| Eczema Eczema = dermatitis Eczema, also called atopic dermatitis (AD), is a noncontiguous inflammation of the skin that is characteristically very dry and itchy. The condition is frequently related to some form of allergy, which may include foods or inhalants. Classification Two groups: • Exogenous (contact)
• Endogenous (constitutional)
Exogenous (contact) eczema Irritant contact eczema • Detergents, alkalis, acids, solvents and abrasive dusts are common causes. • Napkin eczema in babies is common and due to irritant urine and feces • Strong irritants elicit acute reaction at the site of contact • Weak irritants most often cause chronic eczema, especially of the hands, after prolonged exposure Allergic contact eczema Due to delayed hypersensitivity reactions following contact antigens. Common allergens: Nickel in jewellery, jean studs, bra clips Dichromate in cement, leather, matches Rubber chemicals in clothing, shoes, tyres Colophony in sticking plaster, collodion Paraphenyllenediamine in hair dye, clothing Balsam of peru in perfumes, citrus fruits Neomycin benzocaine in topical applications Parabens in preservative in cosmetics and creams Wool alcohols in lanolin, cosmetics, creams Epoxy resin in resin adhesives The eczema reaction occurs wherever the allergen contacts the skin and sensitization persists indefinitely Endogenous (constitutional) eczema Atopic eczema Genetic predisposition to form excessive IgE antibodies to inhaled, injected and ingested antigens and to develop one or more of a group of diseases which include asthma, hay fever, urticaria, food and other allergies Seborrhoeic eczema It is not related to seborrhea but it is used so often that it cannot be discarded The fungus, pityrosporum orbiculare appears to be a perpetuating factor Asteatotic eczema In elderly Over washing and diuretics are contributory factors Most often on the lower legs as a rippled or “crazy paving” pattern of fine fissuring on an erythematous background Gravitational eczema On the lower legs, edema, red or bluish discolouration, loss of hair, induration and ulceration Pompholyx eczema Provoked by heat or emotional upset Occurs in nickel sensitive patients after they ingest small amounts of nickel in food Discoid eczema Most often on the limbs of elderly males Multiple, coin shaped, vesicular and crusted Complications of eczema • Superinfection—most often with bacteria (staph.aureus) and yeasts (candida albicans) and viruses (papilloma virus) • Reaction to local medications • Psychological factors—anxiety states are common and compensation neuroses may dominate the picture in cases of industrial dermatitis Eczema may be caused or made worse by these things: * Soaps, laundry detergents and perfumes. Scratchy clothes (like wool) can also irritate the skin. * Allergens like pollens, pet hair or dander (dried bits of skin), food, feathers and dust mites. (Dust mites are very tiny, spider-like creatures. They make their homes in mattresses, pillows and rugs. They can only be seen under a microscope.) * Low humidity. During cold weather, the heated air inside homes and other buildings can make skin dry and itchy. * Heat, high humidity and sweating. These can make the itching worse. * Some foods cause eczema. * Emotional stress. Feeling upset can cause the face and body to get itchy, red and hot. Treatment The basis of treatment for AD is keeping the skin moist and clean, as well as avoiding irritants and known allergens as much as possible. Further measures become necessary if the case is particularly severe, or if the skin becomes infected. Conventional wisdom has been that minimal bathing of the patient with AD is ideal • The rationale was that bathing would break down the natural oil barrier of the skin and cause further drying. It actually appears now that frequent long, tepid soaks are beneficial to hydrate the very dry skin that this condition produces. Adding a muslin bag filled with milled oats bath to the water can be soothing. • The bath water should cover as much of the skin as possible. Wet towels may be draped around the shoulders, upper trunk, and arms if they are above the water level. • The face should be dabbed frequently during bathing to keep it moist. • The use of soap should be minimized, and limited to very mild agents such as Cetaphil. • The bath must followed within two or three minutes by a gentle patting dry, and a thick application of a water barrier ointment, such as Aquaphor, Unibase, or Vaseline. • Lotions are not generally recommended as they almost universally contain alcohol, which is drying and may burn when applied. • Soaking in plain water can be painful during severe episodes of AD. • Adding one-half cup of table salt to one-half tub of water creates a normal saline solution, similar to what is naturally present in the tissues, and may relieve the burning. • One alternative to bathing is to use soaking wraps. For this method, cotton towels or other cloths are soaked in tepid water, with table salt added for comfort if desired. • The patient's bed is covered with something waterproof, and the bare skin is covered as thoroughly as possible with the wet wrappings. The body should then be covered by a waterproof covering to slow evaporation. Vinyl sheeting and plastic wrap are two alternatives. The wraps should be left in places for as long as possible, but at least for 30 minutes, before the water barrier and any topical medications are applied. • Environmental improvement affords some relief for many patients. • Pet dander and cigarette smoke are potential aggravating factors. Keeping these out of the home is probably for the best, but at minimum, they should not be allowed in the room of the allergic person. • Clothing and bedding should be 100% soft cotton, and laundered in detergent with no perfumes. These items should also be washed before the initial use in order to rid them of potentially irritating residues. • Clothes should fit loosely to prevent irritation from rubbing. • Washing bedding in hot water will help to kill dust mites. • Running laundry through a double rinse cycle will help to remove any vestiges of detergent. • Do not dry clothes or bedding outdoors, because pollen and other potential allergens are likely to cling to it. • The mattress and pillowcase can be covered by special casings that are impervious to the microscopic dust mites that infest them. Under normal circumstances, these mites cause no problem, but they can be a major irritant for the individual with asthma or AD. • Temperature extremes can make AD worse, so heating and cooling should be employed as appropriate, along with adding humidity if needed. • Sweating will frequently aggravate AD. Room temperature should be adjusted for comfort. Central air conditioning is the best option for cooling the home. • Air conditioning rather than open windows should also be used to cool the car. • In the patient's room, dust-collecting items such as curtains, carpeting, and stuffed animals are best minimized. Vacuuming and dusting should be done regularly when the affected person is not in the room. • Some simple mechanical measures will reduce the amount of skin damage done by scratching. It is important to keep fingernails short. • Using a nail file will produce a smoother nail edge than scissors or clippers. • It is particularly difficult to keep children from scratching irritated and itchy skin, but using pajamas and clothing with maximum skin coverage will help to protect the bare skin from fingernails. • Mittens or socks may be used to cover the hands at night to reduce the effects of scratching. Infant gowns with hand coverings are useful for the very young patient. • In addition to the skin care and environmental measures to relieve eczema, there are some complementary therapies that may prove helpful. Acupuncture Any type of therapy that relieves stress can also help to manage AD. Acupuncturists also claim to be able to treat blood and energy deficiencies, and to counteract the effects of detrimental elements, including heat, damp, and wind. Autogenic training Autogenic training is similar to methods of meditation and self-hypnosis. Instructors help the patient to achieve and maintain a relaxed state of positive concentration. This is eventually done independently. Even ten minutes of practice per day can produce beneficial results for mind and body. Research has shown AD to be one of the conditions that is improved by this technique. Aromatherapy/massage Massage is another therapy that can be effective in reducing stress. The oils that are used in the treatment can also make a difference in AD. Some patients get relief from the topical use of evening primrose oil (EPO) diluted in carrier oil. Aromatherapists may use small amounts of essential oils from lavender, bergamot, and geranium. These are promoted to decrease both itching and inflammation. Improper dilutions, however, can worsen the condition. Herbal therapy Some herbal therapies can be useful for skin conditions. Among the herbs most often recommended are: Calendula (Calendula officinalis) ointment, for anti-inflammatory and antiseptic properties. Chickweed (Stellaria media) ointment, to soothe itching. Evening primrose oil (Oenograceae) topically to relieve itching, and internally to supplement fatty acids. German chamomile (Chamomilla recutita) ointment, for anti-inflammatory properties. Nettle (Urtica dioica) ointment, to relieve itching. Peppermint (Menta piperita) lotion, for antibacterial and antiseptic properties. Chinese herbal medicine. In traditional Chinese medicine, there are formulas used to treat eczema that nourish the blood, moisten the skin, stop itching, and encourage healing. Nutritional supplements Oral doses of EPO, which contains gamma-linolenic acid, have been shown to significantly reduce itching. The amount used in studies was approximately six grams of EPO per day. Fish oil has also been shown to improve AD, at an approximate dose of 1.8 g per day. Vitamin C can affect both skin healing and boost the immune system. Doses of 50-75 mg per kilogram of body weight have been proven to relieve symptoms of AD. Additional copper may be required in supplemental form when high doses of vitamin C are taken. Vitamin E is reportedly useful, but there are no documented studies of its benefits. Allopathic treatment Allopathic treatment involves use of oral antihistamines to decrease itching, topical water barriers as mentioned above, mild topical corticosteroids when indicated, and topical antibiotics if needed. The water barrier should be applied generously The corticosteroids and antibiotics used sparingly, and only on areas where indicated. The person applying the topical medications can wear gloves to minimize exposure to the steroids and antibiotics. Oral antibiotics may also be used when widespread infection is present. On rare occasions, oral corticosteroids are prescribed to reduce severe itching and inflammation, but this course is best avoided due to its potential side effects. Prevention One of the best things a mother can do to help keep her child from getting AD is to breastfeed. It is best for the baby to have breast milk exclusively for at least six months, particularly when there is a family history of AD or other types of allergy. There also appears to be an advantage to the breastfeeding mother avoiding foods known to be commonly allergenic, particularly if there is a family history. This would include wheat, eggs, products made from cow's milk, peanuts, and fish. If breastfeeding is not possible, a hypoallergenic formula should be used if there is family history of allergy The patient already diagnosed with AD can minimize flare-ups by avoiding known triggers and following the skin care program outlined above. Eczematous skin is also more susceptible to infections. Patients should try to stay away from people with chicken pox, cold sores, and other contagious skin infections. |
Skin Care
 | |  | |  | |  | |  | |  | |  | |  | |  | |  | |  | |  |
Eczema
