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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.

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How Can I Control Indoor Allergens and Improve Indoor Air Quality?

From the Asthma and Allergy Foundation https://aafa.org

Allergy and asthma control begins at home. Many people with allergies stay indoors when pollen and mold is high. But dust mites, pet dander and even cockroaches can cause problems indoors.1

The Environmental Protection Agency recommends three ways you can improve indoor air quality:2

  • Control your contact with indoor airborne allergens
  • Ventilate your indoor areas well
  • Use air cleaners to clean indoor air

Eight out of 10 people in the United States are exposed to dust mites. Six out of 10 are exposed to cat or dog dander. Cockroaches cause allergic reactions in people who live in the inner cities or southern parts of the United States. 3

Better air quality in your home, office, school and car can reduce allergy and asthma triggers.

What Size Are Allergens?

Allergens are substances that cause allergic reactions and trigger asthma symptoms in some people. The air spreads allergens around. They settle onto furniture and floors. They vary in size and are measured in microns (also called micrometers).4

Is It Possible to Control Indoor Allergens?

You can control indoor allergens with cleaning and reducing allergens in your home. The main sources of indoor allergens are:

  • Pets
  • Wall-to-wall carpet
  • Soft furniture
  • Stuffed toys
  • Bedding
  • Damp areas
  • Indoor plants
  • Mattresses that aren’t in allergy covers
  • Pillows and bedding you can’t wash in hot water

There may be more allergens on surfaces than in the air. Surface allergens enter the air easily when you disturb them by dusting or sitting.

Will Air Cleaning Devices Help?

Air cleaning devices might help. But the best way to improve your air quality is to get rid of the sources of allergens and irritants from your home. Take measures to avoid and reduce your contact with allergens. Also increase the flow of outdoor air into your home and reduce humidity as much as possible.

Reducing humidity decreases dust mites and mold growth. Air conditioners help reduce humidity too. They can also prevent outdoor allergens. Keep your windows and doors closed. Turn your air conditioner on recirculate. These steps can help reduce outdoor allergens like pollen and mold.

Air cleaners with CERTIFIED asthma & allergy friendly® filters can filter almost 98% of allergen particles in the air. Look for CERTIFIED asthma & allergy friendly® devices.

What Steps Can I Take to Control Indoor Allergens?

Control dust mites. Keep surfaces in your home clean and uncluttered. Bare floors and walls are best, especially in the bedroom where you spend one-third of your time. Avoid wall-to-wall carpet, if possible. If you must have carpet, use low-pile carpets or throw rugs you can wash. Also avoid heavy drapes and overstuffed fabric furniture. Replace drapes and blinds with roll-down shades or washable curtains.5

Use zippered allergen-resistant or plastic covers on your pillows, mattresses and box springs. These covers are very effective in controlling your contact with dust mites. Encasing mattresses works better than air cleaners to reduce allergy symptoms. Wash your bedding, uncovered pillows and stuffed toys in water 130 degrees Fahrenheit or hotter each week. Dry them in a hot dryer cycle to kill dust mites.

Vacuum once or twice a week. Vacuuming helps keep allergens low. But poor quality vacuums could put dust into the air. Look for CERTIFIED asthma & allergy friendly® vacuums. These vacuums have been tested and found to prevent allergens from going back into the air.

If you have allergies, wear a mask while doing housework. Use a cloth that is damp or treated with polish for dusting. Leave the house for several hours after cleaning it.

Prevent pet dander. Most doctors suggest that people who have allergies to animal dander not have pets with feathers or fur. There is no such thing as a hypoallergenic pet. People with pet allergies are allergic to animal dander which are shed skin cells that all animals have. Some animal dander has fewer allergenic proteins. This may lead to fewer or no symptoms.

Keep pets out of your bedroom. Close the doors to bedrooms when you are not home to keep pets out. Cover vents with dense material like cheesecloth. Animal allergens are sticky. Wash and change your animal’s favorite furniture and toys often.

Replace wall-to-wall carpet with bare floors or a low-pile carpet. Bathing and brushing your pets often may reduce symptoms. But avoid grooming your pets if you have animal allergies. If you must groom them, wear a mask.

Long-haired pets can also bring pollen inside in high pollen seasons like spring and fall.

If you suspect you have a pet allergy, see a board-certified allergist for allergy testing.

Prevent pollen from getting inside by keeping windows and doors closed. Use air conditioning in warm weather to control dust mites and reduce humidity. Change filters often.

Avoid mold spores. Reduce moisture around the bathroom, kitchen and other areas where there is a lot of water. Here are some ways you can reduce mold:

  • Don’t run your showers for a long time before bathing.
  • Use dehumidifiers to reduce both mold and dust mites.
  • Use humidity monitors.
  • Limit yourself to a few house plants.
  • Fix all leaks and other causes of damp areas.
  • If you see mold on a surface, clean it immediately. Wear a mask and clean the surface each week to keep it from returning.

Control cockroaches. Do not leave food or garbage uncovered. Use poison baits, boric acid and traps instead of chemicals. Chemicals may irritate your sinuses and asthma.

The post How Can I Control Indoor Allergens and Improve Indoor Air Quality? appeared first on Oklahoma Allergy and Asthma Clinic.

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