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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

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New Year’s Resolutions for Asthma and Allergies

Source: Asthma and Allergy Network

Tips to help you gain better control

Are you tired of your nagging cough or runny nose? Does the thought of spring flowers immediately make you want to sneeze? Are you looking for new ways to eat healthy despite your food allergies?

Take control of your allergies and asthma in the new year. No more sleepless nights and red, itchy eyes. No more sitting on the sidelines due to your asthma. Step up to better breathing with these New Year’s tips:

1 – Make a wish list

What would you like to be able to do if asthma or allergies didn’t hold you back? Ask yourself if there is anything that you’ve been avoiding because of your allergies or asthma that you usually enjoy doing.

2 – Review your treatment plan

Schedule an appointment with your doctor apart from an emergency or acute care visit. Share your wish list and ask if there are ways to reach your goals. There is no one, perfect way to treat allergies and asthma. Shared decision making is the key to a successful outcome: Work with your doctor to find the plan that works best for you.

  • Talk with your doctor about what is and is not working with your plan. Be honest about lifestyle and economic barriers you face. Are there medication side effects you’re worried about?
  • Take your medications to the appointment and review each one with your healthcare team: Why is it prescribed? When should you take it? How much should you take? How quickly should you expect results? What should you do if you don’t think it’s working?
  • If you use an inhaler, review your inhaler technique with your healthcare team. The medication can’t work if it doesn’t get into the lungs where it belongs.
  • Do you have a written Asthma Action Plan or an Allergy and Anaphylaxis Emergency Plan? If not, ask for one.

3 – Clean your indoor air

Change or clean air filters in your heating and air conditioning system. Vacuum carpets and corners regularly to keep dust and allergens down. Consider dust-mite proof pillow and mattress encasings and an air purifier if you have pets or mold. Keep pets out of the bedroom.

4 – Plan ahead

For seasonal allergies, begin using your allergy medication 3-4 weeks before your symptoms usually appear. The earliest tree allergens are from mountain cedars, which can peak in Texas and the southwest in January; in other parts of the country tree and grass allergens typically arrive in February and March.

5 – Prevent flares

Take care of yourself. Stop smoking and stay away from smokers; go to bed one hour earlier; get plenty of exercise; eat healthy foods; drink plenty of water per day – at least 2 liters if you do not have a medical condition prohibiting this – as staying hydrated keeps mucus from forming and prevents illnesses; get the flu shot and wash your hands regularly to avoid flu and cold viruses; and use nasal washes to keep your sinuses clean and flush out germs before they take hold.

6 – Follow up

Start a daily symptom diary online or in a notebook. Track your medication use, activities and symptoms; review it at your next appointment with your healthcare provider.

7 – Be reliable and proactive

Keep the appointment! See a board-certified allergist if your treatment plan isn’t working. Practice preventive care – healthcare should be a priority even when you are not sick.

The post New Year’s Resolutions for Asthma and Allergies appeared first on Oklahoma Allergy and Asthma Clinic.

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