Eczema is a common skin condition, which usually manifests as patches of itchy, thickened, and sometimes scaling skin. There is a great variation in the appearance and location of the rash. There is also great variation in the activity of the rash. Chronic waxing, waning, remission and reactivity is typical of eczema.
A standard feature of eczema is itchiness. Scratching the itch often causes the rash to flare. This has lead to eczema frequently being called “the itch that rashes.”
The reason that some people develop eczema has to do with the genetic programming that controls the behavior of their white blood cells. Abnormal behavior of white blood cells in the skin makes the skin prone to inflammation. Inflammation within the skin disrupts the normal tight junctions between skin cells that function to prevent moisture from escaping the skin. Therefore, the inflammation of eczema causes not only the redness and itching typical of inflammation, but also dry skin. Treatment of eczema involves moisturizers to treat the dry skin and anti-inflammatory creams to turn off the process of inflammation.
Food allergy rarely plays a role in eczema. Because eczema is mostly cellular inflammation (delayed-type response), allergy skin or blood tests are not very good at detecting the type of food sensitivity seen with eczema. Trial elimination diet is a more useful test but the likelihood of finding an allergic factor is still low.
Eczema Treatment Strategy
Eczema is commonly referred to as the itch that rashes. It starts with an itch that results in scratching. The scratching produces the typical eczema rash. Consequently, the primary goal in eczema is to prevent itching. Keeping the skin well moisturized is important to preventing itch. Moisturizers are most effective when applied within 3 minutes after bathing so that moisture from the bath is locked in. Sometimes moisturizers do not control the itch and its necessary to use anti-inflammatory medications in addition to the moisturizers.
Anti-inflammatory meds include creams, ointments, and oral agents. Cream versus ointment is a personal preference. Ointments are oil-based and creams are water-based. Anti-inflammatory creams should be applied over a water-based moisturizer. Anti-inflammatory ointments should be applied over an ointment-based moisturizer. Anti-inflammatory oral steroids may be necessary in severe eczema.
Topical steroids can have the effect of oral steroids with much less side effects. Topical steroids are categorized in seven levels of strength. Only the very weakest level is available over-the-counter. Strong topical steroids can thin out the skin revealing blood vessels and producing stretch marks. Newer non-steroid topical anti-inflammatory agents do not thin out the skin. They include Elidel cream and Protopic ointment. In cases where the skin is broken, antibiotics may be necessary to promote healing.
Authored by Robert Settipane, MD