Battle Plan for Eczema

Eczema is a very personal issue for me because it was a skin disorder I struggled with from the age of 8 until my early 30s. Even now I occasionally get patches of eczema and I always have a tube of prescription strength tube of cortisone cream nearby. It was at its worst when I was very young. More than 70% of my body was covered with itchy, raw, reddened, crusted areas of skin. I was in and out of dermatologist offices trying to find some kind of resolution, which never really came until much later in life when the condition resolved itself. I have the deepest empathy for those afflicted with this condition. While we know more about how skin functions than ever before, eczema is still a mystery. Medicine has taken some leaps forward in this arena, but it has also fallen back in dealing with this enormously uncomfortable skin affliction.

Eczema (also known as atopic dermatitis) is a general term used to describe a strange variety of skin rashes ranging from small sections of skin that are slightly itchy, somewhat dry and irritated to chronically inflamed, oozing, crusted areas covering the entire body and accompanied by incessant itching. Though some similarities exist, interestingly, eczema can have multiple appearances, looking and feeling completely different person to person. The most common areas for eczema to occur are in the folds of the arms and legs, the back of the neck, back of the hands, tops of feet, and the wrists.

Despite years of research, the actual cause of this condition remains unknown. One of the predominant theories is that someone with eczema has a short-circuited immune response. What that means is the skin reacts abnormally when a substance comes in contact with the skin. In severe cases of eczema, the substance can be as benign as water. For others the trigger can be anything from clothing, detergents, soaps, grass, food products, allergens (including dust mites) to a lack of humidity, or a combination of elements. Even more frustrating is that the reaction can be intermittent with no real rhyme or reason for why or when. There also appears to be a hereditary component to eczema. For example, children whose parents suffer from eczema run an 80% chance of developing it themselves. Further, in both children and adults, stressful situations tend to trigger, prolong, or worsen eczema flare-ups.

Regardless of the source, eczematous skin reacts to a substance or environmental condition by spinning out of control and generating mild to severe inflammation, which produces itching and scratching.

Some of the more typical forms of eczema are:

Atopic eczema (also referred to as atopic dermatitis): Perhaps the most pernicious and painful types of eczema, it's characterized by its severity and intolerable sensation of itching and irritation leaving skin raw, fissured, and vulnerable to infection.

Allergic or irritant contact dermatitis: This specific form of eczema occurs when a particular substance comes in contact with the skin causing the immune system to overreact, becoming inflamed and sensitized. Most typically this can be caused by fragrance, nickel, detergents, wool, grass, citruses, household cleaning products, and vinegar. Once you’ve identified the specific substance, avoiding it often solves the problem. A subset of this condition is eyelid dermatitis. Typically mild to moderate redness is present, as well as scaling, flaking, swollen skin. This is extremely common and almost exclusively affects women in relation to their use of hairstyling products, makeup, and nail polish when it comes in contact with the eye area with the most common culprits being nail polish, perfume, and preservatives. The best way to solve the problem is to stop use of the offending product(s) and find options that don’t trigger a reaction.

Infantile seborrhoeic eczema: Better known as cradle cap, this form of eczema generally only affects babies during the first year of their life. The crusty, thick, sometimes reddened lesions may look problematic, but this disorder is rarely itchy or even felt by the child.

Adult seborrhoeic eczema: Shows up for most people past the age of 20 and 40. It is usually seen on the scalp as mild dandruff, but can spread to the face, ears and chest. The skin becomes red, inflamed and starts to flake. The condition is believed to be caused by a yeast growth. If the condition becomes infected, treatment with an anti-fungal cream may be necessary.

Nummular eczema: Typically localized on the legs, nummular eczema is characterized by coin-shaped patches of pink to red skin that may take on an orange cast if crusting or scaling is present. If treatment is not used, the dry, scaly spots typically darken and thicken. This type of eczema is most common in adolescent girls and women between the ages of 50–60 and the condition tends to occur in winter.

Treating Eczema

With no cure on the horizon, there are still a number of treatments that can help reduce symptoms and mitigate the level of discomfort.

Gentle, effective skin care: Surprisingly, the first line of defense is a gentle skin care routine that prevents or reduces inflammation and keeps the skin moist and intact. Improving the skin’s outer structure by providing it with antioxidants, ingredients that mimic the substances found in normal, healthy skin, anti-irritants, and emollients can offer amazing results for most forms of eczema. Those specific recommendations are at the end of this article.

Avoid irritants: Aside from using a gentle skin care routine and a well-formulated moisturizer, avoiding the things that can trigger skin reactions is also of vital importance. Steering clear of known irritants and prolonged contact with water can be incredibly beneficial. It also helps a great deal to reapply moisturizer within seconds of washing any part of the body, but especially the hands because soaps and cleansers are notorious for triggering a reaction. If you know what substance is causing your skin to react, don't wear or use it ever again, if possible. And if you use bar soaps or bar cleansers, definitely switch to a water-soluble liquid cleanser that contains gentle detergent cleansing agents (avoid any that contain sodium lauryl sulfate or sodium C14-16 olefin sulfonate).

Topical steroids: The most typical and successful medications used are prescription-strength topical steroids (cortisone creams). Over-the-counter cortisone creams can be effective for very mild or transient forms of eczema but when those fail, prescription cortisone creams can save your skin. Though there are no short-term detrimental side effects of using most strengths of cortisone cream, it is still important to only apply it on the affected areas and then only as needed. Repeated, prolonged application of cortisone creams (over years, not short-term treatment) can cause thinning of the skin and prematurely age skin.

Oral steroids: In severe cases of eczema when topical steroids have failed to produce any relief, oral steroids may be prescribed, but only under a doctor's scrutiny due to the serious side effects associated with this type of medication.

Topical Immunomodulators: In 2000 and 2001, Protopic (active ingredient tacrolimus) and Elidel (pimecrolimus) were approved by the FDA as new topical drugs for the treatment of eczema. These are not cortisones or steroids but drugs that can regulate the skin's immune response. Initial studies were extremely positive and "The FDA based its approval on the results of three 12-week studies which indicated that 28-37% of patients using Protopic experienced greater than or equal to 90% improvement of their skin condition, as measured by physicians, and two one year studies that indicated that the drug is safe for intermittent long term use." (Source: http://www.fda.gov/bbs/topics/ANSWERS/ANS01060.html.) Elidel works in the same manner and studies were equally positive. In other words, by suppressing the immune system it prevents the skin's own problematic immune response to otherwise benign substances from causing red, itchy, inflamed rashes.

Regrettably, in March 2005, the FDA announced a public health advisory for Elidel (pimecrolimus) Cream and Protopic (tacrolimus) Ointment "to inform healthcare providers and patients about a potential cancer risk from use of Elidel (pimecrolimus) and Protopic (tacrolimus)…" The FDA went on to explain that "This concern is based on information from animal studies, case reports in a small number of patients, and how these drugs work [suppressing the immune system can cause cancer cells to proliferate that would otherwise be attacked and destroyed by a normal functioning immune system]. It may take human studies of ten years or longer to determine if use of Elidel or Protopic is linked to cancer. In the meantime, this risk is uncertain and FDA advises that Elidel and Protopic should be used only as labeled, for patients who have failed treatment with other therapies." (Source: http://www.fda.gov/cder/drug/advisory/elidel_protopic.htm.)

Phototherapy: Research has shown that exposing skin to UVA or UVB light can help reduce the symptoms of chronic eczema. Under medical supervision the use of specially designed bulbs encased in a box can allow affected parts of the body to be exposed to the light source. More severe or chronic eczema can be treated with UVA light in combination with a prescription medication called psoralen. Psoralen can be administered either orally or topically, increasing the skin’s sensitivity to light. This treatment is known as PUVA (Psoralen + UVA light).

Phototherapy treatments are complicated and expensive. They are administered several times per week over a span or one week to several months at a doctor’s office. Moreover, the risk of accelerated aging of the skin and increased risk of skin cancer from ultraviolet radiation therapy can be the same as for sunbathing.

Alternative treatments: For those looking for alternatives to prescription treatments and methods over and above the ones mentioned above, an interesting study on eczema appeared in the January 2001 issue of The Archives of Dermatology. This study reports research in Japan that d emonstrated that two-thirds of the patients with eczema improved after a month of drinking a liter of oolong tea daily. According to the study "118 patients … were asked to maintain their dermatological treatment. However, they were also instructed to drink oolong tea made from a 10-gram teabag placed in 1000 milliliters of boiling water and steeped for 5 minutes. After 1 month of treatment 74 (63%) of the 118 patients showed marked to moderate improvement of their condition. A good response to treatment was still observed in 64 patients (54%) at 6 months."

The study concluded that "The therapeutic efficacy of oolong tea may well be the result of the anti-allergic properties of tea polyphenols." While the study didn't look at the effect of tea drinking if the topical treatments were stopped, the patients did receive some benefit. So by combining topical treatments (moisturizers and possibly cortisone cream) with some oolong tea, perhaps the benefits will add up so those with eczema can breathe a sigh of relief.