Eczema

Dr. James Lee's Blog - EczemaEczema is a common skin disorder seen in all ages. Medically it is called Atopic Dermatitis because of its wide array of appearances and manifestations. Eczema is triggered by a sensitivity reaction. This can be a specific allergic reaction (e.g. food) or it can be a hypersensitivity reaction (e.g. contact with a metal or chemical, such as nickel or poison ivy). Eczema patients typically have other allergic tendencies (hay fever /asthma) or a strong family history for allergies. Additionally, environmental and personal lifestyle situations also play a big role in eczema severity. Temperature and humidity changes, illnesses, exercise (sweating); even stress can all contribute to or alter the presentation of eczema. Further, there are many variants of eczema rashes so all of the above can make a treatment plan very challenging.

Eczema should be considered a chronic condition that can wax and wane. Triggers or underlying causes of eczema sometimes need evaluation, depending on the age, severity and response to treatment. Classic childhood eczema typically presents as a red, itchy rash mainly in the crease folds of the elbows and knees but can also present as a rough, irritated patch diffusely spread over the body. Eczema always itches and control of itching is vital to its management.

A few common variants of eczema include Pilaris Keratosis (goose bump skin) which are tiny, red, dry bumps usually on the outer arms, thighs and sometimes face. Foot Dermatitis (sweaty foot dermatitis) is also common. Individuals with eczema generally sweat more or their skin is more irritated by sweating (dyshidrosis). Foot Dermatitis is the resultant combination of an eczema rash triggered or worsened by sweating. Pityriasis Albe is another common variant. These are irregular areas of hypopigmentation that makes the skin look patchy with pale spots. This is most obvious in white children in the summer as a result of sun exposure. Black children can have the opposite reaction- hyperpigmentation or darkened patches of skin.

The role of secondary infection- both bacterial (Impetigo, Staph infections) and viral (Herpes and Warts (Molluscum)) has been shown to be a common cause of worsening or harder to control cases. Sometimes these infections can be subtle (the child is not sick except for worsening eczema) and reinforces the importance of basic eczema control to prevent flares or infections.

Basic skin care of eczema is critical to good management and control. Some basic review pointers:

  1. Bathing is fine (and necessary) but should be brief and not too hot. Bathing frequency should be related to the time of year and patients lifestyle. The application of moisturizers (see below) immediately after bathing (ideally applying to wet/damp skin) is possibly the single most important tool to help in control. The role of bleach baths is potentially necessary and beneficial in helping to prevent colonization of bacteria leading to secondary infection. You may ask for the “recipe” and its appropriateness for your child.
  2. Soaps and moisturizers are part of the bathing program. Harsh soaps should be avoided and consider a soap substitute (Cetaphil). Moisturizers vary in terms of cost and effectiveness. Some recommended brands include; Cetaphil, Eucerin, Aquaphor, Moisturelle and Cerva.
  3. Control of itching. Itching both contributes to and is a main symptom of eczema. Controlling the itch-scratch cycle makes the patient feel better and also helps control the eczema. In addition to the above skin care pointers, the role of antihistamine medications (Benadryl) may be necessary on an on/off pattern. Interesting however, topical Benadryl and certain antibiotics (Neosporin) can actually sensitize or trigger more eczema. This can be a confusing area that may need a doctors input.
  4. Topical steroids continue to be the main treatment of eczema dermatitis. The strength, preparation and areas of skin covered all are part of the treatment plan. The potency of steroid preparations vary from mild OTC forms to very potent prescription strengths. The use of steroids is a common area of concern. Matching the patient’s eczema to the right steroid, both in terms of frequency and strength is an important part of the treatment plan. Doing the right thing at the right time can significantly improve both quality of life and complications of eczema.
  5. Elidel and Protopic are two other medications that you may have heard about. When first produced, there non-steroidal agents were initially hoped to revolutionize eczema care but possible long term side effects have made their role more confusing and are not recommended for “routine” eczema care at present.

I hope this expanded discussion is helpful to those of you who struggle with eczema and its manifestations. My motivation for writing this update came from attending a recent lecture from a University Pediatric Dermatologist, and I would consider the current standard of care.

– Dr. James Lee, Pediatrician

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