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"Eczema" or
dermatitis is the name given to an inflammatory process
of the skin. Itching, scaling,
blistering, weeping, scabbing, thickening of the skin surface,
and scratch marks characterize this skin condition.
Over thirty skin diseases feature eczema. For example:
- atopic dermatitis
- nummular or
coin shaped eczema
- lichen simplex
chronicus
- dermatitis
of the eyelids
- scalp dermatitis
- dyshidrotic
eczema or "palm and sole eczema" irritant & allergic
dermatitis due to exposure to a substance to which the
skin reacts
- even some
nutritional or hereditary disorders
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Atopic Dermatitis
The most common
of the diseases characterized by eczema is called "Atopic
(meaning out of place) Dermatitis."
It occurs in association with a personal or family history
of hay fever, asthma, allergic rhinitis, or atopic dermatitis.
It affects about 15% to 20% of the world's population.
It can cause significant
disruption in the quality of life. Itching associated with
eczema is considered by most as more
disturbing than pain. It impedes concentration on work or
study, and it can strain relationships. When it affects sleep,
it can cause irritability and exhaustion. |
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Atopic dermatitis
at an early age presents with scaly, red patches on the
face and neck, the scalp, the arms and legs and on the
back of the hands. Later, the lesions are seen on the
folds of the neck, the front of the elbows and behind
the knees. Sometimes the eczema favors the palms and
soles causing tiny blisters that evolve into scabbing
and fissuring that bleeds easily.
For more information about Atopic Dermatitis, please
visit:
www.dermnet.org.nz/dna.atopic.dermatitis/info.html
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Appearance
of atopic dermatitis:
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Very dry skin.
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Often red and scaly with a rough, sandpaper-like texture
that can resemble fish or crocodile skin.
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It may resemble a fungus infection with whitish spots
on the arms, a condition called pityriasis alba.
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| How is Eczema or Atopic Dermatitis Diagnosed?
The diagnosis is often easy to make by the trained
eye of the dermatologist, but sometimes a biopsy or
microscopic exam of a tiny piece of the affected skin
is needed. Some laboratory tests like a blood cell
count may show a type of white cell, called eosinophil,
in higher than normal amounts. In addition, the level
of a protein called IgE may be significantly elevated
in the blood.
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| What
Triggers Eczema?
To find the cause for some eczemas, the dermatologist
usually depends on the medical history: i.e., the patient
is asked to recall those factors such as stress, climate,
dust, animals, foods, etc., that may trigger flares of
dermatitis or at least cause itching. If the history is
not clear, allergy tests may be needed. Tests may be in
the form of patch tests, under which perfumes, preservatives,
topical antibiotics, metals like nickel, etc., are placed
under patches on the skin. These are left covered for two
(2) days to see if a reaction is obtained. If so, the substance
at the reaction site becomes a suspect in the cause of
the eczema. Other allergy tests done by allergists, primarily
to determine an airborne, environmental, animal, or food
allergy, may be performed by pricking the skin with a needle
and observing if a drop of one of the usual culprits, i.e.,
dust mites, cat dander or peanuts, caused a reaction. Less
often, a blood test may be used to look for the trigger
of the eczema.
What Are the Treatment Options for Eczema?
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Diet
We advise the patient on the ways to eliminate possible
triggers. A diet eliminating peanuts, milk, eggs
and other foodstuffs, is sometimes suggested.
Breastfeeding for Infants
Breastfeeding may be recommended for infants of parents
who have eczema, asthma, hay fever or hives. |
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Skin
Care Regimens
Proper skin care and hygiene such as the use of gentle
cleansers and tepid instead of hot water are also recommended.
We often rely on a variety of ointments, creams and lotions
to alleviate itch and suppress skin inflammation. Environmental
control by means of regulating room temperature and humidity,
vacuuming to reduce dust and animal dander can be helpful.
Topical Steroids
Until recently, topical steroids were the most often
prescribed medications for eczema. However, chronic
use of these steroids causes thinning of the skin
which can lead to bruising, stretch marks, and
infections. When overused, these medications can
be absorbed and cause systemic effects.
Topical immuno-modulators
Fortunately, a new class of topical medication called "topical
immuno-modulators" was introduced in 2001. These
ointments and creams are as effective as some of
the most powerful steroids, yet they have only minor
risks such as transient stinging when first applied.
The ointments and creams are not absorbed and do
not thin the skin.
We do not recommend unproven topical agents like
herbal medications in our practice as they are unregulated
and some have been found to have toxic side effects
causing liver and kidney toxicity or can contain
steroids not mentioned on their labels. |
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Ultraviolet Light
Some forms of ultraviolet light are useful in reducing
itching, thus breaking the itch - scratch cycle that
perpetuates many eczemas. At our office, we mainly
use a type of new ultraviolet light called Narrowband
UVB, which is extremely helpful. UVA light may also
be prescribed with a pill called psoralen ("PUVA
treatment"). We do not recommend that our patients
go to tanning salons.
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| Oral
Medications
Antihistamines
Both 1st and 2nd generation antihistamines may be
considered to alleviate itching. First generation
antihistamines,
like Benedryl® are safe, but can be sedating.
Second generation antihistamines, which do not cross
the blood brain barrier, are non-sedating.
Cortisone
Short courses (5 to 20 days) of oral steroids like
prednisone, or intramuscular steroid injections,
may be very helpful and safe for some patients who
do not have diabetes, high blood pressure, stomach
or duodenal ulcers, or glaucoma. Long courses should
be avoided. Rarely will patients be allowed to have
prednisone or intramuscular steroid injections more
than 3 to 4 times a year.
Immunosuppressive drugs
Immunosuppressive drugs like Azathioprine best known
as Imuran® or Mycophenolate Mofetil, known as
Cell-Cept®, and Cyclosporine, known as Neoral®,
or Gengraf® can be very helpful. However, they
require careful monitoring by our physicians.
Interferon Injections
Interferon shots may be helpful in some severe cases.
Eczema Research
The doctors at Texas Dermatology Associates have participated
and currently partake in many research studies and
clinical trials for new treatments for eczema and
atopic dermatitis. In this way, we have developed
significant expertise on the subject. Our physicians
lecture extensively and participate on advisory boards
for pharmaceutical companies, both in the United
States and abroad.
For more information about Eczema, please visit: www.eczema-assn.org
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