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Eczema

Eczema is frequently called atopic dermatitis because it was noted to occur in individuals with allergic symptoms, e.g., allergic rhinitis (hay fever) and asthma. The term atopic simply means allergic. Even though eczema was considered to be an allergic problem, allergy seems to be less likely as our understanding of the disease increases. Physicians know that eczema is a very complex disease and contains allergic as well as non-allergic elements in different individuals. As a result, the treatment of every individual may vary.

While the causes of eczema continue to be investigated, certain things are known about the disease. The skin is much more easily irritated than normal skin. Dryness of the skin is a primary component and results in significant itching. Eczema is known as “the itch that rashes”. Itching is made worse by irritants on the skin. Winter months are particularly bothersome because of the dry winter air. Flares in the summer months can occur after exercise because sweat is a significant irritant. Citrus or some vegetables, e.g., tomato, can act as a primary irritant when they touch the skin. Stress in some individuals can affect the skin. While emotional factors may play a role in flaring eczema, they are not considered a primary source of causing the onset of eczema, if it is not already present.

Eczema occurs in about 3% of the population. In about 80% of those individuals, the onset occurs in the first year of life. One-half are free of disease by age 2 years, about one-fourth by the end of adolescence, and the remaining one-fourth will continue to have eczema into adult life. Some individuals do not have the onset of symptoms until adolescence or adulthood.

Treatment is multifaceted and includes lifestyle modification as well as various types of medication. A portion of treatment will be listed in the accompanying tables. Adequate attention to clothing, diet manipulation, and attention to the emotional well-being of the affected patient are very important. It is preferable for a patient with eczema to wear clothing which will not irritate the skin; soft cotton material would be best. The room temperature should be kept moderate with controlled humidity (between 35-50%). Overheating and perspiration should be avoided.

Some investigators believe there is a genetic tendency for eczema with approximately 50% of eczema patients ultimately developing allergic rhinitis and/or asthma. This is compared to about 20% without the presence of eczema. While allergy skin testing and allergy injection treatment are usually helpful in cases of allergic rhinitis and/or asthma, it is generally agreed that this is often not the case with eczema. In some individuals, starting allergy shots for allergic rhinitis and/or asthma may actually result in significant flaring of the eczema.

Prevention

  • Trim fingernails short
  • Cotton gloves at night if needed to decrease scratching
  • Clothing should be double rinsed after washing to remove all residual detergent (irritants)
  • Avoid excessive room temperatures
  • Wear light, non-occlusive clothing (e.g., cotton instead of polyester)
  • Keep the bedroom moderate (cool) and avoid excessive bed clothing
  • Allergen contact or ingestion avoidance (e.g., foods, pets, dust mite) can reduce stimulation of the skin

Treatment

  • Bathing for moisturization, e.g., soaking in tepid water for 30-45 minutes at least once daily and if possible 2-3 times.
  • Within 2 minutes after getting out of the tub, a lubricating cream or ointment should be applied to help hold the moisture in the skin. Examples include Aquaphor, Curel, Moisturel, Eucerin, Keri, Lubriderm, Acid Mantle, Unibase, Vanicream, petrolatum, and chilled Noxzema,etc. Newer medications include Triceram/Certopic, Impruv, Mimyx, Nourica Repair, Cerave, Atopiclair, and Hylira. Some of the newer medications are by prescription only. None of the medications in the above list contain steroids.
  • In general, lotions should be avoided since they contain alcohol which may sting and provide limited moisture.
  • If marked irritation or weeping areas are present, wet wraps with a drying solution (e.g., Burrow’s solution, one tablet mixed in one quart of water is available by prescription) will avoid the stinging or burning sensation that can occur with bathing.
  • Addition of oil or similar substances to the bath water generally has little effect on increasing moisturization.
  • Pat dry with a soft towel; do not “rub” dry since this will remove natural, protective oils from the skin.
  • Showers do not add moisture to the skin and actually remove the protective oils from the skin resulting in increased dryness.
  • Topical steroids are the mainstay of therapy for more severe eczema. Ointments or creams are generally used.
  • Nonsteroidal medications that help the immune system in the skin may be necessary either in addition to or in place of topical steroids if the topical steroids are not adequate for relief. Examples of the nonsteroidal medications are Elidel and Protopic.
  • Antibiotics, topical and/or oral, may be needed if the lesions become infected. An alternative to antibiotics is the use of Clorox baths. One-quarter to one-half cup of Clorox in a full bath provides antibacterial activity that will treat all known bacterial infections. No resistant bacteria to Clorox are known.

Conditions Treated

Recent News

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AAFA’s 2024 Allergy Capitals™ report names most challenging cities for living with allergies, OKC – Fifth; Tulsa – Sixth in the top Ten

Washington D.C., March 14, 2024 — The Asthma and Allergy Foundation of America (AAFA) released its 2024 Allergy Capitals™ report detailing the most challenging cities in the United States for living with allergies. The full report can be found at allergycapitals.com.

This year, Wichita, Kansas takes the top spot due to its higher-than-average tree and grass pollen, higher-than-average medicine use, and limited access to allergy specialists. The top 10 Allergy Capitals™ for 2024 are: 1. Wichita, KS; 2. Virginia Beach, VA; 3. Greenville, SC; 4. Dallas, TX; 5. Oklahoma City, OK; 6. Tulsa, OK; 7. Richmond, VA 8. Des Moines, IA; 9. Raleigh, NC, and 10. Fayetteville, AR.

This year’s report again calls attention to the urgency of the climate crisis. Due to climate change, growing seasons start earlier and last longer than they did just 30 years ago. Some parts of the United States now experience pollen (tree, grass, or weed) year-round. Warmer temperatures also trap heat in urban areas, increase air pollution, and stimulate pollen production.

“Climate change fuels a perfect storm of conditions that make allergy season worse for people with pollen allergy,” said AAFA President and CEO Kenneth Mendez. “Longer growing seasons mean more exposure to pollen allergy triggers. Additionally, pollen counts tend to rise with warmer temperatures. Now, we see both more days of exposure to pollen and higher daily pollen counts leading to more intense, longer-lasting symptoms.”

AAFA’s 2024 Allergy Capitals™ report provides insight into factors impacting seasonal allergies. The report ranks the 100 most populous cities in the contiguous United States by their:

  • Tree, grass, and weed pollen scores
  • Over-the-counter allergy medicine use
  • Availability of board-certified allergists/immunologists 

Experts say a range of treatment options are available for people dealing with seasonal allergies this spring.

“Over-the-counter medicines can help manage symptoms,” said allergist Dr. Neeta Ogden, spokesperson for AAFA. “Working with a specialist can help you develop the best treatment plan.”

While the symptoms of pollen allergy can be managed, they are a significant health concern. Seasonal allergies can even lead to hospitalization if they trigger an asthma episode.

“Our pollen season continues to begin earlier each year,” said Dr. Claire Atkinson, a board-certified allergist with the Oklahoma Allergy & Asthma Clinic (OAAC). “We’ve already had several allergy alert days this year and we’ve not even made it to the official start of Spring. We want to encourage people who are suffering to see their medical provider and consider making an appointment with an allergist.”

A board-certified allergist can diagnose allergies, and determine the specific triggers that cause them, through simple tests. The allergists at OAAC evaluate and manage patients of all ages. The main clinic is on the Oklahoma Health Center campus. For patient convenience, satellite offices are in Edmond, Norman and Yukon.

Visit the OAAC website at www.oklahomaallergy.com to view the addresses for all Oklahoma Allergy and Asthma Clinic locations. To make an initial appointment or to request more information, please call (405) 235-0040 or visit the website.

For information on preventing and treating allergies and asthma, visit aafa.org.

The post AAFA’s 2024 Allergy Capitals™ report names most challenging cities for living with allergies, OKC – Fifth; Tulsa – Sixth in the top Ten appeared first on Oklahoma Allergy and Asthma Clinic.

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