Infected eczema (left) and infantile eczema (right)
What makes eczema worse?
Eczema will often have a mind of its own, coming and going
without any clear reason. Known aggravating factors include:
Principles
of Therapy
Avoid irritants
Eczema skin has a lower oil and water content than usual and
is much easier to irritate than normal skin. Use cotton clothing
in children and do not overdress or overheat. "Night gloves"
and neatly clipped fingernails will reduce the damage from scratching
by youngsters.
Eczema and allergy
Eczema is often called atopic eczema, "allergic"
eczema or atopic dermatitis. This is because many either already
have other allergies (like Hay fever, asthma or food allergy),
or will go on to develop them later. The great majority
of patients with eczema are either allergic to dust mite already
or become so with time. Direct contact with dust mite droppings
("poo"), animal or grass allergens can be scratched
into the skin to worsen the inflammation of eczema.
Food allergy and eczema
Food allergy occurs in around 5 to 10 per cent of very young eczema
sufferers, not all patients. It is relatively uncommon
in adults with eczema. Food allergy does not cause eczema,
but can worsen it. The most common causes are cows milk,
soy protein, egg, nuts, seeds, wheat and seafood. Accurate skin
testing can be performed, even in young infants and affected babies.
The majority of children with food allergy will get intensely
itchy with large hives within an hour or less of eating. Less
commonly, reactions will be delayed over several days. Allergy
testing is less reliable in this situation. Fortunately, most
food allergies that aggravate eczema will disappear within the
first few years of life. Taking young children off wheat and milk
will only help a small proportion of children with eczema, and
almost never makes a difference in adults. Long-term unsupervised
(and often unnecessary) dietary restriction can lead to malnutrition.
Not all eczema is allergic
Not all eczema is allergic. Constant exposure to irritants like
water, soap, grease, food or chemicals can damage the protective
barrier function of the skin. Once the protective barrier of the
skin is lost, dermatitis frequently develops.
Good skin care
Hot water washing with excessive use of soap removes skin
moisture and worsen the itch. Bathing in warm or tepid water,
using a soap substitute or bath oil and liberal application of
moisturizers all help to return the skin from a dry, cracked state
to an intact barrier that is more resistant to external irritants.
There are many brands of moituriser available. As a rule, it is
best to purchase these from a pharmacy / chemist rather than supermarket
or health food store, and to avoid perfumed products. Some moisturisers
will sting or irritate, particularly broken skin, so it pays to
experiment with a range of products to find one that suits. Examples
of mositurisers available in Australia include sorbolene, QV lotion,
Dermoveen Oatmeal lotion, Aqueous cream, Alpha Keri lotion and
Emulsifying ointment.
Eczema can get infected
Our skin is covered in bacteria. One of the most common is Staph
aureus. Not only can it cause skin infections, but the toxins
it releases can also worsen eczema. Infected eczema should be
suspected when rashes are very red, raw and angry (not just pink),
and when there is a lot of skin oozing of fluid ("weeping
eczema"). Mil;d infections can sometimes be treated with
topical antibiotics. Widespread rashes often will need antibiotic
tablets or syrups. Frequent infections can be managed by adding
antibacterial solutions into the bath, such as Oilatum Plus bath
oil, or Ego Flareup oil.
Using cortisone creams wisely
These are applied to inflamed red and itchy areas. They are
the only medications that will reduce the inflammation of eczema.
They do not cure! The preparations used vary in strength.
Your doctor will advise you as to the most suitable preparations
for your problem. Shiny skin, thin skin, stretch marks or easy
bruising are the major concerns with repeated use. The skin of
the face and neck is more sensitive to the side effects of steroid
preparations. Directions should be carefully followed to avoid
side effects, and creams meant for the body should never be used
on the face. Some people find that creams will irritate and sting.
Under these circumstances, greasy ointments are often better tolerated.
Newer topical medications
Newer topical medications such as tacrilimus and picrilimus have
been developed. These reduce inflammation when applied to the
skin. They are not cortisone or steroid-based, but do reduce skin
inflammation. They are difficult to obtain in Australia at present
but are more widely available aboard.
Other forms of therapy
References
1. Beltrani VS (ed). Atopic dermatitis-an update for the next
millenium. J Allergy Clin Immunol 1999; 104: S85-130.
2. Hogan PA. Atopic dermatitis: what to do when the itch becomes
too much. Med J Aust 1997; 13-8.
3. Leung DYM. Atopic dermatitis: the skin as a window into the
pathogenesis of chronic allergic diseases. J Allergy Clin Immunol
1995; 96: 302-18.
4. Friedmann PS et al. Pathogenesis and management of atopic dermatitis.
Clin Exp Allergy 1995; 25: 799-806.
5. Tan BB et al. Double-blind controlled trial of effect of housedust-mite
allergn avoidance on atopic dermatitis. Lancet 1996; 347: 15-8.
6. Isolauri E, Turjanmaa K. Combined skin prick and patch testing
enhances identification of food allergy in infants with atopic
dermatitis. J Allergy Clin Immunol 1996; 97: 9-15.
7. Tanaka M et al. IgE-mediated hypersensitivity and contact sensitivity
to multiple environmental allergens in atopic dermatitis. Arch
Dermatol 1994; 130: 1393-1401.
8. Joint Task Force on Practice Parameters. Disease management
of atopic dermatitis: a practice parameters. Ann Allergy Asthma
Immunol 1997; 79:197-211.
