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.

Itchy Eyes

Have your eyes been itchy and driving you crazy? It might not be what you think it is. Allergic conjunctivitis with hay fever, dry eye, pink eye or blepharitis could lead to wrong treatment and side effects.

With an estimated 50 million white blood “mast” cells, the eye can sense irritants and release histamine and other substances to defeat the irritants. Histamine stimulates eye nerve endings which irritates the eyes causing the itch.

Approximately 50 million people in the U.S. have allergies. Some are allergic to environmental triggers but the majority experience symptoms when grass, pollens and mold are in the air. Common allergens include pollen, dust mites, ragweed, mold, pet dander, perfumes, smoke and some fragrances or cosmetic ingredients.

When allergies target the eyes, the condition can be miserable. Eye conjunctivitis may get treated as part of a nasal allergy or it can be mistaken for other serious conditions like infectious conjunctivitis also known as pink eye, dry eye disease, blepharitis (inflammation of the eyelids), herpes virus or keratitis (corneal ulcer).

Making these distinctions is critical to ensuring the proper treatment is diagnosed, to quickly reduce the symptoms and reduce the potential risk of harm to the eyes. The American College of Allergy, Asthma and Immunology (ACAAI) warns that extended use of some nasal allergy medications can leave allergic eyes drier and even more irritated.

Usually if the eyes are itchy and watery, it’s probably an allergy with intense itching with tearing and redness.

Seasonal Allergic Conjunctivitis

Most of the eye allergies in the U.S. are seasonal conjunctivitis occurring in the spring, summer and fall. Symptoms include dark under the eye circles, light sensitivity and puffy eyelids.

Perennial Allergic Conjunctivitis

This condition is where eye allergies occur year-round but commonly caused by household/workplace irritants, dust mites, mold and pet dander. The symptoms are the same as seasonal conjunctivitis but usually less severe.

Vernal Keratoconjunctivitis

This year-round condition and worsen during pollen seasons and targets boys, young men, and people with asthma or eczema. Symptoms include the feeling of something in your eye and light sensitivity.

Atopic Keratoconjunctivitis

Another year-round atopic (sensitive to allergens) keratoconjunctivitis, this strikes older men who have allergic dermatitis (an immune reaction in the skin). Symptoms are eye burning and a thick mucus that accumulates on eyelids overnight.

Contact Allergic Conjunctivitis

Direct contact with potential allergens such as eye drops with preservatives can lead to this reaction. Symptoms can also cause discomfort wearing contact lenses and mucus discharge.

Giant Papillary Conjunctivitis

This severe condition leads to fluid sacs (papules) forming in the upper eyelid lining. Doctors can see them by turning the lids inside out. Other symptoms include blurry vision from mucus discharge, foreign body sensation, discomfort wearing contacts and a sense that contacts are moving, puffy or droopy eyelids.

What else could it be other than an eye allergy?

Pain in the eye or diminished vision are serious symptoms not typical for allergies. Dry Eye Disease (DED) allergy and DED are very similar. Pink eye causes red, painful eyes indicating infection of inflamed conjunctiva. Pink eye is very contagious and usually begins in one eye and generates a sticky secretion that coats the lashes. A swollen lymph not by the ear may also appear.

Pollen clogged tear grands can resemble blepharitis, a disorder of the eyelid’s oil producing glands. It can almost always be infectious and symptoms include irritation, redness, flaky eyelid skin and crusted lashes.

Karatitis is the inflammation of the cornea, and symptoms include redness, pain, watering, blurry or decreased vision and rarely itchiness. Herpes eye disease can lead to pain, tearing, redness, light sensitivity, and a skin rash or sore near the eye. Observation or special blood tests can confirm this disease.

Other itchy conditions include contact dermatitis, atopic eczema and psoriasis all have itching on the eyelid or the skin around the eye.

Prevention

Avoid a known allergen
Protect eyes with sunglasses, visored hats and swimming goggles
Wash hands when coming indoors (especially after handling animals)
Wash your face to clean off allergens
Soothe eyes with a cold compress
Try preservative free tear substitutes
Consider mite-proof bedding
Wash sheets and blankets in hot water weekly
Check for and eliminate mold by regularly cleaning the areas of your home where moisture may accumulate (base of the toilets, closets, mudrooms, HVAC filers, water filters, windowsills and gutters
Use air conditioning in your car and in your home
Leave your shoes at the door

Avoidance

Eye drops with herbal extracts
Eye products using preservatives
Window fans that draw in allergens
Indoor humidity exceeding 50 to 50 percent to discourage mold
Dry dusting or sweeping floors and spreading allergens
Wearing contact lenses too long
Rubbing eyes

If you think you might have an eye allergy, discuss this with your OAAC provider. There are many types of drugs and treatments available. Your OAAC allergist can find the right mix of medication and treatment to defeat the eye allergy itch.

The post Itchy Eyes appeared first on Oklahoma Allergy and Asthma Clinic.

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