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Steps to controlling eczema

By Dr. Mona V. Mangat and Dr. Ami K. Degala
McClatchy-Tribune

Eczema, also known as atopic dermatitis, is a common skin condition that causes itchy, dry skin. It affects about 10 to 20 percent of the population. Some famous people have eczema: Brad Pitt, Kate Middleton, Nicole Kidman, Adele.

“Eczema” comes from the Greek word that means “to boil out” or “erupt,” which is an appropriate description as the skin is often inflamed, cracked and oozing.

The condition, which is not contagious, is usually seen in young children and often improves by age 5 or 6; however, eczema can occur at any age. The intensely itchy, red, dry rash can appear on the face, wrists, hands or scalp, backs of knees and bends of elbows. It usually spares the diaper area. There is typically a family history of eczema.

Eczema is considered one of the classic allergic diseases along with asthma, hay fever and food allergies, but the link with allergies is complex. Eczema is not a direct reaction to an allergen, but eczema may flare when patients are exposed to dust mites, grass, animals, certain foods or other allergens.

About a third of children with eczema are more likely to develop asthma or allergies.

Studies have shown that patients with eczema have a genetic defect in their skin barrier that leaves skin prone to the irritation and inflammation that cause the itching and the rash.

Eczema has been described as “the itch that rashes.” The more a child scratches it, the more severe the rash becomes. The more severe the rash becomes, the more the child scratches it (the itch-rash-itch cycle). When a child keeps scratching, there is a tendency to cause tears and breaks in an already delicate skin barrier, increasing the chances of infection. The rash may appear weepy or leak fluid and then crust over. Certain triggers – chemicals, irritants, foods, excessive heat or stress – can cause a flare-up.

The best way to control and treat eczema is to avoid triggers and have a good daily skin routine.

The first step is to moisturize, moisturize, moisturize. Because the skin becomes very dry, it is important to moisturize at least two or three times a day. Recommended moisturizer brands include Eucerin and Aquaphor. After you come out of the bath, apply moisturizer within the first two minutes, when your skin is best able to absorb it.

It is vital not to dry out the skin, so short warm baths every other day are recommended. Avoid harsh soaps, bubble baths, scented body washes, washcloths, sponges and loofahs. Some recommended soaps are Dove Sensitive Soap and Cetaphil. Also, avoid washing clothes in harsh detergents. Use dye-free detergent such as Dreft or All Free & Clear. Do an extra rinse cycle for your laundry and try to wear soft, loose-fitting cotton clothing.

The second part is to control the itching and stop the itch-rash cycle. An antihistamine is often recommended for this. Fingernails should be kept short. Scratching is usually worse at night, possibly because there is less distraction and more awareness of the itch. Consider covering hands with gloves or socks when sleeping.

The third step is to treat the rash with medications that reduce inflammation. Topical steroids are very effective. Other medications, called immunomodulators, also may be used. These medications, such as Protopic and Elidel, are available with a prescription and should be taken under physician guidance. Antibiotics may be prescribed if there is an infection.

Everyone’s skin is different, so medications and products that work for some may not work for others. It is important to speak to your doctor and come up with a treatment plan that works for you.

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