Eczema – A recurrent rash everyone complains about

Editor's Note: Covenant Health Plainview is offering a four week segment about common health concerns. These articles are written by the four residents that are currently in rotation with local physicians. These residents are among the best of their peers, and are focused on advancing rural healthcare.

Eczema is a common skin condition that occurs most frequently in children, but can also affect adults. The word Eczema comes from a Greek word meaning "eruption or to boil out". Also known as Atopic dermatitis, Eczema is a skin problem that causes dry, itchy, bumpy, red skin but is not contagious. At this time, there is no cure, but in most cases, symptoms can be controlled.

Eczema usually occurs in the first year of life but may appear as late as the age of five. Many cases, as much as 40 percent of cases, will clear by adulthood. In babies and children, the skin may be intensely itchy, scaly, and many times, red patches are seen on the face, scalp, arms and legs, but groin areas are usually spared. The skin in older individuals, with more recurrent flares, are thickened, dark and scarred due to repeated scratching. It is usually seen in the neck, elbow and the back of the knees. Rashes associated with Eczema can look different in every person so it is important to see your doctor for an accurate diagnosis.

There are many factors that can trigger an Eczema flare such as exposure to certain strong chemicals or cleaning solutions, including some scented soaps and detergents, shampoos, dish-washing liquid, bubble bath, perfumes, cosmetics and disinfectants like chlorine. Allergens such as house dust mites, pets (cats, dogs), mold, pollen (seasonal), dust, and cigarette smoke can stimulate Eczema as well. Other factors, such as wool or synthetic fibers, heat, excessive perspiration, and dry environments can also increase risk for flare-ups. Finally, emotional stress or anxiety can also trigger an Eczema flare. Thus it is very important to avoid these factors in patients with a family history of Eczema. Some people have a higher predisposition for developing Eczema. Those with a family history of asthma and seasonal allergies are more prone to develop Eczema.

There is no known cure for Eczema, but different types of treatments are available to help reduce symptoms such as itchiness and inflammation. The aim of therapy is to control symptoms, prevent recurrent flares, and minimize therapeutic side effects. According to one of my mentors, Dr. Brent Paulger, a well-known Dermatolologist in Lubbock, the most important thing to do is keep the skin moisturized. He suggests using a gentle unscented over-the-counter moisturizer (Cetaphil, Eucerin, Vaseline, CeraVe or Aveeno) at least 2 to3 times per day, but up to 8 or 10 times per day may initially be necessary.

If itchiness, dryness, and skin redness persist, despite regular use of moisturizer, it is important to see your doctor for proper evaluation and treatment. Your Primary Care Provider may start you on a topical corticosteroid.

For mild to moderate Eczema, a weak steroid, such as a Hydrocortisone cream, may be used. In more severe Eczema, a stronger topical steroid, such as Fluocinonide or Clobetasol may be used. The choice of treatment depends on the type of Eczema and the symptoms associated with it.

If you don't respond well to topical steroids, there are other non-steroid topical medications that your doctor may prescribe for you. These are calcineurin inhibitors, such as tacrolimus (Protopic) and pimecrolimus (Elidel). These will control itching, reduce flares and help repair the skin. These therapy regimens are typically recommended for short or fixed periods of time due to possible side effects.

If the Eczema has not responded sufficiently to topical treatments, Phototherapy is the next modality of choice. It may be a better option than more powerful systemic treatments such as cyclosporine or methotrexate which are associated with significant side effects. Phototherapy is also the recommended treatment for widespread Eczema. It is effective in more than 50 percent of patients with Eczema that have not responded adequately to topical treatments, but it is sometimes more costly, time consuming, and improvement can be very gradual.

If you or someone you love suffers from Eczema, make sure you practice proper skin care. Those with Eczema are at increased risk for skin infections whether from a bacterial, viral, or a fungal source. Thus, if you notice any skin changes or irritation that has been lingering for more than one month, consult your doctor immediately.

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Eczema - A recurrent rash everyone complains about