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Eczema


About eczema

Provided by National Eczema Association

Eczema: What you need to know

  • More than 30 million Americans have some form of eczema.
  • Eczema symptoms are different for everyone but may include:
    • Dry, sensitive skin
    • Red, inflamed skin
    • Very bad itching
    • Dark-colored patches of skin
    • Rough, leathery or scaly patches of skin
    • Oozing or crusting
    • Areas of swelling
  • Atopic dermatitis (AD) is the most common and chronic form of eczema. More than 17.8 million Americans have AD. AD is considered to be the most severe form of eczema.
  • It’s most common for babies and children to develop eczema on their face, but it can appear anywhere on the body. Eczema may go away as a child grows older; however, some children will continue to experience eczema into adulthood.
  • Adults can develop eczema even if they never had it as a child.
  • There is no cure for eczema.
  • Eczema is not contagious.

Impact of eczema and AD:

  • People who have asthma and/or hay fever, or who have family members who do, are more likely to develop AD.
  • The impact of AD on quality of life in childhood is comparable to other chronic diseases such as renal disease, cystic fibrosis and asthma.
  • Sleep disruption is common for people with AD.
  • Eczema impacts the quality of life of patients’ families, including parental sleep, time required to manage a child’s eczema and out-of-pocket costs of healthcare.
  • Eczema has been associated with mental health issues, including depression and ADHD.

Facts about atopic dermatitis (AD):

  • AD is the most common, chronic and a severe form of eczema.
  • 17.8 million Americans have AD.
  • AD often appears as a red, itchy condition that typically appears on cheeks, arms and legs.
  • Symptoms of AD may improve at times, but at others it may get worse or flare up.
  • The cause of AD is not known, but a combination of genetic and environmental factors is involved.
  • AD runs in families. If one parent has AD, asthma or hay fever, there’s about a 50% chance that their child will have at least one of these diseases.
  • AD is not contagious.
  • Symptoms of AD include:
    • Dry, scaly skin
    • Redness
    • Itching
    • Cracks behind the ears
    • A rash on the cheeks, arms and/or legs
    • Open, crusted or weepy sores (usually during flare-ups)

For more information about eczema and AD, visit nationaleczema.org.

Treating eczema in infants and toddlers

Provided by National Eczema Association

Eczema usually starts in childhood, and more than 10% of children in the US have some form of eczema. It’s important to discuss your child’s diagnosis and treatment options with your doctor.

Eczema affects everyone differently. No matter what kind of eczema your child has, it’s important to establish a bathing and moisturizing routine every day to help manage the symptoms.

Always look for products that are unscented and dye-free, so you don’t irritate skin.

Moisturizers

The more oil in a moisturizer, the better. Apply moisturizers in a thick layer, at least twice daily and within three minutes after bathing, so the ointment or cream is most effective. Ointments are usually the first choice — they have the highest oil content — followed by creams, then lotions, so they don’t generally burn when they’re applied and are good at sealing in moisture.

Saliva from drooling can irritate the cheeks, chin and neck. When this happens, try applying ointment to lock in moisture and protect these areas. During the summer, you may use cream instead of ointment, to prevent miliaria, or prickly heat. This sometimes develops after ointment is applied when it’s hot and humid.

Creams are second to ointment in the amount of oil they contain and are good at sealing in moisture. Lotions contain the least amount of oil and may have added preservatives that can burn.

If your baby’s skin stings after moisturizing, switching from a cream to an ointment may help. Adding a cup of table salt to bathwater may also reduce stinging.

Steroid ointments

Mild eczema may be controlled with bathing and moisturizing. More serious eczema may require using a low or medium potency steroid ointment known as topical corticosteroids. Steroid ointments are safe when used correctly. Your doctor can help you decide which is best for your baby.

For tips for safe steroid ointment application visit the National Eczema Association website.

Bathing

Soap, additives (like bubble bath) and scrubbers (like washcloths) can dry and irritate skin. Avoid soaps, additives and scrubbers when you bathe your child.

Cleansers should be unscented, dye-free and only used to wash the diaper area, or other areas that are dirty. It is important to moisturize your baby’s skin within three minutes after bathing so the ointment or cream is most effective.

Bathing and bleach baths

A bathing routine is the key to treating dry skin. Baths are preferred over showers, should be warm (not hot) and last less than 10 minutes.

If your child has moderate to severe eczema, or a history of infection, your doctor might recommend bleach baths. Bleach baths help prevent infection by controlling the amount of bacteria on skin.

To learn more about bleach baths for children visit the National Eczema Association website.

Shampoos

Most baby shampoos are safe. Choose shampoos that are unscented and dye-free.

Laundry care: Tips for people living with eczema

Provided by National Eczema Association

Fragrances, dyes and detergents can trigger eczema flare-ups. For some, as long as laundry is thoroughly rinsed, any brand of detergent that’s dye- and fragrance-free is ok. But for others, even a detergent without dyes and perfumes can be problematic. You may have to experiment with different brands and products to find a detergent that works for you.

Here are some tips when choosing laundry products:

  • Look for detergents and fabric softeners that are hypoallergenic, dye- and fragrance-free, and specially formulated for sensitive skin.
  • Try liquid products, because they tend to leave less residue on fabrics than powders.
  • Studies have shown that clothes treated with a fabric softener can have a potential benefit for people with sensitive skin. Make sure to choose a liquid fabric softener.
  • Use your washing machine’s second or extra rinse setting if it has one.

Wash new clothes and other fabrics before using them for the first time

New clothes and fabrics sometimes have a chemical finish to help make them wrinkle-free. These chemicals can cause a skin reaction, so be sure to wash new clothes, sheets, pillowcases, quilts, blankets, towels and cloth napkins before you use them.

For infants

  • Wash everything your baby comes into contact with, including plush toys, bedding, blankets, parent and caregiver clothes, and towels before using them the first time.
  • Try washing your babies’ clothes, bedding and towels separately.

Check the National Eczema Association website for laundry care products that have received the NEA Seal of Acceptance.

Bathing: Critical to eczema care

Provided by National Eczema Association

Daily moisturizing and bathing is an important part of managing eczema.

Some things to remember:

  • Take at least one bath or shower daily.
  • Bathe or shower in lukewarm water for 10 to 15 minutes.
  • Avoid scrubbing.
  • Use gentle cleanser, not soap.
  • During flare-ups, limit use of cleansers.
  • Use a high oil content moisturizer to improve hydration.
  • Moisturize hands every time you wash them or they come into contact with water.
  • Schedule bathing and moisturizing before bed to help skin retain moisture.
  • If you have hand eczema, soak your hands in water, then follow with an application of your prescription medication — if you use one — then moisturizer. Wear cotton gloves in bed to lock in moisturizer.

Should I bathe or shower?

Water is an effective way to hydrate skin, but only if you use lukewarm (not hot) water, avoid scrubbing and apply moisturizer within three minutes. If you follow these rules, bathing and showering are equally effective.

What products should I use?

You should look for products that are fragrance- and dye-free. Avoid waterless, antibacterial cleansers, which contain ingredients that are hard on your skin.

Are there special types of baths that are better?

Soaking in a tub of lukewarm water can help your skin absorb moisture. Remember not to soak longer than 10 to 15 minutes and avoid scrubbing.

Bleach baths

A mild bleach and water solution helps decrease bacteria on the skin, which can lead to infections. Use a half-cup of household bleach for a full tub of water. Soak up to 10 minutes, then rinse. Best when done two to three times per week.

Bath oil baths

Use gentle oils in your bath to help keep moisturized. Be sure to use oils that do not contain fragrances. Be careful — oils can make the tub slippery.

Salt baths

During a flare-up, bathing may cause your skin to sting. Adding one cup of table salt to your bath can ease this symptom.

Baking soda baths

Adding a quarter-cup of baking soda to your bath, or applying it to the skin directly in the form of a paste, is a common treatment used to relieve itching.

Oatmeal baths

Adding colloidal oatmeal to your bath, or applying it to the skin directly in the form of a paste, is also a common treatment used to relieve itching.

For more information about how bathing can help manage eczema symptoms, please visit the National Eczema Association website.

Sun protection: People with eczema should take special care

Provided by National Eczema Association

People with eczema can be more vulnerable than others to the sun’s damaging rays and have challenges finding sunscreen products that work for their skin. Chemicals in sunscreens, like preservatives, can affect different people in different ways.

Protect yourself from the sun

Reduce sun exposure

Limit time in the sun between 10 a.m. and 4 p.m., when the sun’s rays are strongest. Even on overcast days, UV rays can get through the clouds. Stay in the shade as much as possible. Keep infants 6 months or younger away from direct sunlight.

Dress wisely

Wear protective clothing. If you plan on being outside, cover as much as possible. Wear a hat, long sleeves and pants. Consider using an umbrella.

Sunglasses protect eyes from UV rays but also protect skin around your eyes. Sunglasses that block both UVA and UVB rays are best, and most sold in the United States meet this standard.

Use sunscreen

Sunscreens work by absorbing the damaging rays of the sun before they reach your skin, or reflecting them away. Chemical sunscreens absorb sunlight and physical blockers reflect it.

Choosing a sunscreen

Check the label to get:

  • Sun protection factor (SPF) of 30 or more — SPF represents the degree to which a sunscreen can protect the skin from UV rays.
  • Broad spectrum protection — a sunscreen that protects against UVB radiation, which causes sunburn, and UVA radiation, which contributes to skin cancer and skin aging.
  • Water resistance — sunscreen that stays on your skin longer, even if it gets wet. Reapply as directed.

The first time you apply a new product use a small amount — about the size of a pea — to the pulse of your wrist or the crook of your elbow. Do not wash the area for 24-48 hours and watch for allergic reaction such as redness, rash, any form of breakouts, itchiness, pain, flaking, etc.

Check the NEA website for sun care products that have received the National Eczema Association Seal of Acceptance.

Moisturizing: What's the right way?

Provided by National Eczema Association

Moisturizing is one of the most important things you can do to help control eczema. It’s important to understand how and when to moisturize and which products are best when you have eczema.

Remember:

  • If using a prescription topical medication, apply as directed, before moisturizing.
  • Apply a thick layer of moisturizer within three minutes of bathing or showering.
  • Schedule bathing and moisturizing before bed to help skin retain moisture.
  • Fragrance- and dye-free moisturizers are safest and least irritating.
  • Do not use hands to remove moisturizer from the container to prevent contamination.
  • Soften moisturizer by rubbing it between your hands and apply using the palm, in downward strokes. Avoid rubbing up and down, or in circles.
  • If moisturizer feels tacky, don’t remove excess.
  • Moisturize hands whenever you wash them or when they come into contact with water.
  • If you have hand eczema, soak hands in water, then apply prescription medication (if you use one) and moisturizer. At night, apply moisturizer and wear cotton gloves.

Why moisturize after a bath or shower?

Water helps put moisture back into skin, but only if you use lukewarm (not hot) water, avoid scrubbing and apply moisturizer within three minutes. If you don’t moisturize immediately, moisture will evaporate.

What kinds of moisturizers are most effective?

Moisturizers are classified based on how much oil and water they contain. The more oil, the better for treating eczema. The best moisturizers feel greasy, like ointments and creams, because they contain more oil.

Ointments

Ointments are usually the first choice for eczema. They have the highest oil content, so don’t generally burn, and are good at sealing in moisture. Some people prefer using them at night, when they can better be absorbed.

Products high in oil, such as petroleum jelly and mineral oil, are best. But if you don’t like the way these feel, the next best are lubricants, hydrating gels and creams.

Creams

Because they contain less oil, they feel less greasy. Read labels carefully — creams sometimes contain ingredients that irritate.

Lotions

These contain the least amount of oil. They are primarily made of water, evaporate quickly and may contain preservatives that burn.

For more information about moisturizing and eczema, please visit the National Eczema Association website.

Related conditions: What goes with eczema?

Provided by National Eczema Association

People with eczema, including atopic dermatitis (AD), may be prone to other conditions. The most common are:

Asthma

Asthma is an allergic condition in which inflamed airways cause difficulty breathing, tightness in the chest, coughing and wheezing. Asthma often appears in childhood and can continue throughout life.

Some people with asthma experience it occasionally, while others require constant treatment.

Allergic rhinitis

Allergic rhinitis, or hay fever, is inflammation in the nose and sinuses caused by allergens like pollen, dust mites and pet dander. Symptoms for hay fever:

  • Itchy nose, mouth, eyes or skin
  • Runny and/or stuffy nose
  • Sneezing
  • Watery eyes
  • Sore throat

Food allergies

According to researchers, up to 15% of children ages 3¬–18 months who have AD, also have an allergy to one or more types of food. The most common are milk, eggs, peanuts, wheat and soy.

Symptoms of food allergy:

  • Itchy mouth and swollen lips
  • Vomiting, diarrhea, stomach cramps
  • Hives, rash or reddening of skin
  • Blood pressure drop

Food allergy symptoms appear within 30 minutes of eating or breathing in the food allergen. Science suggests that food allergies are not a trigger for AD.

Staph infections

If you have eczema, staphylococcus aureus (also called staph) is the most common bacteria to cause infection.

Some of the most common eczema-related staph infections:

  • Furuncles
  • Impetigo
  • Cellulitis

If you think that you or your child has a staph infection, call your doctor.

Furuncles

Furuncles, also known as boils, are caused most commonly by staph. They start in the hair follicle, where it can become infected. This can be on any area of your body — not just your head.

Infected boils tend to be red, raised bumps, which break open and weep.

Impetigo

Impetigo is a common form of staph and develops with skin that’s open and weepy. If you have impetigo, honey-colored crusts form on the open areas of your skin. Sometimes these become painful and red.

This kind of staph is very contagious, but easily treated.

Cellulitis

Cellulitis is a skin infection that is painful and tender to the touch. People with cellulitis may develop a fever and elevated white blood cell count, and may need to be hospitalized. Other symptoms of cellulitis include rash, dimpled skin, blisters and fever. If you think you or your child may have cellulitis, call your doctor immediately.

Depression

People with AD may have greater risk of depression and anxiety.

According to the National Institute of Mental Health, if you have experienced some of these symptoms for two weeks or longer, you may have depression and should consult a doctor:

  • Feeling sad, empty and/or anxious
  • Feeling hopeless
  • Loss of interest in hobbies or other activities
  • Decreased energy, feeling tired more often
  • Difficulty concentrating
  • Restlessness, unable to sit still
  • Problems sleeping
  • Weight change
  • Thoughts of death or suicide

Attention deficit hyperactivity disorder

Studies show that people with AD may have a greater risk of developing attention deficit hyperactivity disorder (ADHD).

Symptoms of ADHD:

  • Difficulty staying focused, wandering off task
  • Lack of organization skills
  • Hyperactivity
  • Making hasty decisions that could be harmful

If you or your child are displaying these symptoms, call your doctor.

Other related conditions

Research shows that adults with AD may have a higher risk of developing heart disease, high blood pressure and stroke.

For more information on conditions related to eczema and AD, please visit the National Eczema Association website.

Triggers: What makes eczema get better or worse?

Provided by Provided by National Eczema Association

Things we come into contact with or experience every day could cause eczema to flare up, or get worse. These are called "triggers."

Knowing your triggers will help you keep symptoms under control. The most important thing to remember is that eczema is different for everyone. Symptoms you have may not look the same on you as on others, and your triggers may be different from someone else's.

Some of the most common triggers include:

Dry skin

When skin gets too dry, it can become brittle, scaly, rough or tight, which can lead to an eczema flare-up.

Irritants

Everyday products and even natural substances can make your skin burn and itch, or become dry and red. These could be products you use on your body or in your home — hand and dish soap, laundry detergent, shampoo, bubble bath and body wash, or surface cleaners and disinfectants. Even some natural liquids, like the juice from fruit, vegetables or meats can irritate your skin.

Stress

Emotional stress is known to be associated with eczema, but we're not sure why. Some people's eczema symptoms get worse when they're feeling stressed. Others may get stressed thinking about their eczema, which can make their skin flare up.

Hot/cold temps and sweating

Most people with eczema become itchy, or experience a "prickly heat" sensation when they sweat, or get too hot. This can happen when you exercise, dress too warmly or when you quickly move from one extreme temperature to another (cold to hot).

Infection

Eczema can become infected with bacteria or viruses that live in the environment. Staphylococcus aureus ("staph"), is one of the most common types. The molluscum virus, herpes virus (fever blisters and cold sores) and certain kinds of fungus (ringworm or athlete's foot) are other common triggers. It's important to know the symptoms of different infections and what causes them, so that your eczema does not get worse.

Allergens

Everyday materials in the environment can cause you to have an allergic reaction and trigger an eczema flare up. Some of the most common are: seasonal pollen, dust mites, pet dander from cats and dogs, mold, and dandruff.

Hormones

Hormones are substances produced by the body that can cause a wide variety of symptoms. When the levels of certain hormones in your body increase or decrease, some people with eczema (especially women) may experience flare-ups.

For more information about eczema triggers, visit the National Eczema Association website.

A probiotic for childhood eczema

Provided by Healthnotes, Inc.

By Maureen Williams, ND

The link between skin and gut health is often overlooked, but emerging evidence brings it back into view. The British Journal of Dermatology reports that children with eczema responded better to a combination of pre- and probiotic supplements than to a prebiotic alone.

Probiotics are micro-organisms that are beneficial to gut health. Prebiotics are indigestible carbohydrates that support the growth of healthy bacteria in the gut.

Treating the gut to heal the skin

The study included 60 children with moderate to severe eczema who were assigned to receive one capsule of a probiotic plus prebiotic combination or one capsule of a prebiotic alone twice daily for eight weeks. Each capsule of the combination supplement provided 2 billion colony-forming units of Lactobacillus salivarius and 475 mg of fructo-oligosaccharide, while each capsule of the prebiotic provided just 475 mg of fructo-oligosaccharide.

Parents kept track of their children’s eczema symptoms by scoring factors such as the percentage of the body affected, the intensity of redness, crusting, oozing, swelling, dryness, scratch marks, skin thickening, the degree of itching and sleep loss. They also monitored quality of life factors such as whether their symptoms interfered with their ability and willingness to take part in ordinary life activities and events, and how often they needed medication creams to manage their symptoms.

Pre + pro = more effective treatment

Quality of life scores were similar in both groups throughout the study, and children in both groups improved during the study — however, the ones who received the combination supplement improved more. By the eighth week of treatment, moderate or severe symptoms improved in 30% of those in the prebiotic group and 52% of those in the combination group.

Medication use dropped significantly in the combination supplement group but not in the prebiotic group.“In light of our findings, the use of combinations of prebiotics, which selectively promote the growth of certain bacterial species and their activities, and probiotics, which elicit immune modulating effects, may be an effective strategy for treating childhood eczema," said lead study author Dr. Keh-Gong Wu at the Taipei Veterans General Hospital in Taiwan.

Taking care of your child’s skin

Here are some treatment options to consider if your child has eczema:

  • Identify food allergies. Many children with eczema have associated food allergies or sensitivities. Avoiding reactive foods can reduce inflammation and relieve eczema symptoms.
  • Add some fats. Although the results from studies do not all agree, supplementing with evening primrose oil might reduce eczema symptoms. Researchers have also found that fish oil helps some eczema sufferers.
  • Be gentle. Hot water and drying soaps can irritate eczematous skin.
  • Keep the moisture in. Covering the affected skin with a layer of cotton after moisturizing can prevent skin from becoming overly dry. If your child’s hands are eczematous, consider having them wear cotton or medical-grade silk gloves at night.
  • Consider a prebiotic-probiotic combination. The current study provides more compelling evidence that supporting health gut bacteria is one way to support the skin.

(Br J Dermatol 2011; Sep 6. doi: 10.1111/j.1365-2133.2011.10596.x; e-pub)

Maureen Williams, ND, completed her doctorate in naturopathic medicine at Bastyr University in Seattle and has been in private practice since 1995. With an abiding commitment to access to care, she has worked in free clinics in the U.S. and Canada, and in rural clinics in Guatemala and Honduras where she has studied traditional herbal medicine. She currently lives and practices in Victoria, BC, and lectures and writes extensively for both professional and community audiences on topics including family nutrition, menopause, anxiety and depression, heart disease, cancer, and easing stress. Dr. Williams is a regular contributor to Healthnotes Newswire.

In those with deficiency, vitamin D may improve eczema

Provided by Healthnotes, Inc.

By Maureen Williams, ND

Low levels of vitamin D are not necessarily linked to problems with eczema, but, according to the Journal of the American Academy of Dermatology, people with eczema and vitamin D deficiency may get some symptom relief by taking vitamin D supplements.

No link between vitamin D status and eczema

The study was done in Poland, where vitamin D deficiency is common. In the first phase of the study, researchers checked the vitamin D levels in 95 people with eczema and 58 people with healthy skin. The skin condition in those with eczema was also evaluated. The researchers then analyzed the data to see if the presence and severity of eczema were both associated with vitamin D levels.

Approximately two thirds of the people in the study had vitamin D deficiency. Vitamin D levels were similar in people with and without eczema, and people with more severe cases did not have lower vitamin D levels than people with milder cases; however, people with the lowest vitamin D levels had more frequent bacterial skin infections.

Eczema may improve with vitamin D supplements

For the second phase of the study, 20 of the people with eczema who had the lowest vitamin D levels and frequent bacterial skin infections were given 2,000 IU cholecalciferol (vitamin D3) per day. It is important to note that this phase of the study did not include a control (placebo) group; nevertheless, after three months of vitamin D supplementation, the frequency of bacterial skin infections had decreased. In addition, visual examinations showed that eczema severity had improved and symptom surveys showed that itching and sleeplessness due to eczema had diminished.

“The results from this study indicate that vitamin D supplementation may help ameliorate clinical signs of the disease [eczema] and can be considered as a safe and well-tolerated form of therapy,” the authors said. Because of the nature of the study, these conclusions are limited to people with severe vitamin D deficiency. The study did not show whether eczema is likely to improve in people with normal vitamin D status.

Healthy skin

Treating vitamin D deficiency is important for more than your skin: low vitamin D levels have been linked with chronic health problems like cardiovascular disease, depression, and some cancers. If you are at risk for low vitamin D levels — due to living in a northern region, age (seniors are more at risk for deficiency), not getting much sun, or darker skin — ask your doctor about getting your levels tested. In addition to supplementing to correct low vitamin D, here are some things you can do to help your eczematous skin:

  • Rule out food sensitivities. For many people with eczema, identifying and eliminating reactive foods leads to significant improvements in skin appearance and symptoms. A two- to four-week elimination diet followed by individual food reintroductions is the best way to find out if you have food sensitivities. If you have strong reactions to food, do this with a doctor’s supervision.
  • Take a probiotic. Researchers are finding more and more evidence that taking probiotics that supply lots of friendly gut bacteria can help with all kinds of allergic and inflammatory conditions like asthma and eczema. Storing your probiotic in the refrigerator increases the chance that it will benefit you.
  • Feast on fish oil. The anti-inflammatory omega-3 fats from fish have been found to help people with eczema. The omega-6 fats from evening primrose oil is a nice complement to the fish fats, and evening primrose oil supplements have also been found to help with eczema.

(J Am Acad Dermatol 2013; 10.1016/j.jaad.2013.03.014)

Maureen Williams, ND, completed her doctorate in naturopathic medicine at Bastyr University in Seattle and has been in private practice since 1995. With an abiding commitment to access to care, she has worked in free clinics in the U.S. and Canada, and in rural clinics in Guatemala and Honduras where she has studied traditional herbal medicine. She currently lives and practices in Victoria, BC, and lectures and writes extensively for both professional and community audiences on topics including family nutrition, menopause, anxiety and depression, heart disease, cancer, and easing stress. Dr. Williams is a regular contributor to Healthnotes Newswire.


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