What Is Eczema?

Eczema is a very common condition, and it affects all races and ages, including young infants. About 1-2 percent of adults have eczema, and as many as 20 percent of children are affected. It usually begins early in life, even before asthma or hay fever. Most affected individuals have their first episode before age 5 years. For some, the disease will improve with time. For others, however, eczema is a chronic or recurrent disorder. Although it can occur just once, it usually occurs on and off throughout life, or lasts the entire lifetime. Eczema can be a difficult, frustrating condition. The natural human desire to scratch or rub an itchy rash just makes the condition worse, and treatments can be slow and are not always completely effective.

The exact cause of eczema is not known. Although it is activated by the immune system and is related to allergic reactions, it is not the same as other allergic reactions. People with eczema do have the IgE antibodies (immunoglobulin E) produced by the immune system as part of allergic reactions.
Contact with the external trigger (allergen) causes the skin to become inflamed. The duration of the contact is not important. Eczema can develop on first contact (in days to weeks) or over time with repeated contact (in months to years).
Common triggers of eczema include the following:

• Soaps
• Detergents
• Weather (hot, cold, humid, or dry)
• Environmental allergens
• Jewellery
• Creams
• Food handling
• Clothing
• Sweating
• Gloves
• Rubbing
• Bacteria
• Emotional or mental stress

Severe forms of eczema are caused by powerful allergic responses to external agents that cannot be eliminated from the environment.
Risk factors for eczema include the following:

• People with severe eczema usually also have hay fever and asthma.
• Eczema is probably hereditary and often is found in other family members.
• Eczema is not contagious.

Risk factors for an eczema flare include the following:

• Illness
• Physical or mental stress
• Exposure to skin irritant

Medical professionals sometimes refer to eczema as "the itch that rashes."

• Usually the first symptom of eczema is intense itching.
• The rash appears later. It is patchy and starts out as flaky or scaly dry skin on top of reddened, inflamed skin.
• The rash itches or burns.
• If it is scratched, it may ooze and become crusty, especially in young children.
• In adults, the patches are more likely to be brownish, scaly, and thickened.
• Some people develop red bumps or clear fluid-filled bumps that look "bubbly" and, when scratched, add wetness to the overall appearance.
• Painful cracks can develop over time.
• The rash can be located anywhere on the body but is most often found on the face and on the arms and legs, particularly increases and on hands and feet. This pattern makes sense because the face and extremities are in contact with external agents more than any other part of the body.
• The itching may be so intense that it interferes with sleep

If eczema is worsening (spreading, increasing redness, painful, hot) despite multiple daily applications of steroid cream over several days, call your heath care provider.
If you are so uncomfortable that your sleep, work, or other daily activities are disrupted, you need a more effective treatment and should see your health care provider. Generally eczema is not an emergency and should not be handled in a hospital emergency department. Exceptions include the following:

• When the skin becomes so irritated that it breaks down and becomes infected; if the rash has become red, hot, and painful; if red streaks are coming from the rash; or if you have a fever, an emergency department visit may be necessary if you cannot see your regular health care provider within 24 hours.
• Any person with a weakened immune system or certain medical conditions (such as diabetes, on chemotherapy, alcoholism, AIDS, older than 70 years) and symptoms of infection should go immediately to a hospital emergency department.

Removing whatever is causing the allergic reaction is the easiest and most effective treatment. This may be as simple as changing your laundry detergent or as difficult as moving to a new climate or changing jobs.
Prevent dry skin by taking warm (not hot) showers rather than baths. Use a mild soap or body cleanser. Dry yourself very carefully and apply moisturizing skin lotions all over your body. Avoid lotions with fragrances or other irritating substances.
Avoid wearing tight-fitting, rough, or scratchy clothing. Avoid scratching the rash. If you can't stop yourself from scratching, cover the area with a dressing. Wear gloves at night to minimize skin damage from scratching.
Anything that causes sweating can irritate the rash. Avoid strenuous exercise during a flare.
If the allergy-causing agent cannot be removed or identified, the next step is to lessen the allergic inflammatory response.

• Apply an nonprescription steroid cream (hydrocortisone) along with anti-itching lotion (menthol/camphor, such as calamine). The cream must be applied as often as possible without skipping days until the rash is gone.
• Diphenhydramine (Benadryl) in pill form may be taken for the itching. Caution - this medication may make you too drowsy to drive a car or operate machinery safely.
• Clean the area with a hypoallergenic soap every day. Apply lubricating cream or lotion after washing.

Avoid physical and mental stress. Eating right, light activity, and adequate sleep will help you stay healthy, which can help prevent flares. Do not expect a quick response. Eczema is easier to control than cure.

British Association Dermatology
http://www.bad.org.uk/public/leaflets/atopiceczema.asp Talk Eczema
http://www.talkeczema.com/ National Eczema society
http://www.eczema.org/