The term eczema conjures up images of intractable and disabling skin conditions. However, “eczema” simply means chronic inflammation of the skin. In the context of allergy, two skin conditions are to be considered. First, “atopic eczema” or “atopic dermatitis” which appears in allergic individuals who also may have asthma and allergic rhinitis. The rash, which usually first appears in infancy, is mostly in the bend of the elbows and knees and behind the ears. When it appears in early infancy, the face and, if the condition is severe, almost any part of the skin may be involved. The second is contact eczema. Examples of this are nickel allergy (where rash appears where skin contacts ornaments) and rubber or leather allergy. In many occupations, other materials that the worker comes in contact for long periods may be responsible for this type of dermatitis.
The treatment of atopic eczema revolves around moisturizing the skin (by avoiding too long a contact with water and avoidance of soap where possible) and use of creams and lotions after showers and whenever needed. The acute stage of the eczema responds very well to local application of steroid creams and ointments and, when bacterial infection is present, treatment of these with appropriate antibiotics. The newer treatments which help ‘spare’ steroids are two cream/ointments called “Protopic” and “Elidel”. For milder cases of the atopic eczema these will certainly help reduce the use of steroid creams. When a food item leads to flares of this type of eczema, a judicious food avoidance will help. Some food allergens that are commonly implicated are eggs, milk, soy, corn, wheat and fish.
The first step in treating contact allergy skin rashes is identifying the causative agent. If it is not obvious, a ‘patch testing’ can help. In this test, a series of suspected contact materials is applied on a patch of tape on the back of the patient and left there for at least 48-72 hours. After this period, when the patch is removed, a positive reaction is revealed if the area of contact is red, itchy and swollen. In severe allergies, the contact area may even have blisters. Once identified, removal of contact is the best treatment and if this is accomplished, the result is a cure. As with any other inflamed skin condition, steroid creams and ointments can afford relief from the symptoms at least on a temporary basis.
There are many types of eczema where the actual cause is unknown and treatment then depends on controlling symptoms with, along with the steroid creams, itch control with antihistamines. A particular type of eczema called ‘stasis eczema’ that depends on stagnation of blood in varicose veins will be helped by adequate (including surgery) treatment of the varicose veins.
If you have any questions or comments, you may e-mail P.K. Raghuprasad, M.D. at firstname.lastname@example.org
Disclaimer: The facts presented in this article and the views expressed are solely those of the author(s) and do not necessarily reflect the views of the Board of Directors or other members of West Texas Physicians Alliance.