Eczema*The information on this website is not intended to diagnose, treat, cure or prevent any disease.
What Is Eczema?
Eczema (also called atopic dermatitis) is a condition which results in inflammation of the skin which causing a red, often itchy rash. Chronic eczema may also cause thickening of the skin in affected areas. The distribution of eczema can range from small areas to nearly the entire body. The itching can become quite severe, and many people find it worse at night when trying to sleep. The constant urge to scratch can be stressful, but also further damages the skin barrier and secondary infections may occur.
Eczema often begins in early childhood and may continue into adulthood. It may be an ongoing problem, or arise and resolve seemingly spontaneously. It is incredibly common, affecting somewhere between 10-30% of people in the United States. Because many people may never even go to a doctor for their condition, the exact incidence of this condition is unclear.
Eczema is generally not a life-threatening condition, although it can be a very annoying problem to have. Aside from ongoing itchiness, it can also lead to sleep disturbances, feelings of social stigma (particularly if it is in area which is difficult to conceal such as the face), and cause other problems like infections. For most people, the condition will not continue beyond the teenage years, but for many others, it becomes a life-long issue.
When the skin becomes inflamed, it has limited ways to respond. The general symptoms of eczema resemble many other rashes. These include:
- Red, dry skin
- Thickened, cracked skin
- Red to brown splotches on the hands, feet, chest, knees and elbows.
- Blister-like lesions which leak fluid
The diagnosis of eczema is usually based on a history and physical examination. Most of the time, special tests are not required, however diagnostics which may be performed could include:
- Skin biopsy or skin scrapes
- Patch tests to identify allergens
- Infectious disease testing for unusual presentations
- Fungal cultures
- Lyme disease testing
- Parasite testing/microscopic examination
The following treatments may be recommended:
Pharmaceuticals and Medical Procedures:
- Topical Corticosteroid Creams: These are topical steroids which are anti-inflammatory in nature and can provide incredible relief to sufferers of itchy skin. There are both prescription and over-the-counter options for these medications.
- Calcineurin Inhibitors: These are immune-modulatory medications which decrease the response of T-cells involve in the immune response. These medications can be helpful for people who have chronic, ongoing eczema
- Antibiotics: Topical or oral antibiotics may be required for skin infections due to scratching. Antibiotics may also be useful if your doctor suspects your eczema is related to more systemic issues like Lyme disease.
- Oral corticosteroids: For very severe cases, oral steroids may be more helpful. If the affected area is quite diffuse, oral may be more effective than topical.
- Dupilumab: This is a monoclonal antibody which is used for people who do not respond to standard therapy.
- Immunosuppressives: These drugs may also be sometimes used in the event that eczema does not respond to the other therapies listed above. Drugs like cyclosporine, azathioprine, and methotrexate may be used.
- Light Therapy: Prescription UV lights may be helpful in a subset of people with eczema. It can be overdone, however, as UV light is also damaging the skin over the long-term.
- Emollients/Moisturizers: Over the counter products may be helpful in some people with eczema. Emollients can help maintain hydration in the skin and provide a protective barrier against irritating chemicals/allergens.
- Occlusive Dressings: These are water-tight bandages which can be applied to the skin at night to protect it. In addition to keeping moisture in the skin, they also likely help prevent further damage from scratching.
There are many non-pharmaceutical options for the management of eczema
- Mind-Body Techniques: A major problem for sufferers of eczema is the continual itching, which leads to an itch-scratch cycle and further damages the skin. Mind-body techniques can help reduce the urge to scratch and ignore the itching sensation.
- Acupressure: Similar to acupuncture sans needles.
- Colloidal Oatmeal: Oatmeal has very well-known anti-itch properties and can be applied to a number of different skin issues. Colloidal oatmeal is available as topical creams/ointments, as well as bath products for more generalized issues.
- Coconut Oil: Topical coconut oil is both anti-inflammatory and anti-bacterial. It can help moisturize the skin, reduce the chance of infection and reduce the urge to scratch
- Sunflower Oil: Like coconut oil, sunflower oil is effective at maintaining the moisture barrier in the skin and reducing inflammation.
- Topical Vitamin B12: This seems to help some people with eczema. You can make it yourself at home following this simple recipe.
- Witch Hazel: This is a topical astringent which can help dry out oozing crusts. It also creates a cooling sensation to help decrease the urge to itch.
- Turmeric: You can make your cream by mixing this powerful anti-inflammatory with water and applying topically to the skin.
- Calendula Cream: Made from the flowers of the Calendula plant, this helps heal irritated skin.
- Mold Binders: Eczema may be an outward sign of toxic mold exposure. Using mold binders like cholestyramine can help clear the body of toxins.
- Humidifiers: Using a humidifier, especially during the winter when heaters dry out the air, can help prevent drying of skin.
- Epsom Salt Bath: These baths can be very soothing to the skin. Make sure the water is not too hot, as this can dry out and damage the skin further.
- Dietary Modifications: Some people may have flare-ups related to specific foods. These can vary from person to person, so it is important to keep track of what you have been eating when you have flare-ups. If you notice that there appears to be a specific type of food related to your flare-ups, try eliminating this food from your diet. Many people with Celiac disease also suffer from eczema. Consider eliminating gluten from your diet to see if it helps control your flare-ups.
- Probiotics: The GI system is an important regulator of the body’s immune system. Maintaining healthy GI flora with the use of probiotics can significantly reduce eczema flare-ups.
- Oral Supplements:
- Evening Primrose Oil: This has systemic anti-inflammatory effects and is high in omega-6 fatty acids which are important for maintaining skin health.
- Vitamin D: Vitamin D is important for maintaining many facets of health, including a healthy, functioning immune system as well as maintaining the health of the skin.
- Omega-3/Omega-6 Fatty Acids: Increase intake of these anti-inflammatory compounds by supplementing fish oil. These good fats are important for skin health and can help temper over-active immune systems.
Eczema flare-ups are often triggered by stress. Practicing regular mind-body techniques like Yoga, meditation, massage, and other therapies can naturally help lower stress levels and make breakouts less likely. In addition, it is important to take good care of your skin. Avoiding things like hot showers or using dehydrating products like harsh soaps can make eczema flare-ups more likely. Use moisturizing cleansers to keep your skin hydrated, and shower under lukewarm water. After showering, apply moisturizers to your skin to help seal in moisture as well as provide a protective barrier against allergens and irritants which may trigger flare ups.
You may also need to modify your wardrobe. Certain fabrics such as wool can be very irritating to the skin and may lead to flare ups. Also, some people find that they are allergic to some fabrics. If you find that certain fibers irritate your skin, remove them from your wardrobe. Launder your clothes in detergents which are free of dyes and perfumes and are labeled as being designed for sensitive skin.
Many cases of eczema are also related to environmental allergies such as dust, pollen, or animal dander. Maintaining a clean house, investing in a HEPA filter, and changing your air filters frequently can help reduce the buildup of these allergens in your home. Vacuum and clean your house regularly. Make efforts to avoid allowing irritants like mold to grow in bathrooms, kitchens, or garages.
Dietary modifications can be more difficult to implement, as triggers may be hard to identify. There appears to be a link between Celiac disease and eczema in some people, which may implicate gluten. Try going gluten-free for several months to see if your eczema is better-controlled. Alternatively, keep a food diary and keep track of your flare-ups and see if they correspond with anything you have eaten recently.
In most people, eczema is likely a complex process which is due to an interplay between inherent biological/genetic factors as well as environmental factors. There is no clear answer as to why eczema occurs. There have been multiple genes implicated in a predisposition to eczema, and it is known to occur more frequently in people with Celiac disease. It appears that it is likely overall due to immune dysregulation – an issue that is related to many other systemic diseases.
Environmental allergens frequently linked to eczema include pollen, animal dander, and dust mite feces. An increased sensitivity to these and other allergens may be increasingly common in the developed world. The reasons behind this are unclear, but a major theory as to why is called the “Hygiene Hypothesis.” In a nutshell, the hygiene hypothesis implies that our immune systems are improperly trained when we are young by not being exposed to bacteria, viruses, and parasites as normally occurred through most of our evolution and history. Without his exposure, the immune system begins to inappropriately view environmental allergens as threats, mounting an inappropriate response.
Immune dysregulation may also occur due to other issues as well. Vitamin D deficiency is commonly linked to abnormal immune function. In the developed world, many people are deficient due to jobs which tend to keep us indoors most of the day. Most developed nations also are at higher latitudes, which means there are large portions of the year where there is reduced daylight hours, which may further exacerbate this issue.
Western diets also tend to be heavy in carbohydrates and refined sugars, which are often pro-inflammatory, as opposed to Mediterranean-style diets, which tend to be higher in antioxidants and anti-inflammatory compounds like omega-3 and omega-6 fatty acids.
There may also be a link between eczema, immune dysfunction, and issues like Lyme disease, which are likely underdiagnosed in the United States. Lyme disease is a condition which can manifest in many different ways and cause many unusual problems in the body. If you live in a Lyme-endemic area, you may consider this possibility.
Another common issue which is underappreciated is mold exposure. Molds are also major allergens, and frequent invaders of older homes and office buildings. People are often not only allergic to the molds themselves, but may also be exposed to the toxins carried in their spores. Keeping a clean house can be essential to controlling eczema flare-ups.
Clinics for Management of Eczema