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tch . . . scratch . . . .
Itch . . . scratch . . . scratch . . . .
In brief, this is the story of what people frequently call “eczema” and what dermatologists call “atopic dermatitis.” It is the disease that starts from scratch and one that may last a lifetime. It is the eczema of infancy, the chronic, relentless dermatitis of childhood and adolescence, and the fierce and uncontrollable itching of the adult.
Eczema is a general term that, to most people, means a diffuse rash with itching. It is a synonym for dermatitis, which literally means “inflammation of the skin.”
But when physicians speak of eczema, they usually refer to the persistent, incessant itchy eruption that almost invariably begins in infancy, is inherited, is often accompanied in later years by hay fever or asthma, and in rare circumstances lasts a lifetime. It is atopic dermatitis, a disease that affects about 15 million people in the United States alone. The word atopic is used to describe the group of diseases – eczema, asthma, allergic rhinitis, and hay fever – that often affect several members of the same family. The prevalence of eczema has nearly tripled since 1970 and it has been suggested that this increase is a result of environmental factors.
No one yet knows the “why” of this virtually uncontrollable, allergic process. It begins with itching on a perfectly normal-looking skin. You then rub, claw, tear, and scratch where it itches and you, yourself, produce the rash we know of as eczema. People with eczema appear to have a reduced itch threshold and this, it seems, is considered to be a hallmark of the disorder.
There are three different types or “stages” of atopic dermatitis.
The infantile form. This usually begins about six or eight weeks after birth. The itching is often intense and lasts up until about the age of two years. The rash, which almost always affects the cheeks and mouth, usually worsens after vaccinations and immunization injections and during the teething phase. During the second year of life, the itchy areas develop over the hands, wrists, and outer portions of the arms and legs. Sixty percent of patients develop eczema in the first year of life.
The childhood type. While the infantile form in over half the cases fades out between the ages of two and four, it may continue into the so-called childhood type of eczema. The areas that suffer most here are the creases in the elbows and the bends of the knees. The affected areas are drier, the skin becomes thicker and grayish in color, the itching becomes fierce, and the children are restless, anxious, and hyperactive. Loss of sleep for young children suffering from eczema can lead to lack of concentration at school and irritability.
Of all the eczemas that occur during childhood, atopic dermatitis is not only the most prevalent disorder, but it is also one of the most mystifying and difficult to manage.
The adolescent and adult types. The infantile and childhood eczemas often disappear after a few years only to reappear in late adolescence. While it usually fades away by the age of 20, it may persist throughout the entire lifetime of some unfortunate person. The itching, again, may be intense and is usually worse at night. The areas affected are the bends of the elbows and knees, the face, the shoulders, and the upper back. The itchy and scratched skin becomes thick and leathery, darker than the surrounding skin, and develops dry scales. Many adult patients may have only chronic hand eczema.
Another characteristic feature is the accentuated groove beneath the lower eyelids. This is called the atopic pleat.
Triggering factors for certain people with atopic dermatitis include the following:
The management of eczema is an enormous challenge for the physician. No one treatment for eczema works for everyone, since the areas involved and the degree of itching affect different people in different ways. At best we try to alleviate the intense itching that, in essence, is the disease. Interrupt and stop this fierce symptom and we break the itch-scratch reflex that is wholly responsible for the clinical manifestation – the rash.
Although there is no specific treatment for controlling eczema, here are some general rules and measures to follow:
For the milder cases of eczema, over-the-counter hydrocortisone creams along with an oral antihistamine (never use topical antihistamines and never use Neosporin!) might relieve some of the subjective manifestations of the disorder. But proper control belongs in the hands of a dermatologist.
Above all, try to be patient and keep a positive attitude. Despite the agony it can cause, eczema is not a serious disorder. If you can learn to live with it and keep the rash under control, chances are it will burn itself out of its own accord.
If, however, your rash persists and the itching is uncontrollable, see your dermatologist. He or she will be able to prescribe some time-tested remedies in the form of creams, lotions, cortisone-like drugs, ultraviolet light therapy in persistent cases and, perhaps, antibiotics if your rash becomes infected.
A new surface medication, by prescription only, is an immunomodulator drug that has shown remarkable results in the treatment of atopic dermatitis. Called Protopic – the generic name of which is tacrolimus – it may prove a godsend for patients with longstanding eczema. Ask you dermatologist for the details of this innovative therapeutic “miracle.”
Note: For itching, never use any surface medications containing neomycin or “-caine” derivatives, the most common being benzocaine.
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For more information about eczema, contact National Eczema Association for Science & Education 1220 SW Morrison - Suite 433 – Portland, OR 97205 Tel: 1-800-818-7546; 503-228-4430 or www.familydoctor.org/handouts/176.html or www.aad.org 1-888-462-DERM x22 |
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| TREATING ECZEMA |
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For the acute, weeping, and oozing type of eczema, soothing wet dressings and baths will help relieve the inflammation and itching.
For acute, localized eczema, use the following as an open wet dressing:
Bluboro Powder
Domeboro Powder
Directions are on the package. Use as open wet dressings as described on page 000.
For acute, widespread eczema, the best form of therapy is a soothing bath taken in either of the following bath oils:
Alpha Keri Bath Oil
Aveeno Bath Oil
Directions are on the bottles.
When the weeping and oozing have begun to dry up, discontinue the wet dressings. Now you can use a cream or lotion to help relieve the itching and help the skin maintain its smoothness and resiliency. Try any of the following:
Hytone Cream 0.5%
Cort-Aid Cream
Quitch Cream
Directions: Apply every 2 or 3 hours and after your bath.
For the dry, scaly chronic variety of eczema, where the skin is tight and thickened, you may try the following lubricating preparation:
Cort-Aid Ointment
Quitch Ointment
For generalized, chronic eczema use the following bath additive:
Balnetar
Directions for use are on the bottle.
For any stage of eczema, never use soap. Use the following cleanser or soap substitute bar for all cleansing purposes:
Cetaphil
Aveeno Bar
For the itching that accompanies all eczema, take either of the following antihistamines every 4 hours as necessary.
Benadryl (25 mg)
Chlor-Trimeton Tablets (4 mg)
See directions and cautions on the labels for proper dosage.
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| ORAL ANTIHISTAMINES |
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For the itching that accompanies all eczema, take either of the following antihistamines every 4 hours as necessary.
Benadryl (25 mg)
Chlor-Trimeton Tablets (4 mg)
See directions and cautions on the labels for proper dosage.
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