Atopic Eczema

Like asthma, eczema seems to run in families. Certain genes make some people have extra-sensitive skin, and certain environmental factors -- like stress -- can trigger an episode of eczema. Eczema is also caused or worsened by contact with

• • irritants in common substances such as:
    
  • woolen and synthetic fabrics
    
  • soap and other agents that dry skin
    
  • heat and sweat
    

Eczema can also be worsened by dry skin. Since eczema may in part be an internal response to stress, any emotionally charged event -- from a move to a new job -- may trigger a flare-up.

Causes of Eczema

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 unknown triggers. 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.

Managing Eczema

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.

Itchy and rash 

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.

Itchy before the rash

Almost always, there's an itch before a rash appears in eczema. Typically, eczema shows itself as:

• • Patches of chronically itchy, dry, thickened skin, usually on the hands, neck, face, and legs. In children, the inner creases of the knees and elbows are often involved.
    
  • Scratching can lead to sores with crusts.

Diagnosing Eczema

Eczema can be diagnosed by a pediatrician, allergist, immunologist, dermatologist or your primary care provider. 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.

Call Your Doctor About Eczema If

• You develop an otherwise unexplained rash and have a family history of eczema or asthma. You should have a medical diagnosis of the condition.
  
• The inflammation does not respond within a week to treatment with over-the-counter hydrocortisone creams. A doctor may suggest more aggressive forms of treatment.
  
• You develop yellowish to light brown crust or pus-filled blisters over existing patches of eczema. This may indicate a bacterial infection that should be treated with an antibiotic.
  
• During a flare-up of eczema, you are exposed to anyone with a viral skin disease such as cold sores or genital herpes. Having eczema puts you at increased risk of contracting the viral disorder.
  
• You develop numerous small, fluid-filled blisters in the areas of eczema. You may have eczema herpeticum, a rare but potentially serious complication caused by the herpes simplex virus.
  


The goal of treatment for eczema 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 products

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

• • The FDA has approved two drugs known as topical immunomodulators (TIMs) for the treatment of moderate 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.

Antihistamines

Other eczema 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.
 

Preventing Eczema Flare-ups

• 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)