Eczema and its causes and treatments
Though eczema is extremely common, you're not likely to see a telethon about it. People with eczema -- an umbrella term for a variety of skin conditions -- tend to suffer in silence, hiding rashes under their clothes and dabbing at them with creams. Treatments often provide relief, however.
Here's what you need to know:
1. Irritants can cause eczema.
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Eczema refers to certain types of itchy rashes. Symptoms can include itching, sometimes severe, as well as small, raised bumps on the skin, thickened or scaly skin and skin that becomes sensitive from scratching.
The word "eczema" is often used interchangeably with the term "contact dermatitis," which refers specifically to a rash that someone gets after coming in contact with an irritant, such as poison ivy or the metal wristband of a watch.
"This can be as simple as a mom who washes her hands constantly after changing baby diapers," explained Dr. Donna Serure, chief of dermatology at St. Catherine of Siena Medical Center in Smithtown. "The constant exposure to soap and water can irritate the skin," she said.
"Another example could be a hairdresser who is exposed to hair products, colors, dyes and even hair sprays that aerosolize," Serure noted. "Often hairdressers who don't protect their hands with gloves will develop hand eczema/dermatitis. I've also seen a lot of eyelid dermatitis from aerosolized products that irritate the delicate skin around one's eyes."
2. Kids have their own forms of eczema.
Babies and other youngsters sometimes develop skin rashes -- known as "baby" or "childhood" eczema -- for reasons that aren't clear, although genetics might play a role, said Dr. David Silverstein, a clinical assistant professor in the dermatology department at Stony Brook University School of Medicine.
In kids, though, eczema is typically temporary. "There is technically no cure for baby or childhood eczema, although most people with the condition do improve considerably with treatment and as they age," Silverstein said. "Indeed, most babies and children with eczema will not have it by the time they reach adulthood."
Baby eczema usually develops when the child is 2 months to 2 years old, Serure said, and clears about half of the time by age 3. Childhood eczema can develop in kids 3 to 11 years old, although most of the time it appears and disappears by age 6.
3. Simple treatments are sometimes enough.
"If a patient has a substantial amount of eczema all over the body, it is most appropriate to visit a dermatologist immediately," Silverstein said. "On the other hand, if the eczema is limited to just a few patches on the body, over-the-counter hydrocortisone might be enough to help."
Hydrocortisone products, which reduce inflammation, are used to treat a variety of skin conditions.
Silverstein said moisturizing the body is crucial. That includes taking "warm showers and baths instead of hot ones, as this can dry the skin," he said. "Also, it is important to moisturize with something thicker, like Aquaphor or even Vaseline, immediately after a shower or bath, as this preserves the integrity of the skin barrier."
In general, the best treatments are drugs like hydrocortisone and medications that work in similar ways, Silverstein said. "For most patients with limited disease, when used correctly, these medications work very nicely with minimal side effects," he added.
When over-the-counter treatments fail, doctors sometimes prescribe the creams pimecrolimus (brand name, Elidel) to treat mild to moderate eczema, or tacrolimus (Protopic) for moderate to severe eczema, according to the U.S. National Institutes of Health.
Another treatment is phototherapy, exposing the skin to ultraviolet light.
4. The development pipeline may yield new options.
A new drug called apremilast is now being studied and could be "game-changing," Silverstein said, but only for people with severe eczema. The drug, being developed by the Celgene company, works to reduce inflammation.
Another treatment being studied, called allergen immunotherapy, attempts to expose people with eczema to allergens that cause the skin disease in order to lower their reaction. Dr. Marianne Frieri, chief of allergy and immunology at Nassau University Medical Center in East Meadow, said, "This method of therapy involves an understanding of the triggers specific to a patient to desensitize them to that particular allergen."
5. A dose of prevention might help.
It's wise to avoid excessive sun exposure, clothing fabrics that irritate the skin and harsh cleansers, Frieri said.
People susceptible to eczema also should avoid foods that trigger their rashes. These might include eggs, milk, wheat, corn, soy and peanuts, she said. Even dust mites can be a factor for some.
Serure also recommends being careful about laundry products. "The chemicals in laundry detergent are pretty harsh," she said. "Even though our clothes get rinsed, there is a residue left behind in the fabric that can be very irritating. I recommend using laundry detergents free of perfumes and dyes. I would also avoid fabric softener, bleach and dryer sheets."