Hammerling: Eczema causes the itch that persists
Not only can itchy skin drive you crazy throughout the day, it can also affect you socially by having to explain what the rash is on your skin.
The main characteristic of eczema, also known as atopic dermatitis, is the "itch," which may become unbearable in some people causing sleep loss, stress and depression, as well as limiting day-to-day activities.
Living with atopic dermatitis in a hot and humid climate like Florida can be difficult when trying to cover up the rash with long sleeves or pants when it's 90-plus degrees outside.
Eczema can affect people of all ages and races, but is seen mostly in children. The most common areas of eczema are on the arms, back of the legs, face and neck.
Certain ethnicities can have different patterns of eczema. For example, eczema can be around the front of the knees and the back of the elbows in addition to the skin creases.
A popular pattern with red bumps can appear over the chest or abdomen. Eczema can persist into adulthood in 10-30% of cases.
Most cases will have a family history of eczema or other conditions such as asthma or hay fever are present.
It is not contagious.
The exact cause of eczema is not known. However, there has been lots of discussion as well as research on the possible triggers.
Multiple factors include genetics, environmental, dysfunction of the epidermis and an immunology component. They all can contribute to the flaring of atopic dermatitis. There is an Atopic Triad which includes: asthma, allergies and atopic dermatitis.
Common irritants include: nickel, cigarette smoke, soaps, household cleaners, wool or polyester, Neosporin/triple antibiotic ointment, bubble baths, certain ingredients in shampoos and lotions.
Daily moisturizing is one of the most important elements in managing all types of atopic dermatitis. A good resource of products to use with eczema is https://nationaleczema.org
Creams are popular as a moisturizer because they feel light and cool to the skin. All creams contain preservatives and people can develop a rash from them.
Ointments are greasy and some patients do not like the greasiness on their clothes. They are very effective as a moisturizer because it helps to hold water in the skin. Lotions are not that effective but are more practical for hairy areas.
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If used daily, moisturizers sometimes can keep mild to moderate eczema under control. Some popular examples of over the counter emollients are Cerave Cream, Vanicream or Aveeno.
Regular soap can be irritating to the skin as well. Popular over-the-counter non-soap substitutes are Cerave hydrating cleanser or Vanicream soap.
Some treatment goals are to treat the active inflammation in the skin by adopting a good skin care routine and identify and avoid common irritants/triggers.
Topical treatments include topical steroids or non-steroids referred to as topical immunomodulators, Protopic Ointment and Elidel Cream.
Depending on the severity, oral treatments may include steroids, Singulair, Methotrexate, Azathiaprine and anti-histamines.
Dupixent (dupilumab) is the first biologic medication approved by the U.S. Food and Drug Administration for adults with moderate to severe atopic dermatitis for those who have failed other treatments.
This has been a life changing medication by giving patients relief within a week. The mechanism of action is it limits the immune system from overreacting, lowering the severity of inflammation and decreasing the symptoms of atopic dermatitis.
Dupixent is taken by subcutaneous (under the skin) injection every other week after an initial loading dose and is available by prescription only.
Phototherapy, also called light therapy, means treatment with a special kind of light.
The most common type of phototherapy used to treat eczema is narrowband ultraviolet B (UVB) light.
Phototherapy helps to reduce itch, calm inflammation, increase vitamin D production and ramp up bacteria-fighting systems in the skin.
Overall, phototherapy is considered safe. Known risks of phototherapy include: sunburn, skin aging, melanoma, headaches and nausea (with PUVA treatment), cataracts from insufficient eye wear during treatment.
In conclusion, there is no cure for atopic dermatitis, but with a good skin care routine and moisturizing daily, eczema can be managed effectively. If you are not able to get the eczema under control by using a good moisturizer and non soap cleanser, then see your dermatologist for treatment options.
Susan Hammerling-Hodgers, a Member of the National Psoriasis Foundation, is a PA-C (Certified Physician Assistant) and MPAS (Master of Physician Assistant Studies) and works at Brevard Skin and Cancer at the Merritt Island and Palm Bay offices.