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.

Back to School with Asthma and Allergies

Back to School

Where did the summer go? It’s almost back to school time for thousands of Oklahoma children. Is your family ready? Are your children starting a new school? Was your child recently diagnosed with an allergy, a food allergy and/or asthma? OAAC will help you be prepared for back to school!

First, if you need birth certificates, they can be ordered online oklahoma.gov/health/services/birth-and-death-certificates.html or by calling 877-817-7364. The cost is $15. Additional copies $15. There is an online/phone convenience fee of $5.

Need immunization records? You can access them online through the Oklahoma Immunization Information System Portal - shotrecords.health.ok.gov

Children with Asthma
Talk to your OAAC provider especially if your child’s asthma is not in control. Update or complete an Asthma Action plan to use at home and at school. You can download a plan from the OAAC website oklahomaallergy.com/wp-content/uploads/521-ASTHMA-ACTION-PLAN.pdf Update any medication orders. If your child is going to a new school, make an appointment to have a conversation with the school staff. Review when your child should take his/her asthma medications. Ensure your child or teen is using daily controller medications on schedule and quick-relief medication as needed.

Visit with the school’s nurse or school administrator about your child’s asthma. Take the medication, forms and supplies to school before or by the first day. For those with children who use a nebulizer, check with the school to see if you need to provide tubing and a face mask and/or the nebulizer itself.

Develop a healthy schedule which includes eating regular, nutritious meals and a set sleep routine.

Check with your child at the end of school day to see if he/she experienced any issues maintaining their asthma at school.

Children with exercise-induced bronchoconstriction may complain about participating in physical activities. However, it is very important for children to stay active, so work with school staff to develop strategies to keep your child symptom-free while exercising. These may include:
•    Using a short-acting inhaler 15 minutes prior to exercise
•    Drinking plenty of water before, during and after exercise
•    Choosing sports that are less likely to trigger symptoms.

Allergies at School

Depending on your child’s allergic condition, you may want to:
•    Tour the school to identify potential allergy triggers
•    Talk with your child’s teacher(s) and other relevant school personnel (such as sports coaches) about your child’s condition and treatment plan
•    If your child is at risk for life-threatening reactions, such as those to food or insect stings, complete an Anaphlyaxis Action Plan and show school staff how to administer autoinjectable epinephrine.

In the Classroom
There are many potential allergy and asthma triggers in schools. It is very important that your child’s allergies have been accurately diagnosed in order to determine what allergens to avoid. If your child has not been tested, make an appointment with the OAAC for testing.

Common asthma and allergy triggers in the classroom include:
•    Dust mites
•    Mold
•    Chalk dust
•    Animal dander

At Recess, Gym Class and After-School Sports
Recess may be the favorite time of the school day for many children, but for those with allergies or asthma, it can be a minefield of potential triggers.

If your child has allergic rhinitis (hay fever), you can view the daily pollen and mold counts (Monday-Friday) on the OAAC website and on social media. When levels are very high, plan accordingly if your child takes medication to control symptoms. When indoors, ask staff to keep windows closed to keep pollen out.

Insect bites can cause severe reactions in children with stinging insect allergy. Explain the symptoms to school staff and make sure your child always carries auto injectable epinephrine in case of an emergency.

Working as a team with your OAAC provider, your school staff and your family, back to school can be an easy transition with proper preplanning.

The post Back to School with Asthma and Allergies appeared first on Oklahoma Allergy and Asthma Clinic.

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