vary, the primary symptom of this condition is itchy skin. More rarely, it may appear on the genital area, such as the vulva or scrotum.[11] Symptoms of this type of dermatitis may be very intense and may come and go. Irritant contact dermatitis is usually more painful than itchy.

Although the symptoms of atopic dermatitis vary from person to person, the most common symptoms are dry, itchy, red skin. Typical affected skin areas include the folds of the arms, the back of the knees, wrists, face and hands.

Dermatitis herpetiformis symptoms include itching, stinging and a burning sensation. Papules and vesicles are commonly present. The small red bumps experienced in this type of dermatitis are usually about 1cm in size, red in color and may be found symmetrically grouped or distributed on the upper or lower back, buttocks, elbows, knees, neck, shoulders, and scalp.[12] Less frequently, the rash may appear inside the mouth or near the hairline.

The symptoms of seborrheic dermatitis on the other hand, tend to appear gradually, from dry or greasy scaling of the scalp (dandruff) to hair loss. In severe cases, pimples may appear along the hairline, behind the ears, on the eyebrows, on the bridge of the nose, around the nose, on the chest, and on the upper back.[13] In newborns, the condition causes a thick and yellowish scalp rash, often accompanied by a diaper rash.

Perioral dermatitis refers to a red bumpy rash around the mouth.[14]

A patch of dermatitis that has been scratched

The cause of dermatitis is unknown but is presumed to be a combination of genetic and environmental factors.[2]

The hygiene hypothesis postulates that the cause of asthma, eczema, and other allergic diseases is an unusually clean environment. It is supported by epidemiologic studies for asthma.[15] The hypothesis states that exposure to bacteria and other immune system modulators is important during development, and missing out on this exposure increases risk for asthma and allergy.

While it has been suggested that eczema may sometimes be an allergic reaction to the excrement from house dust mites,[16] with up to 5% of people showing antibodies to the mites,[17] the overall role this plays awaits further corroboration.[18]

A number of genes have been associated with eczema, one of which is filaggrin.[3] Genome-wide studies found three new genetic variants associated with eczema: OVOL1, ACTL9 and IL4-KIF3A.[19]

Eczema occurs about three times more frequently in individuals with celiac disease and about two times more frequently in relatives of those with celiac disease, potentially indicating a genetic link between the two conditions.[20][21]

Diagnosis of eczema is based mostly on the history and physical examination.[3] However, in uncertain cases, skin biopsy may be useful.[22] Those with eczema may be especially prone to misdiagnosis of food allergies.[23]

Patch tests are used in the diagnosis of allergic contact dermatitis.[24][25]

The term "eczema" refers to a set of clinical characteristics. Classification of the underlying diseases has been haphazard and unsystematic, with many synonyms being used to describe the same condition.

A type of dermatitis may be described by location (e.g. hand eczema), by specific appearance (eczema craquele or discoid), or by possible cause (varicose eczema). Further adding to the confusion, many sources use the term eczema interchangeably for the most common type of eczema (atopic dermatitis) .

The European Academy of Allergology and Clinical Immunology (EAACI) published a position paper in 2001, which simplifies the nomenclature of allergy-related diseases, including atopic and allergic contact eczemas.[26] Non-allergic eczemas are not affected by this proposal.

There are several different types of dermatitis including atopic dermatitis, contact dermatitis, stasis dermatitis, and seborrheic eczema.[2] Many use the term dermatitis and eczema synonymously.[1]

Others use the term eczema to specifically mean atopic dermatitis.[27][28][29] Atopic dermatitis is also known as atopic eczema.[3] In some languages, dermatitis and eczema mean the same thing, while in other languages dermatitis implies an acute condition and eczema a chronic one.[30]

There is no good evidence that a mother's diet during pregnancy, the formula used, or breastfeeding changes the risk.[32] There is tentative evidence that probiotics in infancy may reduce rates but it is insufficient to recommend its use.[33]

People with eczema should not get the smallpox vaccination due to risk of developing eczema vaccinatum, a potentially severe and sometimes fatal complication.[34]

There is no known cure for some types of dermatitis, with treatment aiming to control symptoms by reducing inflammation and relieving itching. Contact dermatitis is treated by avoiding what is causing it.

Bathing once or more a day is recommended.[3] It is a misconception that bathing dries the skin in people with eczema.[35]Soaps should be avoided as they tend to strip the skin of natural oils and lead to excessive dryness.[36] It is not clear whether dust mite reduction helps with eczema.

There has not been adequate evaluation of changing the diet to reduce eczema.[37][38] There is some evidence that infants with an established egg allergy may have a reduction in symptoms if eggs are eliminated from their diets.[37] Benefits have not been shown for other elimination diets, though the studies are small and poorly executed.[37][38] Establishing that there is a food allergy before dietary change could avoid unnecessary lifestyle changes.[37]

People can also wear clothing designed to manage the itching, scratching and peeling.[39]

Moisturizing agents (also known as emollients) are recommended at least once or twice a day.[3] Oilier formulations appear to be better and water-based formulations are not recommended.[3] It is unclear if moisturizers that contain ceramides are more or less effective than others.[40] Products that contain dyes, perfumes, or peanuts should not be used.[3]Occlusive dressings at night may be useful.[3]

There is little evidence for antihistamine and they are thus not generally recommended.[3] Sedative antihistamines, such as diphenhydramine, may be tried in those who are unable to sleep due to eczema.[3]

If symptoms are well controlled with moisturizers, steroids may only be required when flares occur.[3]Corticosteroids are effective in controlling and suppressing symptoms in most cases.[41] Once daily use is generally enough.[3] For mild-moderate eczema a weak steroid may be used (e.g. hydrocortisone), while in more severe cases a higher-potency steroid (e.g. clobetasol propionate) may be used. In severe cases, oral or injectable corticosteroids may be used. While these usually bring about rapid improvements, they have greater side effects.

Long term use of topical steroids may result in skin atrophy, stria, telangiectasia.[3] Their use on delicate skin (face or groin) is therefore typically with caution.[3] They are, however, generally well tolerated.[42]Red burning skin, where the skin turns red upon stopping steroid use, has been reported among adults who use topical steroids at least daily for more than a year.[43]

Topical immunosuppressants like pimecrolimus and tacrolimus may be better in the short term and appear equal to steroids after a year of use.[44] Their use is reasonable in those who do not respond to or are not tolerant of steroids.[45] Treatments are typically recommended for short or fixed periods of time rather than indefinitely.[3] Tacrolimus 0.1% has generally proved more effective than picrolimus, and equal in effect to mid-potency topical steroids.[32]

The United States Food and Drug Administration has issued a health advisory a possible risk of lymph node or skin cancer from these products,[46] however subsequent research has not supported these concerns.[45] A major debate, in the UK, has been about the cost of these medications and, given only finite NHS resources, when they are most appropriate to use.[47]

When eczema is severe and does not respond to other forms of treatment, systemic immunosuppressants are sometimes used. Immunosuppressants can cause significant side effects and some require regular blood tests. The most commonly used are ciclosporin, azathioprine, and methotrexate.

Light therapy using ultraviolet light has tentative support but the quality of the evidence is not very good.[48] A number of different types of light may be used including UVA and UVB;[49] in some forms of treatment, light sensitive chemicals such as psoralen are also used. Overexposure to ultraviolet light carries its own risks, particularly that of skin cancer.[50]

There is currently no scientific evidence for the claim that sulfur treatment relieves eczema.[51] It is unclear whether Chinese herbs help or harm.[52] Dietary supplements are commonly used by people with eczema.[53] Neither evening primrose oil nor borage seed oil taken orally have been shown to be effective.[54] Both are associated with gastrointestinal upset.[54]Probiotics do not appear to be effective.[55] There is insufficient evidence to support the use of zinc, selenium, vitamin D, vitamin E, pyridoxine (vitamin B6), sea buckthorn oil, hempseed oil, sunflower oil, or fish oil as dietary supplements.[53]

Other remedies lacking evidence to support them include chiropractic spinal manipulation and acupuncture.[56] There is little evidence supporting the use of psychological treatments.[57][needs update] While dilute bleach baths have been used for infected dermatitis there is little evidence for this practice.[58]

Most cases are well managed with topical treatments and ultraviolet light.[3] About 2% of cases however are not.[3] In more than 60% the condition goes away by adolescence.[3]

Globally dermatitis affected approximately 230million people as of 2010 (3.5% of the population).[59] Dermatitis is most commonly seen in infancy, with female predominance of eczema presentations occurring during the reproductive period of 1549 years.[60] In the UK about 20% of children have the condition, while in the United States about 10% are affected.[3]

Although little data on the rates of eczema over time exists prior to the 1940s, the rate of eczema has been found to have increased substantially in the latter half of the 20th Century, with eczema in school-aged children being found to increase between the late 1940s and 2000.[61] In the developed world there has been rise in the rate of eczema over time. The incidence and lifetime prevalence of eczema in England has been seen to increase in recent times.[3][62]

Dermatitis affected about 10% of U.S. workers in 2010, representing over 15 million workers with dermatitis. Prevalence rates were higher among females than among males, and among those with some college education or a college degree compared to those with a high school diploma or less. Workers employed in healthcare and social assistance industries and life, physical, and social science occupations had the highest rates of reported dermatitis. About 6% of dermatitis cases among U.S. workers were attributed to work by a healthcare professional, indicating that the prevalence rate of work-related dermatitis among workers was at least 0.6%.[63]

from Ancient Greek kzema,[64] from - ekz-ein, from ek "out" + - z-ein "to boil"

The term "atopic dermatitis" was coined in 1933 by Wise and Sulzberger.[65]Sulfur as a topical treatment for eczema was fashionable in the Victorian and Edwardian eras.[51]

The word dermatitis is from the Greek derma "skin" and - -itis "inflammation" and eczema is from Greek: ekzema "eruption".[66]

The terms "hypoallergenic" and "doctor tested" are not regulated,[67] and no research has been done showing that products labeled "hypoallergenic" are in fact less problematic than any others.

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Dermatitis - Wikipedia

Home Topics AZ Atopic eczema

Author: Dr Amy Stanway, Department of Dermatology, Waikato Hospital, February 2004.

Atopic eczema is a chronic, itchy skin condition that is very common in children but may occur at any age. It is also known as eczema, atopic dermatitis and neurodermatitis. It is the most common form of dermatitis.

Atopic eczema usually occurs in people who have an 'atopic tendency'. This means they may develop any or all of three closely linked conditions; atopic eczema, asthma and hay fever (allergic rhinitis). Often these conditions run within families with a parent, child or sibling also affected. A family history of asthma, eczema or hay fever is particularly useful in diagnosing atopic eczema in infants.

Atopic eczema arises because of a complex interaction of genetic and environmental factors. These include defects in skin barrier function making the skin more susceptible to irritation by soap and other contact irritants, the weather, temperature and non-specific triggers: see Causes of atopic eczema.

There is quite a variation in the appearance of atopic eczema between individuals. From time to time, most people have acute flares with inflamed, red, sometimes blistered and weepy patches. In between flares, the skin may appear normal or suffer from chronic eczema with dry, thickened and itchy areas.

The presence of infection or an additional skin condition, the creams applied, the age of the person, their ethnic origin and other factors can alter the way eczema looks and feels.

There are however some general patterns to where the eczema is found on the body according to the age of the affected person.

More images of atopic eczema and flexural dermatitis.

Atopic eczema affects 15-20% of children but is much less common in adults. It is impossible to predict whether eczema will improve by itself or not in an individual. Sensitive skin persists life-long.

It is unusual for an infant to be affected with atopic eczema before the age of four months but they may suffer from infantile seborrhoeic dermatitis or other rashes prior to this. The onset of atopic eczema is usually before two years of age although it can manifest itself in older people for the first time.

Atopic eczema is often worst between the ages of two and four but it generally improves after this and may clear altogether by the teens.

Certain occupations such as farming, hairdressing, domestic and industrial cleaning, domestic duties and care-giving expose the skin to various irritants and, sometimes, allergens. This aggravates atopic eczema. It is wise to bear this in mind when considering career options it is usually easier to choose a more suitable occupation from the outset than to change it later.

Treatment of atopic eczema may be required for many months and possibly years.

It nearly always requires:

In some cases, management may also include one of more of the following:

Longstanding and severe eczema may be treated with an immunosuppressive agent.

Excerpt from:
Atopic eczema | DermNet New Zealand

Symptoms

Eczema, also known as atopic eczema or atopic dermatitis, is a skin condition causing inflammation and intense irritation. Eczema symptoms tend to be caused by dry skin. The skin becomes hot, itchy and inflamed; it may also be red and appear irritated. Atopy, or being atopic, means having a genetic tendency for your immune system to make increased levels of IgE antibodies to certain allergens. An atopic individual is likely to have more than one allergic condition during their lifetime, such as eczema, asthma, hay fever or food allergy.

In young children, patches of dry, scaly skin, or (less commonly) wet, weepy skin, can appear anywhere on the body. In older children, the eczema usually appears on wrists, ankles, elbows, knees and face, including the eyelids. In adults, it may localise, affecting the face, hands, neck and scalp although it can affect any part of the body.

Skin that is affected by eczema gets sore and broken when it is scratched, it can look wet and may bleed. Scratching is hard to avoid since the main distressing symptom of eczema is unbearable itching but once the skin gets broken and cracked, infections can set in, causing even more discomfort. Those with severe eczema often feel cold when others are hot. This is because the skin is the largest organ of the body and one of its roles is helping to regulate body temperature. Conversely, being hot in bed causes severe irritation.

This skin condition can affect any age range and it is thought to be caused by a defect in the skin barrier that makes it more susceptible to inflammation and allows allergens and bacteria to make contact with the immune system.

Eczema can affect ones quality of life significantly and may also affect sleep patterns. Whilst this can make you irritable and frustrated, good management can help alleviate these problems. This skin condition is well understood and dermatologists (skin doctors) have developed effective skin treatment regimens to control and manage the symptoms. It can take some time to find the most suitable therapy for each individual, often causing embarrassment and daily frustration with the symptoms in the meantime. Many people do not understand that eczema is neither infectious nor contagious.

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Generally, GPs can diagnose eczema and differentiate whether you have eczema or another skin condition. Seasons of the year (for example, in winter), or even emotional responses (such as stress), may cause eczema to worsen. However, a large number of eczema sufferers are not able to link a cause to their symptoms. It is essential that any known triggers are avoided and sometimes keeping a trigger symptom diary at home may help you to realise what might be causing flares. Important things to consider include bubble baths, shampoos, make-up products, chemicals such as cleaning products and occupational irritants such as hairdressing products or heavy oils and lubricants used in the motor industry or allergens, such as latex gloves, leather, cement or certain plants.

If further investigation is needed, or the skins condition is not improving with barrier protection and prescribed treatment, your GP may make a referral to see a dermatologist to pinpoint the exact cause of the condition. Allergy patch tests can identify substances causing contact allergy. Allergy tests (either skin prick testing or a specific IgE blood test) may help to identify airborne or food allergens involved in flares, as many people with atopic dermatitis/eczema may also have asthma, allergic rhinitis/hay fever. Allergens that trigger these may also trigger symptoms in eczema, such as house dust mite, animal dander, mould spores, pollen or foods. You may need to be referred to an allergy clinic for skin prick or specific IgE blood tests.

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No. Children are born with the tendency to have eczema and many things can make their eczema worse. These are known as triggers for the eczema. Foods can be triggers for eczema especially in infants but the foods are not the primary cause of the eczema. If a food is found to make eczema worse, excluding that food may significantly improve symptoms but not cure the condition. A food that is not eaten often but causes symptoms may be easier to identify than one that is eaten daily, such as milk/dairy products, wheat or soya.

Some patients with the IgE-associated variety of AEDS suffer from worsening of their skin symptoms after contact with certain airborne allergens, such as house dust mite, pollens, or animal hairs, and improve after appropriate allergen avoidance strategies are introduced.

Emollient lotions and creams are prescribed for eczema and dry skin, and are, in their simplest form, mixtures of oil and water. Some emollients may also contain slight amounts of antibacterial chemicals (to avoid infection in broken skin), or steroids (to reduce inflammation).

Emollient products range in their consistency, from being runny lotions to thick creams, and while they can be a very cooling and soothing treatment for eczema, the stickiness of the thicker products can sometimes make them a source of annoyance. It is important to find a product that is suitable for you.

Dry skin is more susceptible to eczema, and once the skin barrier is broken, it is open to potential infection and further irritation from allergens and other chemical irritants. Scratching also causes the body to release histamine, which further aggravates the symptoms. Emollients work to reduce eczema symptoms by creating a protective barrier on the top layer of the skin, moisturising it and reducing water loss. The oil also provides lubrication so that the dry skin, which is often itchy and rough, will not be as easily irritated.

Although emollients do not stop the underlying cause of eczema, they calm and soothe the skin, and give it time to repair itself. For emollients to work effectively, they need to be used as part of a regular treatment regimen. This means that they should be applied at set times of day, and should be used whether they appear to be needed or not.

Eczema can flare up at any time, in some instances due to infection, hormonal changes, stress or allergens, but also for no obvious reason. Even when emollients are used, there may be times when eczema seems to get worse. However, regular treatment can help to minimise the number and severity of flare ups.

Emollients should be continued, even when all traces of eczema have vanished. By keeping the skin moisturised, it will be better hydrated and with less chance of the skin barrier being broken, the risk of allergens and other irritants causing eczema is reduced.

Emollients are available as lotions, creams, ointments, shower and bath products and soap substitutes. These products should be used every day as emollients support the skins barrier function by helping it to retain water and form a protective layer against allergens or bacteria. They can also help to relieve the itchy symptoms typical of eczema.

Water can have a drying effect on skin and so emollients are also available as bath products, which help to hydrate and protect the skin while soaking in the water, although it is no longer advised to soak for more than 15 minutes. In addition, soap can also make eczema worse because it dries the skin further. Soap substitute emollients can also be prescribed, which can be rubbed on and rinsed off skin just like liquid soap.

You may find that you are prescribed several creams if your eczema symptoms vary and different creams may be more suitable for different times. For example, you may prefer to use a less oily cream during the day and use a thicker cream or ointment treatment at night. Ointment also have the advantage of needing less or no preservatives, to which a few people can eventually react.

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It is sometimes necessary to apply topical corticosteroids (e.g. hydrocortisone), as these reduce inflammation in the skin.

Many people worry when steroids are mentioned as a treatment option because of stories they may have heard in the media, particularly related to anabolic steroid abuse in sports. These, however, are not the same steroids that are used as medical treatments and, when used as directed by a physician, steroids have an important role to play in treating a range of ailments, including eczema.

Topical steroids are safe to use but it is important to always follow the instructions provided, making sure you understand which areas you apply the cream to and exactly how much. If you have any questions, then ask your doctor or nurse for further advice and information.

Steroid creams only need to be applied to the inflamed areas of skin. One fingertip of cream (where the cream is squeezed along the fingertip as far as the first joint) is usually enough to cover an area of skin twice the size of an adults hand. Fingertip units are used as a guide for the amounts needed for different parts of the body.

Sometimes emollients and other creams (i.e. steroids and antibiotics) are needed in combination. It is important to leave an adequate gap between applying the different creams to allow one cream to be absorbed before applying another, ideally at least 10 minutes. If creams are applied too soon after each other they may be diluted so healing and control of the symptoms can take longer. Steroid creams, when used for a long time at a high dose, can cause skin to be thinned. This will not happen when steroid creams are prescribed at the appropriate strength, with less potent steroids being prescribed on the face than on the body. It is also important to use steroid creams as early into flares as possible, as this will avoid the need for higher strength preparations, required when the eczema is severe. Doctors are also increasingly using steroid creams proactively for only a couple of days a week (weekend therapy), even when the eczema is well controlled, to prevent future flares, as this has been shown to reduce the amount of steroids needed in the long-term.

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Sometimes, special pyjama-like garments (known as wet wraps) that are used for children, may also help certain areas of your body that have not responded to the usual topical application of emollients and steroids. Wet wraps can also be useful if you suffer from itch at night and cannot sleep, allowing you to have a better quality of sleep during times when the eczema is particularly bad. There are various ways of applying these garments and your nurse or doctor will be able to demonstrate the best way of application.

It important to follow the advice of your treating practitioner for the length of time of wet wrap treatment, and it is important to have your skin re-assessed when the treatment comes to an end.

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Calcineurin inhibitors are an alternative to steroid creams. There are two different preparations, Tacrolimus (0.03% and 0.1%) and 1% Pimecrolimus (also known as Protopic and Elidel), licensed for use in children over the age of two. Like steroid creams, they reduce the skin inflammation and can lessen itching.

These creams are suitable for use on almost every part of the body, as they do not thin the skin and are often used when steroids have proved unsuccessful, or are not suitable, for example, on sensitive skin around the eyes. Emollients should continue to be used as well as these creams.

A common side effect of these creams is a short-lived burning sensation on application, which is harmless and generally settles down after a few applications. These drugs are thought to be safe and effective in the short-term but their safety for long-term use has yet to be proven.

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There are many other types of dermatitis/eczema, which are non-atopic, i.e. not triggered by allergens or related to allergy, such as seborrhoeic; pompholyx; irritant contact; gravitational/asteototic; discoid/nummular. Information on these is available from http://www.eczema.org

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Atopic Dermatitis / Eczema - Allergy UK

Evidence reviews Effects of antihistamines on eczema

Eczema is a common chronic disease. Itch is the most important symptom, and eczema is often accompanied by dry skin. Skin lesions include rash, redness, swelling of the skin, crusts, oozing, and sometimes also bleeding as a consequence of persistent scratching. Although the disease can resolve during childhood, it might also recur in or persist into adult life. The cause of eczema is considered to be a combination of genetic and environmental factors. Moisturisers, topical corticosteroids, and topical immunomodulators are the mainstay during treatment of eczema, while more severe cases might need UV light therapy or systemic immunosuppressants. Itch is very difficult to treat and leads to scratching, which leads to more inflammation of the skin, and often people with eczema end up in a vicious circle of itching and scratching. The role of histamine in itching associated with eczema is not fully elucidated, but oral H1 antihistamines have been used for many years in the treatment of eczema. These might have been used largely for their sedative action, with highly sedative antihistamines, e.g. chlorpheniramine and hydroxyzine. However, oral H1 antihistamines are widely used in the treatment of allergic disorders, such as urticaria, allergic rhinitis, and allergic conjunctivitis, but their efficacy in alleviating itch and eczema remains unclear. This systematic review sought evidence for the effects and safety of the use of oral antihistamines for eczema, to guide their use in clinical practice.

Atopic eczema (atopic dermatitis or childhood eczema) is a big problem worldwide. The skin of people with atopic eczema often contains high numbers of a bacterium called Staphylococcus aureus (S. aureus).

This review of clinical trials aimed to find out whether topical pimecrolimus is better than topical corticosteroids or tacrolimus for treating eczema in infants, children and adults by assessing the improvement of eczema and adverse events associated with treatments.

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Eczema is a common chronic disease. Itch is the most important symptom, and eczema is often accompanied by dry skin. Skin lesions include rash, redness, swelling of the skin, crusts, oozing, and sometimes also bleeding as a consequence of persistent scratching. Although the disease can resolve during childhood, it might also recur in or persist into adult life. The cause of eczema is considered to be a combination of genetic and environmental factors. Moisturisers, topical corticosteroids, and topical immunomodulators are the mainstay during treatment of eczema, while more severe cases might need UV light therapy or systemic immunosuppressants. Itch is very difficult to treat and leads to scratching, which leads to more inflammation of the skin, and often people with eczema end up in a vicious circle of itching and scratching. The role of histamine in itching associated with eczema is not fully elucidated, but oral H1 antihistamines have been used for many years in the treatment of eczema. These might have been used largely for their sedative action, with highly sedative antihistamines, e.g. chlorpheniramine and hydroxyzine. However, oral H1 antihistamines are widely used in the treatment of allergic disorders, such as urticaria, allergic rhinitis, and allergic conjunctivitis, but their efficacy in alleviating itch and eczema remains unclear. This systematic review sought evidence for the effects and safety of the use of oral antihistamines for eczema, to guide their use in clinical practice.

Probiotic supplements for pregnant women and babies can prevent the development of eczema in some children. Probiotics have been better researched than prebiotics.

Atopic eczema (atopic dermatitis or childhood eczema) is a big problem worldwide. The skin of people with atopic eczema often contains high numbers of a bacterium called Staphylococcus aureus (S. aureus).

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Eczema - National Library of Medicine - PubMed Health

What is eczema?

Eczema, also known as atopic dermatitis, is a chronic allergic condition in which the skin develops areas of itchy, scaly rashes.

Eczema can occur on almost any part of the body but eczema on face areas is common, as is eczema on the scalp, inside of elbows, knees, ankles, and hands. It typically appears as extremely itchy patches on the skin. Eczema can get worse when scratched; in fact, itchy skin may appear normal until scratched; the irritating action may then cause the characteristic rash and scales to develop.

Other eczema symptoms include:

Scratching can introduce infectious agents into the skin, leading to secondary complications including bacterial infection and permanent scars.

Eczema is caused by a reaction similar to that of an allergy and can promote chronic inflammation. The condition will often wax and wane and accompany other allergic conditions such as asthma. In some cases, a specific substance, such as certain soaps, detergents, or metals, dust mites, and animal dander, can trigger eczema. For many people, however, there is no known allergen that causes this reaction. Eczema can be worsened by dry climates, exposure to water, temperature changes, and stress.

Eczema is particularly common in infants and children. A persons risk of developing the problem also increases if he or she has a family history of eczema or allergic conditions such as asthma and hay fever.

Physicians usually diagnose eczema by conducting a physical exam and asking questions about the patients symptoms, medical history, lifestyle, and habits.

Conventional doctors often recommend a combination of self-care techniques and medical therapies in the treatment of eczema. First, people with eczema should avoid any potential triggers that appear to make symptoms worse. Take warm, not hot, showers or baths if you have eczema. Use soap as sparingly as possible, and apply a soothing, hypoallergenic moisturizer immediately after bathing. Physicians may also suggest using over-the-counter anti-itch lotions or low-potency steroid creams.

When these measures dont alleviate eczema, the doctor may prescribe one or more of the following treatments:

Read the original:
What is Eczema? Eczema Treatment | Dr. Weil

Eczema refers to a chronic inflammatory skin condition, characterized by dry skin, with patches that are red and intensely itchy. These patches of eczema may ooze, become scaly, crusted, or hardened. Symptoms can range from mild to severe, and the condition can negatively impact quality of life. Eczema can occur anywhere on the skin and is commonly found on the flexors (bends of the arms, backs of the knees).

There are many types of eczema, with the most common one being atopic dermatitis. Atopy refers to a hereditary tendency toward eczema, asthma, and allergic rhinitis (hay fever). People with eczema may suffer with one of the other atopic diseases.

The exact cause of eczema is unknown, however, there are genetic, immunological and environmental factors that play a role. Eczema can come and go, and can migrate around the body; just as one patch clears up, another may develop. This is the chronic nature of the disease. When the skin cycles back to inflammation, the patient is experiencing a flare-up.

Atopic eczema is the most common form of eczema and is closely linked with asthma and hayfever. It can affect both children and adults, usually running in families. One of the most common symptoms of atopic eczema is itching (pruritus), which can be almost unbearable. Other symptoms include dryness of the skin, redness and inflammation. Constant scratching can also cause the skin to split, leaving it prone to infection. In infected eczema the skin may crack and weep and develop pustules. Treatments include emollients to maintain skin hydration and steroids to reduce inflammation.

ACD develops when the bodys immune system reacts against a substance after contact with the skin. The allergic reaction often develops over a period of time through repeated contact with the substance. For example, an allergic reaction may occur to nickel, which is often found in earrings, snaps on baby's undershirts, belt buckles and jean buttons. Reactions can also occur after contact with other substances such as perfumes and rubber. In order to prevent repeated reactions it is best to prevent contact with anything that you know causes a rash.

This is a type of eczema caused by frequent contact with everyday substances, such as detergents and chemicals, which are irritating to the skin. It most commonly occurs on the hands of adults and can be prevented by avoiding the irritants and keeping the skin moisturized. It commonly occurs in patients who have atopic dermititis.

A condition that affects babies under one year old, the exact cause of which is unknown. Also referred to as cradle cap, it usually starts on the scalp or the nappy area and quickly spreads. Although this type of eczema looks unpleasant, it is not sore or itchy and does not cause the baby to feel uncomfortable or unwell. Normally this type of eczema will clear in just a few months, though the use of moisturising creams and bath oils can help to speed this along.

Characteristically affects adults between the ages of 20 and 40. It is usually seen on the scalp as mild dandruff, but can spread to the face, ears and chest. The skin becomes red, inflamed and starts to flake. The condition is believed to be caused by a yeast growth. If the condition becomes infected, treatment with an anti-fungal cream may be necessary.

Varicose eczema affects the lower legs of those in their middle to late years, being caused by poor circulation. Commonly the skin around the ankles is affected, becoming speckled, itchy and inflamed. Treatment is with emollients and steroid creams. If left untreated, the skin can break down, resulting in an ulcer.

Is usually found in adults and appears suddenly as a few coin shaped areas of red skin, normally on the trunk or lower legs. They become itchy and can weep fluid. Usually discoid eczema is treated with emollients (and steroid creams if necessary).

Some complications of eczema include skin infections, eczema herpticum, neurodermatitis, and eye complications.

Scratching that is associated with eczema can break the skin causing open sores which can then become infected. This can cause mild or more serious infections. See a physician if there is swelling, pain, crusting, or oozing of the eczema.

Skin that becomes inflected with the herpes simplex virus (the virus that causes cold sores) is called eczema herpeticum. The symptoms may include painful pus or fluid filled blisters or sores, which may be accompanied by fever, tiredness, and swollen glands. Prompt treatment is very important, as the inflection can spread to the eyes or internal organs, causing serious problems.

Caution should be taken around anyone with a cold sore; kissing and skin-to-skin contact should be avoided. Take extra caution with infants and children, especially those with eczema and/or open areas on their skin. Sometimes, with infants and small children, contact with the herpes simplex virus can be fatal. See a doctor immediately if there are concerns.

Long term itching and scratching of the skin can lead to an increased sensation of itch, which could possibly lead to neurodermatitis (also known as lichen simplex chronicus). These areas of the skin that are frequently scratched become thick and leathery in appearance, and the patches can be red and darker than the rest of the skin. Persistent scratching can lead to permanent changes in skin colour. See a physician if experiencing intense itch and/or there are noticeable changes in the skin.

In rare cases, severe atopic dermatitis can lead to eye complications which could potentially cause permanent eye damage. See a physician if experiencing eye watering, inflammation around the eye, and eye discharge.

Our skin is the barrier to the outside world, is somewhat waterproof, and keeps our internal organs and systems safe from the elements and from bacteria invading our bodies. Atopic dermatitis patients have impaired barrier function. This means that the skin barrier is broken down, loses moisture, and can allow bacteria to grow and enter the body (causing bacterial infections on the skin). The loss of water leaves the skin dry and cracked. The goal of eczema management is to replenish moisture, and create a barrier to protect the skin. This is why moisturizers can help.

Flare-ups can be prompted by environmental elements or triggers such as certain soaps, clothing fabrics, deodorants, carpet fibres, dust, and others. Sometimes a flare-up will occur, however, with no discernible trigger. Overheating, excessive sweating, low humidity, certain foods and stress can also contribute to flare-ups. When the skin becomes irritated by any one of these irritants, it itches, causing the sufferer to scratch the affected area. Scratching makes the condition worse and the skin becomes inflamed and reddened, aggravating the itch. This is called the itch-scratch cycle and can become severe and cause pain.

Look around you and write down all of the possible things in your surroundings that could be contributing to your flare-ups. For example, do you experience a flare-up or worsening of your eczema when you wear a certain sweater? Is your eczema worse in the winter? Do you itch on the days when you clean your house? Does perfume irritate your skin? Use this trigger chart to help to identify your triggers.

Controlling factors in your environment can help minimize flare-ups from occurring. By minimizing or eliminating your triggers, you can help to reduce the number of flare-ups experienced. One of the frustrating parts of eczema is that flare-ups can still occur even when you are diligently avoiding triggers and taking care of your skin. Keeping your skin moist is your first line of defence against eczema.

Certain foods can trigger a flare-up, just like other environmental triggers. This can occur by eating the trigger food, or by skin contact with the food during preparation or during eating (on the hands and around the mouth). It is important to note that food allergies do not cause eczema, however foods can trigger a flare-up. It is not recommended to withhold foods, or entire food groups, for long periods of time without consulting your doctor or your allergist to confirm that there is in fact an allergy to that food. Allergy skin testing can help to provide clues about environmental and food allergies, however patients with atopic dermatitis have high false positive rates, as the simple act of scratching the skin during testing can cause inflammation which may then be misinterpreted as an allergic reaction. Antihistamine use can also impact the accuracy of allergy testing. Speak with your allergist about your eczema, and your medical treatments prior to testing.

Atopic eczema is a chronic, recurring condition with "flares" (active or new patches of eczema which look red, scaly, and/or bumpy) and remissions (when eczema is not as active). Some people always seem to have some active areas. There are no definite cures for eczema although patients can achieve excellent control and live quite comfortably. Most children will grow out of their eczema, and flares will gradually reduce over time. We recommend following our Triangle of Control (LINK) and Regimen (LINK) to ease your eczema symptoms and prevent future flares. This is the first line of defence!

When one member of the family suffers with eczema, the whole family suffers. Rigorous bathing and moisturizing regimens, constant monitoring of the condition, lifestyle changes in an effort to avoid triggers, and sleepless nights can greatly impact the quality of life for all members of the family.

Talking with others who understand what you are going through is very important. Eczema is a spectrum disease, meaning that there are very mild conditions which are not bothersome to the patient, and then there are moderate and severe conditions that have significant physical and psychological impacts. Often the impact of eczema is minimized.

Eczema has a significant psychological impact on sufferers and their families.

Eczema impacts quality of life for the sufferer and their whole family. Social interactions, relationships, work, family, comfort, and self-image can all be negatively affected when eczema is not well controlled.

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About Eczema - What is Eczema?

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