ECZEMA (atopic dermatitis)

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Eczema is one of the most common skin conditions, affecting people of all ages and both sexes. According to the American Academy of Dermatology approximately 10 to 20 percent of the world population is affected by the form of eczema known as atopic eczema (or atopic dermatitis) at some point during childhood. People who have it as children often have dry or extra-sensitive skin, later as adults.

The terms eczema and dermatitis are often used by doctors to describe the same set of symptoms; irritated, red and itchy inflamed skin. This condition can be extremely uncomfortable and can affect your self-confidence. Fortunately there are things you can do to soothe the symptoms, making eczema easier to cope with.

What is eczema?
The word 'eczema' comes from Greek and literally means 'boiling over'. Normal skin acts as a barrier to prevent water loss and stop skin irritants from penetrating. If you have eczema your skin doesn't do this as effectively as it should, leading to dryness, itching and cracked, scaly skin which lets in bacteria and allergens that can cause an allergic reaction.

Eczema is the body's over-reaction to foreign substances, causing the skin to become red, inflamed and very itchy. It tends to occur in people who have a natural tendency to develop allergies such as asthma, hay fever and food allergies. This tendency can be inherited and tends to run in families. The condition is very itchy and mainly affects the inside of the elbows and knees, and the wrists and ankles. It is most frequently seen in children, although adults can experience it too.

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Eczema Symptoms are Variable

Mild Dry Eczema
The mildest form of eczema involves chronic dry skin and itching. (Refer to the sections on Dry Skin and Dry Itch) Some people never develop the inflammatory symptoms associated with acute eczema, but the condition is still unpleasant and requires treatment with moisture therapy.

Acute Eczema
At its worst, acute eczema can involve a range of severe symptoms including dry skin, inflammation, itching, blistering, redness, scaling and weeping.

Chronic Eczema
Once someone has been suffering from acute eczema, his or her symptoms may enter the long-term stage, as the skin function deteriorates. This is known as chronic eczema. The following features may occur:

  • Initial inflammation subsides and is replaced by a thickening of the epidermis
  • Scales appear as cell turnover increases
  • Itching and scratching leads to fissuring of the epidermis when the skin becomes broken and cracked
  • Incessant scratching may produce secondary thickening
  • The skin remains very dry

What causes eczema?
No one really knows what causes eczema but we do know that certain things can make it worse. When eczema gets worse, it is called a flare-up. A flare-up occurs when the immune system in people's skin overreacts to environmental or emotional triggers and results in red, scaly and itchy skin.

Common triggers and what to do about them:
Although eczema cannot be cured, for most patients the condition may be well managed with treatment and avoidance of triggers. Since it is the scratching of the itch that then causes the rash, it is important to relieve the itch and keep the skin well moisturized to break the itch/scratch cycle. Since triggers vary from person to person, it is important to try to notice what causes flare-ups for you or your child and try to avoid them.

Allergies: You may experience allergic reactions such as asthma, breathing difficulty, hives, etc. that are enough to justify avoiding allergens regardless of their effects on your eczema. However, it is also important to identify allergens that specifically trigger eczema flare-ups.

Although people with eczema are more likely to develop allergies to food (milk, eggs, wheat and peanuts) and airborne allergens (dust mites, molds and pet hairs), it is important to note that allergies can occur independently from eczema. Pay attention to any allergy that may worsen or trigger your eczema, and let your doctor know. We suggest you may wish to enlist the help of a specialist to determine what you are allergic to and what you should avoid.

Changes in Temperature/Humidity: Maintaining a moderate and stable temperature and humidity all year is helpful. Heat, sweating and flushing (reddening of the face, or blushing) can cause flare-ups in some patients, as can skin that is too dry from exposure to dry heat, wind or air conditioning.

In the winter, eczema often becomes worse as cold air holds less moisture and central heating is more widely used, leading to a reduction in room humidity. Since dry skin is more prone to itching, using a humidifier during the winter months can keep the humidity at an optimal level. When it's warm and humid in summer, make sure the temperature inside remains cool with an air conditioner. Also keep in mind that air-conditioned air may also be drying to your skin, so be sure to use a moisturizer.

Clothing: Dyes, detergents and rough or synthetic fabrics can be very irritating. Try choosing all-cotton clothing and avoid materials that feel "itchy" such as wool. Wash new clothes before wearing them to remove excess dye. Choose a mild, non-sensitizing, fragrance-free laundry detergent and be sure your clothes are rinsed thoroughly.

Foods: Some atopics react to foods such as milk, eggs, wheat and peanuts. Try to watch for a connection so you know which foods to avoid. Also certain food additives, such as preservatives can trigger a reaction.

Intense Emotion or Stress: In adults, stress, anxiety, depression and other psychological factors can all influence atopic conditions. In particular, they can make the severity and flare-ups of eczema much worse. Sometimes, it's hard to stay relaxed, especially when your eczema flares-up. Yet research is now showing that keeping a calm head and good mental outlook may be one of the best ways to help keep eczema in check. Meditation, relaxation techniques and stress management have proven to be effective.

Irritants: Irritants can be both physical and chemical. Avoid products containing potentially irritating chemicals. Usually, these are easy to identify - things like pesticides, paint strippers, etc. - but others may not be as obvious. Ingredients such as alcohol, astringents, and fragrances may trigger or worsen eczema. These ingredients can be found in cosmetics, emollients, cleaners, air fresheners, toilet paper, etc. Reading ingredient lists on products is a smart way to avoid contact with irritants.

What can help?
Since there is no cure for eczema, the focus instead is on managing the condition and minimizing the occurrence and severity of flare-ups. The most effective ways of managing eczema are to:

  • try to reduce the trigger factors
  • treat the dry skin and inflammation symptoms

The following are a number of different techniques for managing eczema:

Soap Substitutes and Washes
Regular soap can dry and irritate your sensitive skin, and could contain ingredients (such as fragrances or deodorants) that may trigger a flare-up. Instead, try soap substitutes or washes that are gentler on your skin.

Moisture Therapy
Moisturizers are the first line treatment for dry skin, eczema, dermatitis and the symptoms of dry skin associated with psoriasis. When moisturizers are used correctly, mild and moderate symptoms can often be managed without resorting to any of the medicated skin treatments, such as steroids. And even if other medical treatments are recommended by your doctor, moisturizing therapy will be necessary. Many dermatologists believe that by adopting a regular routine of effective moisture therapy, the number of flare-ups and the amount of steroids required can be reduced. When used as directed, LINACARE has success where many other products have failed. (See Testimonials)

Moisturizers come in a range of different formats and help to keep the skin moist and flexible so that it doesn't itch as much. Creams and ointments are generally greasier than lotions but they provide longer lasting moisturization. But LINACARE is different. It has the benefits of a lotion as it is quickly absorbed and leaves no greasy after-feel, but it provides the long-lasting moisturization of a cream. The longer lasting the moisturizer - the fewer times you need to apply it during the day.

Steroids
Introduced in the 1950s, steroids have dramatically improved the treatment of eczema. They are anti-inflammatory products, which vary in potency. Although they can be effective in managing the symptoms, long term, continued use of steroids is not recommended. Adequate moisture therapy as an adjunct therapy can help reduce the number and intensity of the flare-ups and lessen the dependency on steroids.

If in doubt always consult your doctor or pharmacist.

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Your Optimal Daily Skincare Routine

If you have eczema, dry skin can be a serious problem. But with proper care there are things you can do to help reduce dry skin and itching.

Morning: Wash with a soap substitute or wash with warm, not hot water, and gently pat your skin dry. Don't rub your skin as this may trigger itching. Apply moisturizer on damp skin to seal in moisture.

Throughout the day: Use a soap substitute to wash your hands and apply a moisturizer whenever your skin feels dry or itchy. Don't allow your skin to dry out.

Evening: Have a warm shower or bath (10 minutes). Gently pat the skin dry and while still damp apply moisturizing cream liberally.

Following these steps will improve the health and appearance of your skin. Remember to choose products that don't contain any fragrance, lanolin, vitamins, alpha hydroxy and urea or other potential sensitizers that can be irritating to the skin.

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What Else Can I Do to Improve the Condition of My Skin?

Although eczema cannot be cured, there are certain steps you can take to make the condition a lot easier to live with, either for your child or for yourself. Since it is the scratching of the itch that then causes the rash, it is important to relieve the itch and keep the skin well moisturized to break the itch/scratch cycle.

Eczema in Children

  • A positive attitude is important. Even very young children will pick up on your feelings so even though it may not be easy, try to hide your concerns and your child may start to feel better about having the condition.
  • Keep a routine. Not only does this help a child feel calmer, it also helps you remember the bath/moisturizer/medicine schedule. It's important for anyone who cares for your child to keep the same schedule.
  • Talk to your child about eczema. Teach them about triggers and how to avoid them. Explain how important their treatment is, and how important it is for them to use the moisturizer and medicine. They will also need help in deciding how to handle comments from other children or even adults.
  • Above all, let your child know that chances are likely that they will outgrow it.

Helpful Hints for Everyone with Eczema

  • Follow the optimal daily skincare routine outlined above
  • Woolen clothing will make your skin hot and itchy so try to wear 100% cotton instead.
  • Keep fingernails short to lessen the damage you can do when you scratch.
  • Bed linen should be cotton and pillows and duvets feather free.
  • Keep the bedroom cool as overheating aggravates itching. A saucer of water placed in warm rooms will help to keep moisture in the air as the liquid evaporates.
  • Use non-biological, fragrance-free washing powders and fabric conditioners.
  • Keep pets out of the house as fur and feathers can irritate the condition.
  • Try to reduce dust as much as you can. House dust mites are linked to eczema attacks.
  • Eczema is often aggravated by psychological factors in which case stress reduction therapies may help. These include relaxation therapy and progressive muscle relaxation training. In children, massage therapy using moisturizers has been shown to have a beneficial effect.
  • Stay in control. The more you know, the better you'll be able to fend off flare-ups.
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