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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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Ragweed Season is HERE

Ragweed Season

Ragweed Plants Packed with Pollen

Summer fun can turn to fall misery for millions of people who suffer from seasonal allergic rhinitis (hay fever). Sneezing, stuffy or runny nose, itchy eyes, nose and throat, or worsening of asthma symptoms are common in people with undiagnosed or poorly managed hay fever.

The primary culprit of fall allergies is ragweed pollen. A ragweed plant only lives one season, but it packs a powerful punch. A single plant can produce up to 1 billion pollen grains. These grains are very light weight and float easily through the air.

Fall allergy symptoms used to start in mid-August and run through September. In many parts of the country these symptoms now begin in early August and extend through October. Some studies suggest that rising temperatures and higher carbon dioxide levels contribute to longer growth time of allergen-producing plants. In 2023, OAAC reported high ragweed counts beginning in the third week of August. In fact, on August 28, 2023, we had our first ragweed allergy alert day.

Allergies occur when the body’s immune system treats the allergen, in this case ragweed, as a foreign invader. This starts a chemical reaction which produces and sends histamine throughout the blood stream. These chemicals cause allergy symptoms to develop.

Controlling symptoms
Proper diagnosis is the first step in managing your symptoms. An allergist will give a physical exam, ask about your health history and perform allergy testing to determine exactly what you are and are not allergic to.

Although there is no cure, ragweed allergy can be managed to improve the quality of your life.

The best control is to avoid contact with the pollen. This can be difficult, but resources are available. The National Allergy BureauTM (NAB) tracks pollen counts regionally to help you plan when you should avoid spending a lot of time outdoors. Remember to follow the OAAC on social media for the OKC area. Our counts are collected from the top of our main office building Monday-Friday by our certified pollen counters.

Talk to your doctor about medications that may provide temporary relief from symptoms. Your allergist/immunologist may also recommend immunotherapy (allergy shots) or sublingual immunotherapy (SLIT) allergy tablets, treatment. This long-term treatment approach can significantly reduce the frequency and severity of symptoms caused by allergic rhinitis.

Did you know?

  • The tall goldenrod species of ragweed gets blamed for most of the pollen, but a primary cause of allergy symptoms is the tooth-leaved ragweed that lives low in the grass.
    • Ragweed can be found in almost all states in the United States as well as in Canada.
    • An accurate diagnosis is essential for managing symptoms. Allergy testing performed by an allergist can determine what you are and not allergic to.To the point
    Although often associated with hay fever, ragweed can also cause skin conditions such as allergic contact dermatitis and hives.

Source: AAAAI.org

The post Ragweed Season is HERE appeared first on Oklahoma Allergy and Asthma Clinic.

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