Irritated by Eczema

Successful eczema treatment depends on a precise diagnosis. Why? Several different conditions can cause this skin disorder.

Eczema isn't just one thing. Several quite different conditions cause the itchy skin condition. Early on, it looks like red skin that can develop oozing blisters. Later, the skin can get scaly or thick.

It's not easy to tell one kind of eczema from another. That's why you need to see a doctor about it. Successful eczema treatment depends on the correct diagnosis.

The Problem

The vast majority of people with eczema have atopic dermatitis, an allergic symptom. That's the kind that shows up early in life, almost always by age 5. Eczema that shows up later than this usually is another kind of eczema.

"Atopic dermatitis, asthma, and allergic rhinitis (think hay fever) -- that's what we call the allergic triad," dermatologist Jeffrey Weinberg, MD, director of clinical research at St. Luke's-Roosevelt Hospital Center in New York, tells WebMD.

A lot of people think eczema is a food allergy. But there's little evidence for this, Weinberg says. In his experience, food allergies cause eczema only in some younger children.

The good news is that by the time they reach their teens, 70% to 80% of kids find that their eczema is much less severe. But about half will have some symptoms throughout their lives.

The Solution

There are several treatment strategies available:

* Change how often you bathe. One school of thought says you shouldn't bathe a lot because the water evaporates and leaves the skin dryer than ever. Skin affected by eczema loses water more quickly than normal skin. On the other hand, there are those who say bathe more often -- hydrating the skin by soaking in a cool bath, and then treating the skin with emollient cream or ointment. "Both strategies have some success," Weinberg says. His advice: See what works for you.
* Use a gentle soap. "Use something like Dove For Sensitive Skin or Cetaphil Gentle Cleansing Bar," Weinberg says. "Moisturizing is the key. After bathing, use a cream or ointment rather than a lotion. Use a product like Aquaphor, Cetaphil cream, Eucerin, or Vaseline. Those are the things that help most."
* Antihistamines -- a specific type of allergy pill -- may be very helpful to some people. Benadryl may relieve itching as well as help children sleep.
* Antibiotics may help when you have a sudden eczema flare-up. Many dermatologists think these flare-ups are linked to infections.
* Topical corticosteroid creams and ointments are the mainstay of medical treatment. They slow immune responses and relieve itching. "But you must be careful because of the side effects," Weinberg warns. "Steroids cause thinning of the skin. And you want to be careful around the eye, in the diaper area, and around body folds."
* New topical immune-modulating drugs also may help. Sold as Protopic and Elidel, the drugs offer many of the benefits of corticosteroids -- and avoid the side effects. Some dermatologists have begun to use these products as first-line therapies, although such use remains controversial.

Published August 2003.

SOURCES: Jeffrey Weinberg, MD, director of clinical research, St. Luke's-Roosevelt Hospital Center, New York. American Academy of Dermatology.

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