Eczema

Eczema is term for a group of medical conditions that cause the skin to become inflamed or irritated.

The most common type of eczema is known as atopic dermatitis, or atopic eczema. Atopic refers to a group of diseases with an often inherited tendency to develop other allergic conditions, such as asthma and hay fever.

According to the National Institute of Allergy and Infectious Disease, the prevalence of atopic eczema is increasing and affects 9 to 30% of the U.S. population. It is particularly common in young children and infants. While many infants who develop the condition outgrow it by their second birthday, some people continue to experience symptoms on and off throughout life. With proper treatment, the disease can be controlled in the majority of sufferers.

What Are the Symptoms?

No matter which part of the skin is affected, eczema is almost always itchy. Sometimes the itching will start before the rash appears, but when it does the rash most commonly occurs on the face, knees, hands or feet. It may also affect other areas as well.

Affected areas usually appear very dry, thickened or scaly. In fair-skinned people, these areas may initially appear reddish and then turn brown. Among darker-skinned people, eczema can affect pigmentation, making the affected area lighter or darker.

In infants, the itchy rash can produce an oozing, crusting condition that occurs mainly on the face and scalp, but patches may appear anywhere.

What Causes It?

The exact cause of eczema is unknown, but it's thought to be linked to an overactive response by the body's immune system to an irritant. It is this response that causes the symptoms of the disease.

In addition, eczema is commonly found in families with a history of other allergies or asthma.

Some people may suffer "flare-ups" of the itchy rash in response to certain substances or conditions. For some, coming into contact with rough or coarse materials may cause the skin to become itchy. For others, feeling too hot or too cold, exposure to certain household products like soap or detergent, or coming into contact with animal dander may cause an outbreak. Upper respiratory infections or colds may also be triggers. Stress may cause the condition to worsen.

Although there is no cure, most people can effectively manage their disease with medical treatment and by avoiding irritants. The condition is not contagious and can't be spread from person to person.

How Is It Diagnosed?

A pediatrician, dermatologist or your primary care provider can make a diagnosis of eczema. Since many people with eczema also suffer from allergies, your doctor may perform allergy tests to determine possible irritants or triggers. Children with eczema are especially likely to be tested for allergies.

How Is It Treated?

The goal of treatment is to relieve and prevent itching, which can lead to infection. Since the disease makes skin dry and itchy, lotions and creams are recommended to keep the skin moist. These solutions are usually applied when the skin is damp, such as after bathing, to help the skin retain moisture. Cold compresses may also be used to relieve itching.

Over-the-counter or prescription creams and ointments containing corticosteroids, such as hydrocortisone, are often prescribed to reduce inflammation. For severe cases, your doctor may prescribe oral corticosteroids. In addition, if the affected area becomes infected, your doctor may prescribe antibiotics to kill the infection-causing bacteria.

Other treatments include antihistamines to reduce severe itching, tar treatments (chemicals designed to reduce itching), phototherapy (therapy using ultraviolet light applied to the skin) and the drug cyclosporine for people whose condition doesn't respond to other treatments.

The FDA more recently has approved two drugs known as topical immunomodulators (TIMs) for the treatment of moderate-to-severe eczema. The drugs, Elidel and Protopic, are skin creams that work by altering the immune system response to prevent flare-ups.

On March 10, 2005, the FDA warned doctors to prescribe Elidel and Protopic with caution due to concerns over a possible cancer risk associated with their use.

As of January 2006, these two creams carry the FDA's strongest "black box" warning on their packaging to alert doctors and patients to these potential risks. The warning advises doctors to prescribe short-term use of Elidel and Protopic only after other available eczema treatments have failed in adults and children over the age of 2.

How Can Flare-ups Be Prevented?

Eczema outbreaks can usually be avoided or the severity lessened by following these simple tips.

• Moisturize frequently
• Avoid sudden changes in temperature or humidity
• Avoid sweating or overheating
• Reduce stress
• Avoid scratchy materials, such as wool
• Avoid harsh soaps, detergents and solvents
• Avoid environmental factors that trigger allergies (for example, pollen, mold, dust mites, and animal dander)
• Be aware of any foods that may cause an outbreak and avoid those foods