ECZEMA

You have a skin problem called eczema. Atopic dermatitis, eczema, neurodermatitis, and dermatitis are different names for the same disease. Eczema is an itchy, scaly skin rash that occurs in people like you who have sensitive skin. Normal mild irritations of daily living, such as soap, water, stress, rubbing from clothes, and sweat, cause irritation in sensitive skin. Although some people feel irritation as soreness, people with eczema usually feel irritation as an itch. Scratching feels really good to most people with eczema, but scratching irritates the skin even more. The itching causes the scratching, and the scratching worsens the itching. There is no cure for eczema. However, cortisone creams put on the skin to decrease itching and irritation, and very careful skin care to minimize irritation, usually control the problem. Eczema is usually not an allergic reaction to a particular thing, but instead a reaction to irritation. If your doctor thinks you're allergic to something that is touching your skin, she or he will talk to you about it, and if you feel that there is an allergy to a particular substance, let your doctor know.

The treatment of eczema includes:

1. Avoid irritation to your skin: Washing the skin is the most common and harshest irritation for skin. Washing dissolves the natural oils in the skin and allows tiny, invisible cracks and breaks that itch. Therefore, bathing (either shower or bath) should be limited to three times a week, avoiding hot water and harsh soaps. Dove soap is the least expensive mild soap. Also, a moisturizer should be applied immediately after bathing to help replace those natural oils that were washed away. Rough fabric, new, stiff fabrics, and wool should be avoided. Overheating can worsen itching, and sweat can be very irritating, so patients with eczema should stay as cool as comfortable. This is especially important for children who are too small to tell their parents that they are hot. It is especially difficult to protect the hands and feet from irritation, since shoes tend to trap heat and sweat against the skin, and hands handle all kinds of rough and irritating chemicals and objects. Overwashing of the hands is especially common.

2. Use a cortisone ointment or cream: This medication helps soothe irritation and inflation and also helps stop the itching. Although cortisones are extremely useful in the treatment of eczema, simply applying the cortisone without attention to moisturizing the skin and avoiding excessive washing and irritation often do not improve eczema very much. Cortisones are applied very sparingly – more does not work better than less – and they are applied only to the areas of scaling, redness, or itching. The cortisone should be used until the skin feels normal to the touch, and then often it can be discontinued.

3. Keep your skin moisturized: This is important because flaking and cracking of the skin are very irritating and worsen itching. Covering the cracks with a moisturizer soothes the skin and decreases itching. Also, when moisturizers are applied over the cortisone, they help push the cortisone into the skin and make it work much better. The best moisturizers are those that are very stiff and that do not pour. The greasier the moisturizer, the better it works. Moisturizers should be applied both immediately after the cortisone and as often as necessary, to keep the skin from feeling and looking dry. People with severe eczema may need five or six applications a day until their skin improves. Moisturizers that pour from a bottle have been mixed with alcohols (which are irritating) and water. Good moisturizers to try are plain Vaseline petroleum jelly, Eucerin cream (not lotion), Aquaphor, and even vegetable shortening like Crisco from the grocery store. Moisturizers are available over the counter. Vaseline and vegetable shortening are the least expensive.

4. Take medication at night: Medication at night to make you sleep without scratching is important. As long as the skin is being scratched, it will not heal. You can take an antihistamine such as diphenhydramine (Benadryl) that is available over the counter. The usual dose is one to three 25-mg capsules. Or, your health care provider may have given you a prescription for a different medication.

5. Take an antibiotic: When your skin gets infected from scratching, you should take an antibiotic. Signs of infection are weeping and crusting of the skin. Treatment of your eczema will be a lot of work. It is important to follow, these instructions carefully until the eczema is much better. You should see your regular health care provider in a week if you are receiving prednisone, or in a month if you are doing well and using creams only. Your health care provider will decide when to decrease the frequency of cortisone use, moisturizing, and nighttime medication. However, even after your eczema is controlled, your skin may worsen from stress and new irritations. If you understand how to treat your skin, and you have the medications at home ready to use, you will be able to treat your skin quickly.