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.

Making Halloween Fun for Everyone

When a child has a food allergy, holidays can be especially tough for both the child and the child’s family, says Oklahoma Asthma & Allergy Clinic’s Board-Certified Allergist Dr. Maya Gharfeh.

“Holidays are such an important and fun part of childhood,” said Gharfeh. “One of the most important things of raising a child with a food allergy is to not let him or her feel different or isolated because of the food allergy. Instead, we adapt and still let the holiday be as fun as possible.”

The Teal Pumpkin project is an initiative created by the Food Allergy Research and Education (FARE) network to promote a safe Halloween for all including those with a food allergy. It encourages families to place a teal pumpkin on their doorstep to let families know they have non-food treats available for kids with food allergies. Those who wish to participate can register their home address on the FARE website so families can pre-plan their trick or treating.

Any food allergy is potentially life threatening. An accidental exposure through ingestion of a food allergen may quickly lead to a life-threatening situation where a child would need emergency medication – like epinephrine – for survival.

As the mother of a child with a food allergy, Gharfeh has first-hand knowledge. She suggested ideas they’ve done to make a happier Halloween for their daughter.

“We have a rule of no eating or snacking on candy while trick or treating. We go house to house and collect treats as normal. Once we get home, we dump them out and I sort the candies into safe and non-safe, specific for my daughter,” Gharfeh said.

She always keeps safe treats at home for a swap out for those unsafe ones.

“No one wants a half-full Halloween basket,” she said.

Non-food items for those swap outs could include stickers, glow in the dark bracelets and necklaces, Halloween pencils, spider rings, etc.

“Since my daughter has a nut allergy, we try to stay away from most of the chocolate candies and stick with sugar candies such as Skittles or Jolly Ranchers,” Gharfeh added. “We always carry our emergency epinephrine device with us while trick or treating to be ready for an emergency.”

Other ideas for making Halloween safer, Gharfeh says, includes hosting your own Halloween party with allergy safe food treats and non-food items as treats. She encourages families to educate their neighbors and friends about the Teal Pumpkin project. Volunteer for school positions to allow more involvement in choosing snacks/treats for holidays such as Halloween.

“Kids love painting pumpkins,” Gharfeh said. “By inviting your neighbors to participate, you have provided an opportunity to ensure some safe stops for your food allergic littles in your neighborhood.”

FARE recommends has these ideas to celebrate the teal pumpkin project:

Decorate your front door. Grab some teal plastic pumpkins (available at local retailers), festive decorations and transform your door. Get your whole neighborhood involved.
Host a virtual Halloween party. Staying inside this year? Plan a virtual party so kids can dress up and show off their costumes. Make the party even more interactive by playing fun games online like bingo or trivia.
Set up a craft and activity station and let the kids loose! From coloring sheets to word matches, FARE has printable resources for getting kids excited about Halloween.
Halloween Scavenger Hunt – get your kids outside and moving. Take a walk or drive around to try and spot sooky sights. Bonus points for spotting teal pumpkins.
Stay in for a scary movie night. Invite your friends and neighbors over to watch your favorite Halloween movie.
For food allergy friendly recipes, check out the FARE website www.foodallergy.org

If families suspect their child might have a food allergy, Gharfeh says, “Come see a board-certified allergist. We want to help not only diagnose but also to help you, your child, and your family know what a food allergy means and the steps to ensure a safe, healthy and fun childhood, even with a diagnosis of a food allergy.” Teal Pumpkin Campaign

The post Making Halloween Fun for Everyone appeared first on Oklahoma Allergy and Asthma Clinic.

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