General Information
Eczema, also known as atopic dermatitis, is a skin problem that causes dry, itchy, scaly, red skin
The cause of eczema is not completely understood, although it does tend to run in families
In many people, eczema is caused by a genetic dysfunction in the outer layer of the skin
The role of the outer layer of skin is to keep environmental irritants, allergens (proteins that cause allergy) and microbes from entering the body
Eczema is a chronic condition, it typically improves and then flares (worsens) periodically
Despite popular belief, mild to moderate eczema is rarely related to food allergy
In 30% children under age 5 years old with moderate to severe eczema, foods such as cow’s milk, egg, wheat and soy may flare in the eczema. If a food allergy is suspected, the patient should be evaluated by a trained allergist
Eczema Symptoms
Most people with eczema develop their symptoms before age 5
Common symptoms of eczema include itching, patches of red, bumpy and open skin plus skin flaking
Scratching, often worse at night, causes further skin inflammation, which further worsens the itch
Eczema can occur anywhere on the body but the most common areas are:
Front of arms and legs, cheeks and scalp in infants (the diaper area is not usually affected)
Neck, elbow creases, back of knees, eyes, wrists and hands in children and adults
The skin may become thickened or darkened from repeated scratching
The skin may also become infected with painful red bumps that somethings contain pus. Your doctor should assess the skin if an infection is suspected
Eczema Diagnosis
There is no specific test to diagnose eczema
The diagnosis is based on the medical history and physical exam performed by your doctor
Often people with eczema have a personal or family history of allergic conditions such as food allergies, asthma and allergic rhinitis (runny nose, congestion, sneezing when around things such as pollen and animals)
Treatment Options
Eczema is not curable, although symptoms can be controlled
Your doctor will advise you on the treatment option that is best for you / your child
Eliminate factors the worsen eczema such as heat and excessive sweating, dry environments, exposure to harsh chemicals or cleaning solutions, house dust mites and wool or synthetic clothing
Wear 100% cotton clothing as much as possible
Consider double rinsing all laundry and do not use fabric softeners or dryer sheets
Keep nails short and clean
Daily bath with lukewarm water for 5 - 10 minutes. Avoid perfumed or coloured soaps and bathoils. Pat the skin dry following the bath
Keep the skin well hydrated with a moisturizer (ex Vaseline, Vaseline Creamy, Eucerin, Cetaphil) used several times per day and always after a bath
Topical steroid ointments are used to decrease the inflammation and skin damage. Once the skin is healed these medications can be stopped. You may have to start and stop these medication several times
The goal is to use the lowest amount and lowest dose of topical steroids to prevent side effects such as skin discolouration and thinning of the skin. These side effects happen with large amounts of high doses of the medications
Newer skin treatments for eczema include tacrolimus (Protopic) and pimecrolimus (Elidel)
In some cases your doctor may recommend dilute bleach bath to help reduce the number of bacteria on the skin which can cause infections or worsen symptoms. To prepare a bleach bath, add ¼ to ½ cup of bleach to a full bathtub (40 gallons of water). Bleach baths are usually taken for 5 - 10 minutes twice a week. Always rinse off after a bleach bath
Wet wraps are another option to control eczema. This involves dampened cotton wraps that are worn over the affected area usually in the night
Your doctor will discuss other treatment options if the topical medications are not effective
Oral antihistamines can be tried to help with the itch but are often not overly helpful. Some ofthese medications can lead to drowsiness